About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question I went 4 months ago for my annual checkup to a new dentist in mexico and she told me I should replace the 10 30- year old metal amalgum fillings in my molars because they would cause me problems in the future. (at time of checkup I had not experienced any problems). she recommended porcelain fillings, I agreed, and she did the fillings three months ago. Since then, chewing is painful and my teeth are extremely sensitive to hot and cold. She has filed the teeth some more and has told me to use sensidine toothpaste. She says this is a common side affect of porcelain fillings for people that had old fillings for many years and that I should be patient. 4 questions: 1. what is the most likely cause of these symptoms? 2. does her diagnosis sound reasonable?. 3. how long is this problem likely to last?. 4. what treatment do you recommend? Thank you in advance.
Answer Dear Ray,
Yours is a cautionary tale, a corollary of the general principle of "if it ain't broke don't fix it." It would be interesting to know just what problems in the future your dentist anticipated, in light of her expectation that your teeth would indeed be sensitive. One could legitimately question whether your teeth are better off for having done the work, and whether you would have opted to submit to treatment if you had been informed in advance to expect sensitivity. As to the questions:
1. what is the most likely cause of these symptoms?
A: Composite resin (synthetic porcelain) fillings are inherently irritating to the pulp (nerve) of a tooth. The process by which they are placed involves etching the inside of the cavity with acid (which is irritating) and placing organic solvents inside the tooth (which is irritating). The filling material itself has a mild inflammatory effect on the pulp, and it doesn't seal the cavity as well as silver amalgam, allowing some leakage (which is irritating). In a shallow cavity, resin fillings seldom provoke noticeable sensitivity; however, a deep cavity makes a tooth quite vulnerable to the irritating effects of a composite resin filling-- sometimes to the extent that the nerve of the tooth is injured beyond repair, necessitating root canal treatment. For this reason, a benefit/risk assessment should always be done when choosing a filling material. The only real advantage of composite resin is its cosmetic appeal, so its use is seldom justified in areas of the mouth that are not in direct view. Composite resin is softer, has poorer compressive strength, and does not seal the cavity nearly as well as silver amalgam, so these fillings do not have the same anticipated life span.
2. does her diagnosis sound reasonable?
A: Sensitivity is not a diagnosis, but merely a symptom. It is obviously related to the placment of the resin fillings, and your increased sensitivity is consistent with what I have observed when using resin. What is uncertain is the projected course of your sensitivity and whether some intervention is necessary.
3 & 4- how long is this problem likely to last? what treatment do you recommend?
A: In the 3 months since the fillings were placed, you should have experienced some diminishing trend in the symptoms if they were going to resolve on their own. If there has indeed been a reduction in the amount of sensitivity, I would take this as an encouraging sign, and would caution against any additional operative procedure which might irritate the teeth anew. However, the absence of any diminishing trend in the severity of the sensitivity would indicate that a more aggressive management is in order-- perhaps a root canal treatment. If your dentist feels unqualified to make this determination, you should request referral to an endodontic specialist.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
