Expert: Mark Bornfeld DDS - 4/23/2007

Question
Hello there,
On Tuesday (today is the following Monday 6 days later) I had some work done on my number 46 tooth.  On the bill says a pulpotomy,a pulp cap and an amalg. filling.  The next morning I did have a small amount of discomfort at the back of the jaw where the needles were put in. There was no other pain or discomfort. This pain subsided by the next day.  However, the last couple of days I have had a dull ache in my jaw on that side. It is certainly not severe enough for pain relief, but I am aware that it's there.The filling does not feel uneven, the bite feels fine.  I live a long way from town, and wonder whether I should go back again, or whether this sort of dull ache is normal with the work I had done.
thanks so much.
Kind Regards
Olivia

Answer
Dear Olivia,

I suspect you are writing from outside the United States based on the numbering system used to denote your tooth; as such, the way the terms "pulp cap" and "pulpotomy" are used by your dentist may be different from the way I use them. However, the way those words are defined here in the U.S., the two procedures are mutually exclusive-- at least in terms of a single visit-- in other words, one cannot perform a pulp cap AND a pulpotomy at the same time, and doing so makes no sense, unless it is for the purpose of unjustifiably padding the fee.

However, neither a pulpotomy nor a pulp cap will reliably prevent pulpal infection on a tooth whose pulp has been penetrated by decay. The delayed emergence of symptoms suggests that all is not well with the tooth, and you may need a formal root canal treatment.

I suspect that your tooth will require further treatment, either at your previous dentist or another. If you do return to your dentist, you might want to discuss his billing practices, which to me seem to reflect a questionable grounding in ethical principles.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY