Expert: Mark Bornfeld DDS - 5/18/2007

Question
Dr. Bornfeld,

After allowing my teeth to get into pretty bad shape (won’t do that again) I visited my dentist who I’ve known since Jr. High School. There were cavities abound, many at the gum line. I also needed a crown to replace the one that fell off (previous root canal) and needed a root canal and crown for a back upper molar (temporary filling is on now). I have yet to do these two procedures and here’s why. My Dentist assured me he could restore the teeth except for the two I just mentioned. I was excited to hear this and began going to weekly dental appointments in February of this year. My dentist used Resin for all the fillings. Except for the four front teeth on top and bottom I have Resin in every tooth in some amount from a little to a lot. I counted 20 teeth with Resin, 4 on each side on the top and 6 on each side on the bottom. A week after my first Resin fillings I woke up in the middle of the night in extreme pain. My dentist explained the sensitivity factor and since I sleep with my mouth open the pain was probably due to the air making contact with my teeth. He prescribed Hydrocodone as needed. As more Resin fillings were added the pain increased and it has been a nightmare since. About 3 weeks ago I started having unbearable pain in my face and jaw and can feel/hear popping or cracking noises in my sinuses (I am guessing this is where it happens). Advil cold and sinus is helping with this pain and I now take it daily. Because I am not a big fan of taking medication I’ve been nibbling at the Hydrocodone trying to avoid relying on pain killers and this has meant a slew of other pills like Advil, Alieve, Tylenol PM and some Orajel to boot. I never thought I would be afraid of leaving my apartment without my pharmacy in tow but I am. Throughout this ordeal my Dentist seemed surprised at the amount of pain I’ve experienced. After my last tooth was filled with Resin in mid April I decided to give myself a break from dental work before having the root canal and two crowns done. I wanted to give my teeth and gums some time to heal, hoping the pain would subside. The pain is not as extreme as it was however I am still taking medication every day because the pain comes and goes from bad to worse. I cannot get through a day or a night’s sleep without some kind of medication and this is upsetting me greatly. Right now the sinus medication and Hydrocodone seem to be the only medications that take the edge off the pain. I have lost weight because eating is painful (especially after) and I still cannot eat hard food like pita chips. And at times my face feels puffy around my jaw and cheek areas and at times my teeth and gums ache and my gums feel swollen. After my last visit I also developed an upside down V ‘cut’ against the inside gum/tooth of an upper molar that is not only very painful but is taking forever to heal. My dentist prescribed a Z-pack which I took but it didn’t seem to help. A client of mine sent me an online article about a man who wrote that his wife had Resin fillings 5 weeks prior and he described the same exact pain that I have been experiencing. The dentist who responded to him wrote that the cause may have been due to the Dentist’s lack of training in this specialty and listed many procedural problems that can occur when the fillings are done by someone who does not have this kind of training. He also wrote that Resin is used for front teeth and should not be used in molars. Considering that my molars are filled with the most Resin, his response has made me fearful that this pain will not stop any time soon or may be permanent. I like and have great respect for my Dentist but am hesitant to question if his ability or lack of training could have caused the pain that I am experiencing. Although the molar that needs the root canal is painful at times I am afraid to go back and have additional dental work done. I understand that you cannot diagnose or treat online so I am looking for some guidance in how to proceed from here. I was thinking about taking the article to my Dentist or going to another Dentist who specializes in Resin fillings to see if the work had been correctly. Or I was thinking since I have so much Resin in my mouth maybe time is all that is needed. And maybe also a trip to an ENT to check out my sinuses. Overall I am in more pain that I was when I had all the cavities and this doesn’t seem right. I would greatly appreciate any feedback you can offer as to what step(s) would be good to take from here. Thank you for reading my long question and thank you for your work online. Christine


Answer
Dear Christine,

You're correct that it would be foolhardy for me to try to attempt to diagnose your problem without an in-person assessment of the necessary information. However, there is one glaring omission in your dentist's comportment that begs the question-- isn't your dentist the least bit interested in diagnosing your pain? It would seem that he can't be bothered with dealing with his patient's concerns while he's steamrolling across your mouth with resin. Perhaps he doesn't realize there's a person attached to those teeth.

Granted, resin does have a greater tendency to provoke postoperative sensitivity than does a more traditional restorative material such as amalgam. However, any person with a modicum of sense (and certainly someone with the presumed training and knowledge of a dentist) would know that pain severe enough to warrant the use of narcotic analgesics such as hydrocodone is not normal postoperative pain.

I would not go so far as to say that composite resin should not be used on posterior teeth, although I do agree that some functionality is sacrificed in doing so. That seems to be the direction the current conventional wisdom is going-- that it's better to look good than to feel good, and resin fillings are a particularly good exemplar of that philosophy. I would also point out that the use of composite resin does not require specialty training-- it's definitely not rocket science, and any dentist worthy of membership in the profession is perfectly capable of using the material. But what a dentist must also do is ply his trade wisely, and that takes some common sense and, more importantly, some concern for the well-being of his patient. To wit:
-Use dental materials appropriately. Composite resin does not work particularly well in the mouth of a patient that is prone to tooth decay, due to its greater tendency to leak around the margins and develop recurrent decay; resin is not appropriate for very deep fillings, due to its tendency to provoke sensitivity; and resin in difficult to use in gum-line fillings, where moisture and lack of enamel makes sealing of the margin unreliable.
-prescribing antibiotics and analgesics is fine, assuming the cause of the presumed pain and infection has been determined and a course of treatment for those problems has been formulated. If not, prescribing drugs is a lazy man's substitute for diagnosis, and not a particularly good one at that.
-finally (and most telling), you're coming to me with these questions rather than your dentist, and that speaks volumes alone.

Either your dentist attends to your needs, is accessible to questions, and shows enthusiasm for problem-solving, or it's time to go elsewhere for dental services.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY