Expert: Steven C. Scherr, D.D.S. - 1/2/2007

Question
Dear Dr. Scherr,
One month ago I had two metal fillings replaced with composite material.  Both are molers and one tooth is doing fine.  I am experiencing pain in the other.  It is not sensitive to hot, cold or sweets.  It only hurts when I chew and then only when I bite a hard piece of food on that tooth.  I have been back to the dentist twice.  Both times she thought the filling was still too high and ground more of the filling away to make my bite even.  It has not worked.  I live in Ukraine and dentists here do not normally take x-rays so I'm not sure if she drilled too deep when replacing the filling which I'm assuming may be the problem.  What should I do?  Thank you for your help.

Answer
Mike,

Each tooth has an inner nerve that has a limited capacity to heal.  A little of this capacity is used up each time we eat, swallow, clench, develop cavities, have fillings placed, etc.  Once the nerve's healing capacity becomes exhausted, the nerve will become inflamed and ultimately die.  If the cumulative insults to the nerve approach capacity, the nerve may become inflamed and develop sensitivity.  Depending on the healing capability that remains, this inflammation may be either reversible (healing and resolution will occur) or irreversible (the nerve cannot heal).

A dentist must remove all of the decay present in a tooth before placing a filling.  The depth of the filling is primarily dictated by the depth of decay.  While the presence of pain before treatment is always important, the lack of pain gives no information about the prior depth or extent of decay present.  I have seen decay on many occasions that had already invaded the inner nerve without any pain or sensitivity.

Without prior xrays, it is impossible to say if there was decay under the old fillings that were replaced.  In any case, it is impossible to know how much healing potential was left in the tooth before replacing the filling.  At this point, you might consider waiting it out to see if the tooth is able to heal.  If it begins to get worse, or if the pain goes away and later returns, root canal therapy to remove a damaged nerve from the tooth could be needed.

Best wishes Mike,

Steve