Question:
I may be in trouble here. About 6 weeks ago, I went to have a
cavity filled with a composite filling. The filling was hurting and I
kept going back to the dentist to have it polished because they
thought it was "too high." Although it improved slightly by lowering
it a bit, it still gave me a sharp pain to chew anything hard like a
corn chip. Then a few weeks ago, the tooth started becoming sensitive
to cold. All this dentist was doing is polishing the tooth and it
wasn't helping. They gave me an xray and could find nothing wrong. I
decided to give up on them and went to a new dentist for a second
opinion.
He decided to refill the tooth. He also said that the another filling
I had was cracked(done by the previous dentist) and redid that one as
well. He gave me new composite fillings and said that it is technique
sensitive. My previous dentist didn't want to do them but I requested
it and she seemed unsure about doing them(unbeknownst to me, a big
mistake!). So I figured that the previous dentist didn't know what she
was doing with the composites and screwed my teeth up.
So now it's been several days, and even though my teeth don't hurt as
much as they did before, I still have some pain. My dentist said to go
ahead and give it a week before going back in. But the pain doesn't
seem to be lessening by the day. It got a little bit better, then
stopped getting better.
Answer:
Sometimes,,,,, just doing the tiniest filling (and doing it perfectly) will
result in a tooth dying and requiring root canal therapy. It just happens.
Sort of like hitting the lottery.
Composite restorations on back teeth are very technique sensitive. Most of
the problems I see (other dentist's work) are not in immediate sensitivity,
but longevity of the restoration. Every now and then, I see one which is
sensitive like you describe. Sometimes, just exposing the filling to more
time with the curing light will salve this problem. Curing lights degrade
over time, and the dental office needs to expose the filling to light for
longer time as the light ages. Most often, I would say sensitivity like you
describe is due to a leaking restoration. Somewhere (usually between the
teeth) the filling does not seal perfectly. This happens more often if no
rubber dam is used and if the filling is deeper. If this is the case, your
filling may be repairable or may need to be re-done yet again.
If the pulp is dying, you need a root canal treatment (RCT), period. It
has, probably, no bearing on the work of either dentist, but on the unique
conditions of your tooth. Especially if the filling is not near the pulp,
then the process of placing the filing did not (probably) kill the tooth.
Have the tooth tested thermally, electrically, and percussion tested. Have
the dentist evaluate with a "Tooth Sleuth" to rule out fractured tooth.
Then, sit with the dentist and discuss possibilities. Perhaps you may
choose to have the tooth filled with amalgam or with IRM for a short period
to rule out specific problems. Perhaps if you find out the filing is not
sealed adequately, you may choose to have a different material placed. You
can have gold, amalgam, direct composite, indirect composite, Laboratory
fired porcelain, milled porcelain, and some mixtures of porcelain and resin.
If you need RCT, then get it done and start feeling better soon. Nothing
you describe would make it sound like a RCT was caused by your treatment.
More likely by the accumulation of decay and fillings on this tooth prior to
now.
Insurance will generally pay whatever they would pay against a RCT
regardless of when it was filled last. They often have provisions where
they will not duplicate payment for a filling within 3-7 years--depending on
the plan. If you choose to upgrade to an onlay or crown (for example) your
insurance plan *probably* will deduct the money they paid towards the
composite from what they will pay for the onlay or crown. This assumes you
have not exhausted your annual maximum and have met your deductible. There
are a few weird plans out there, so don't take what I say as being specific
for your particular plan.
Bottom line--------------we cannot diagnose your problem over the internet.
It would not be legal even if we could, if you were in a different State
from us. We can discuss the science and the art of what we do in a general
sense.
So,,,,,,,,,,, don't be so quick to "bad mouth" the first dentist he/she may
not have done anything wrong. The second dentist may have tried the obvious
first. Now, you need to discuss it further with "a" dentist and decide on a
course of action. Mostly you need communication and more testing on this
tooth. NO EASY ANSWER.
I forgot to mention, prior to having the tooth filled. I had no pain
or anything. I was actually surprised to find out I had a cavity. It
only hurt after the work was done, so it's hard to imagine the cause
being anything inherantly wrong with my tooth. In the possibility that
the pulp would have decayed, I can't see how that would've happened
given that I only had a shallow cavity. I'm just hoping it's not
something that needs a root canal.
Often teeth that have problems do not hurt until after they get filled. Any
pressure which builds up inside the tooth can drain out through the "hole".
We close the hole and all that pressure just keep building inside the tooth
until it hurts.
I am not trying to defend anyone here. I just want you to realize that
there is more to it than meets the eye. Without being there in person, I
cannot possible comment on your particulars.
And,,,,,,,,,,, I am sorry if it should be spelled "tooth Slooth". That may
be, I have not ordered new ones in a long time. Just a plastic stick with a
"volcano" shaped bump. This way we can localize the pressure to just one
cusp at a time and check better for cracks.
