Persistent Tooth Pain After Dental Cleaning: Causes and Next Steps

Toothache, but the doctor diagnosed it as gingivitis. After dental cleaning, the pain remains severe?

Symptom Report: Yesterday, there was no pain in my teeth, but my gums were swollen (this has persisted for about 3 days, and there was bleeding while brushing, feeling swollen).
1.
However, upon waking today, I felt a throbbing pain in my upper gums (intermittent, not requiring biting, just a painful sensation), and all my upper molars (excluding the front teeth) felt swollen and painful.
2.
By noon, the pain on the left side was more pronounced than on the right side, and when biting down, the pain lasted for more than 5 seconds.
3.
Around 8:30 PM, I visited a nearby dental clinic, and the dentist said I only had gum inflammation and some calculus, so he performed a "scaling" and mentioned that the pain would disappear after the cleaning.
I expressed that biting down causes pain, and the dentist responded that it should be due to "gum inflammation making the teeth more sensitive," and he discovered I had cavities, advising me to return in a week.
(The dentist mentioned that I might be experiencing this due to staying up late recently, which weakened my immune system, leading to gum inflammation, and that normalizing my routine would resolve this!) *However, after returning home, I found that the pain did not subside and became more pronounced; other pressures (such as finger pressure or pushing with my tongue) made the pain feel very sensitive, especially in the lower left first molar and the first and second molars.
I am now afraid to bite down because it is quite painful, and there is slight swelling on the left side of my cheek.

Questions: 1.
Should I go back to the doctor immediately, or wait a week for my follow-up? 2.
What could this condition possibly indicate? What treatment options would a general dentist consider in such cases? 3.
My right central incisor and lateral incisor have cavities (on both sides where the two teeth intersect, for about 2 years now!).
How would a dentist typically handle this? (The delay is because my previous fillings needed to be redone about every six months, either due to the filling material failing or persistent pain.) 4.
How can I choose a good dentist?

pái lǐ, 20~29 year old female. Ask Date: 2006/03/22

Dr. Zeng Guanghui reply Dentistry

Swelling and pain in the upper gum, along with bleeding during brushing, generally indicate gingivitis or even periodontal disease.
After receiving dental cleaning treatment, most symptoms tend to improve.
However, if the pain persists, it may be necessary to consider other conditions, such as issues with the dental pulp or fractures or cracks in the crown itself, or even severe infections of the alveolar tissue (such as cellulitis).
It is advisable to return for a follow-up appointment to receive appropriate treatment.
Regarding the cavities in the right central incisor and lateral incisor that have previously been filled and have fallen out, the sensation of sensitivity should be evaluated based on the extent and depth of the decay.
If the cavity is too extensive, it may not be possible to secure a filling effectively, and a crown may be necessary for restoration.
If the decay is too deep and close to the pulp, pulp capping or root canal treatment should be considered, followed by restoration with a crown.
It is recommended to consult a dentist for further examination and treatment.

Reply Date: 2006/03/22

More Info

Persistent tooth pain after dental cleaning can be concerning and may indicate underlying issues that need to be addressed. Based on your symptoms and the information provided, let's break down your situation and explore the potential causes, necessary actions, and treatment options.

1. Immediate Need for Medical Attention
Given that you are experiencing persistent pain, especially after a dental cleaning, it is advisable to seek further medical attention sooner rather than later. While the initial dentist suggested that the pain would subside, the worsening symptoms—such as increased sensitivity, swelling, and pain upon pressure—indicate that there may be more than just inflammation at play. If the pain is severe enough to prevent you from biting down or if you notice swelling in your cheek, these are signs that you should not wait a week for your follow-up appointment. Instead, consider visiting a dental clinic as soon as possible for a more thorough evaluation.

2. Possible Conditions and Treatment Approaches
Your symptoms could be indicative of several dental issues:
- Gingivitis or Periodontitis: The swelling and bleeding gums suggest inflammation, which could be due to gingivitis or a more advanced form of gum disease. Treatment typically involves professional cleaning, improved oral hygiene practices, and possibly antibiotics if an infection is present.

- Dental Abscess: The localized pain and swelling could also suggest a dental abscess, which occurs when bacteria infect the tooth or gums. This condition often requires drainage and antibiotics.

- Tooth Sensitivity: If your teeth are sensitive due to gum recession or enamel wear, this can lead to discomfort when biting or applying pressure. A dentist may recommend desensitizing toothpaste or fluoride treatments.

- Cavities: The presence of cavities, especially if they are deep, can lead to pain and sensitivity. If the decay has reached the pulp of the tooth, root canal treatment may be necessary.

3. Treatment for Cavities
Regarding the cavities you mentioned in your central incisors, treatment typically involves:
- Fillings: If the cavities are not too deep, the dentist will remove the decayed portion of the tooth and fill it with a dental material such as composite resin or amalgam.

- Root Canal Therapy: If the decay has reached the pulp, a root canal may be necessary to remove the infected tissue and seal the tooth.

- Crowns: In cases where the tooth structure is significantly compromised, a crown may be placed to restore function and aesthetics.

4. Choosing a Good Dentist
Selecting a competent dentist is crucial for your oral health. Here are some tips:
- Referrals and Reviews: Ask friends, family, or healthcare providers for recommendations. Online reviews can also provide insight into patient experiences.

- Consultation: Schedule a consultation to meet the dentist. This allows you to ask questions about their approach to treatment and gauge their communication style.

- Qualifications and Experience: Check their credentials, including education, training, and any specializations. Experience in treating specific conditions similar to yours is also beneficial.

- Comfort Level: Ensure you feel comfortable with the dentist and their staff. A good rapport can make a significant difference in your treatment experience.

Conclusion
In summary, your persistent tooth pain and swollen gums warrant immediate attention from a dental professional. The potential causes range from gum disease to cavities or even more serious conditions like abscesses. It is essential to address these issues promptly to prevent further complications. Additionally, when selecting a dentist, consider their qualifications, experience, and your comfort level with them. Prioritizing your oral health will lead to better outcomes and a more positive dental experience.

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