Tooth Pain After Filling: Is It Pulpitis Again?

Tooth number 16 has pulpitis, and after receiving a filling a few months ago, it started hurting again?

The tooth number 16 has a deep cavity and was filled a few years ago.
After the filling, I started experiencing tooth pain in November of last year, especially at night when lying down, which made it difficult to sleep.
Drinking cold water provided only temporary relief.
After taking migraine pain medication, I visited a dentist who diagnosed me with pulpitis.
The dentist mentioned that the previous filling might have been too deep, putting pressure on the dental nerve.
They removed the old filling and placed a temporary filling, stating that if the pain persisted, I would need a root canal treatment.
They also mentioned that my tooth would be difficult to access the nerve, and if there was no pain, they could just refill the tooth without a root canal.
A week later, since I was not experiencing any pain, the dentist refilled the tooth without performing a root canal treatment.
After the filling in November, I was afraid to chew on that tooth and only used the other side.
A few months later, in April of this year, I felt slight pain in the filled tooth again.
When I tried to bite down on it, I felt pain, but after a day or two, the pain subsided.
Today, in May, I am again experiencing slight pain when biting on the filled tooth, and pressing on the cheekbone above the filling causes soreness.

1) I would like to know why there is occasional pain; is it normal for it to hurt again? Also, why does pressing on the cheekbone cause soreness? Could it be related to the nerve?
2) Are these symptoms indicative of a recurrence of pulpitis? Although it’s not as painful as before, it still hurts enough to require pain medication.

3) I am hesitant to use the filled tooth for chewing because I fear putting more pressure on the filling.
Is it okay to only chew on the other side? Could this have any negative effects?
4) If tooth number 16 requires extraction and a root canal treatment is not performed, will I definitely need a dental prosthesis afterward? What are the potential negative effects of not getting a prosthesis? Thank you.

Christine, 20~29 year old female. Ask Date: 2020/05/02

Dr. Huang Tingfang reply Dentistry

Dear Ms.
Christine,
Hello! As mentioned, the nerve of tooth #16 appears to be decayed, and there is also an infection near the root.
It is important to return to a medical facility for treatment as soon as possible; otherwise, it may develop into cellulitis.
Take care and wishing you all the best!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2020/05/02

More Info

Tooth pain after a filling can be a complex issue, and your concerns are valid. Let's break down your questions and provide a comprehensive understanding of what might be happening with your tooth.

1. Why does the tooth occasionally hurt? Is it normal for it to hurt?
It's not uncommon for a tooth that has had a deep filling to experience some sensitivity or discomfort after the procedure. This can be due to several factors, including the proximity of the filling to the dental pulp (the nerve and blood supply of the tooth). If the filling is too close to the pulp, it can cause irritation, leading to symptoms similar to pulpitis. The fact that you experience pain when biting down or when pressure is applied to the area suggests that there may still be some inflammation or irritation present. The soreness in your cheekbone area could be related to referred pain from the tooth or possibly muscle tension from clenching or grinding your teeth, which can occur subconsciously, especially during sleep.

2. Could these symptoms indicate a recurrence of pulpitis?
Given your history of pulpitis and the symptoms you describe, it is possible that the pulpitis could be recurring. The intermittent nature of your pain, especially if it worsens at night or with certain activities (like chewing), suggests that the nerve may still be inflamed or that there could be a new issue developing, such as a secondary infection or a crack in the tooth. It's essential to monitor these symptoms closely. If the pain persists or worsens, it would be prudent to return to your dentist for further evaluation, which may include X-rays to assess the health of the pulp and surrounding structures.

3. Is it okay to avoid using the filled tooth for chewing?
While it is understandable to avoid using the filled tooth for chewing due to fear of aggravating the filling, consistently avoiding that side can lead to other issues. Over time, you may develop an imbalance in your bite, which can lead to jaw discomfort, muscle strain, or even issues with your temporomandibular joint (TMJ). It is generally advisable to use both sides of your mouth for chewing to maintain a balanced bite. If you are concerned about the filled tooth, consider discussing with your dentist the possibility of a more definitive treatment, such as a root canal if necessary, or a crown to protect the tooth.

4. What happens if the tooth requires extraction? Is a dental prosthesis necessary?
If the tooth cannot be saved and extraction is necessary, it is generally recommended to replace it with a dental prosthesis, such as a bridge or an implant. Not replacing a missing tooth can lead to several complications, including shifting of adjacent teeth, bite misalignment, and potential bone loss in the jaw where the tooth was removed. These changes can complicate future dental work and affect your overall oral health. Therefore, while it may not be strictly necessary to replace every extracted tooth, doing so is usually in your best interest for maintaining dental function and aesthetics.

In summary, your symptoms warrant further investigation by your dentist. It is crucial to address any recurring pain, as it may indicate underlying issues that need treatment. Regular dental check-ups and open communication with your dentist about your concerns will help ensure that your dental health is managed effectively.

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