Post-Filling Care: Pain and Next Steps in Dental Treatment

Q: Post-Filling Care: Pain and Next Steps in Dental Treatment

Hello： Based on your detailed description of the clinical course and symptoms, I recommend that you observe this molar for another month. <br>After that, we can decide whether to proceed with root canal treatment based on clinical objective symptoms and electrical vitality testin

Post-filling observation period and subsequent management inquiries?

Dear Dr.
Liu,
I would like to consult you regarding some issues related to my dental filling.
I appreciate your time in responding.
Thank you...^^
Let me first describe the main situation as follows:
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Discovery of Cavities: One day during lunch, I bit down on a hard object with the second-to-last molar on the upper left side, which caused an immediate sharp pain.
That evening, while eating potato chips, a corner of that molar suddenly fractured, resulting in slight bleeding, which stopped after rinsing my mouth.
Prior to this incident, I only experienced discomfort when drinking cold water; otherwise, I felt fine while eating or talking.
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Medical Consultation: The next day, I visited the dentist, who diagnosed me with moderate caries.
He explained that the dentin had softened, so when I bit down on something hard, there was no internal support, which naturally led to the enamel fracturing.
The dentist then removed the softened dentin from the fractured area and applied a material (I am unsure if it was calcium hydroxide or zinc oxide eugenol).
He mentioned that this material would stimulate the nerves to form a protective layer and that I should be observed for at least a month to check for any spontaneous pain.
If there was none, he would remove the material and fill it with silver amalgam or composite resin to complete the treatment.
P.S.: The X-ray taken after the repair showed that the depth of the removal had "slightly" contacted the pulp horn.
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Observations: Over the past month, there has been no spontaneous pain, but I have experienced "pressure pain," which can be categorized into two situations: First, after the dentist completed the filling, he pressed on the repaired area and asked if it hurt.
I replied, "No." Moreover, during 90% of the time when I wasn't eating, I felt no discomfort when pressing with my hand or tongue.
Second, during the remaining 10% of the time when I was not eating or while eating soft foods (like bread or tapioca), pressing on the repaired area or biting into these foods caused intense pain, but after avoiding pressure for a while, the discomfort subsided.
P.S.: Drinking cold water also causes a brief discomfort, which goes away after some time!
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Questions:
Question 1: Although I do not have spontaneous pain, I do feel pain when eating or pressing with my hand occasionally.
Could this pain be due to pressure on the pulp horn? If so, even if the final filling is done with resin, wouldn’t I still experience pain while eating? Wouldn't that mean the filling was ineffective?
Question 2: Do I need to undergo root canal treatment? If so, are there any alternatives to root canal treatment that could remedy the situation?
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Postscript: I have noticed that you answer patients' questions very thoroughly, and I feel that you are a dedicated physician.
Thank you in advance for taking the time to respond to my questions.
I am grateful...
^^
Jack

Jack, 20~29 year old female. Ask Date: 2006/04/30

Dr. Liu Tiancai reply Dentistry

Hello: Based on your detailed description of the clinical course and symptoms, I recommend that you observe this molar for another month.
After that, we can decide whether to proceed with root canal treatment based on clinical objective symptoms and electrical vitality testing.
Generally, when a tooth's cusp fractures, exposing dentin or even slightly exposing the pulp tip, it can lead to pulp congestion and increased sensitivity (to temperature changes, pressure changes such as biting or touch, and concentration changes like salt or sweetness) due to trauma.
However, since you are young and have strong reparative capacity, and the doctor has already performed pulp capping, it is expected that the congested pulp will return to normal as reparative dentin accumulates beneath the fracture site.
The worst-case scenario is that after another month, if the tooth remains abnormally sensitive (to cold, heat, biting, or touch) or experiences spontaneous pain, it would indicate pulpitis, at which point root canal treatment would be necessary to remove the inflamed pulp.
However, if after a month there is no pain and everything seems normal, a vitality test should still be conducted.
It is possible that if the injury was too severe, the pulp may have necrosed and become non-vital, which would also require root canal treatment to prevent it from becoming a chronic periapical condition without your knowledge.
Sincerely, Dr.
Huang Chih-Cheng, Dentist.

Reply Date: 2006/04/30

More Info

Hello Jack,
Thank you for reaching out with your concerns regarding your dental treatment. I appreciate the detailed account of your situation, which helps in understanding the complexities involved. Let’s address your questions one by one.

Question 1: Pressure Pain and Pulp Horn Contact
The pressure pain you are experiencing, especially when biting down or pressing on the repaired area, could indeed be related to the proximity of the restoration to the pulp horn. When dental work is performed close to the pulp, it can lead to sensitivity or discomfort, particularly when pressure is applied. This is because the pulp contains nerves and blood vessels, and any irritation can trigger pain responses.

However, the absence of spontaneous pain is a positive sign. It suggests that the pulp may not be inflamed or infected at this moment. The discomfort you feel when chewing or applying pressure could be due to the restoration itself, the surrounding dentin, or the remaining tooth structure being sensitive to pressure.
If the final restoration is done with a material that properly seals and protects the tooth, it may alleviate some of the discomfort. However, if the sensitivity persists, it could indicate that the pulp is under stress or that there is an underlying issue that needs to be addressed.

Question 2: Need for Root Canal Treatment
As for whether you need root canal treatment, it depends on the health of the pulp. If the pulp is healthy and you are only experiencing pressure sensitivity, you may not need a root canal. However, if the pressure pain worsens or if you develop spontaneous pain, it could indicate that the pulp is inflamed or infected, which would necessitate a root canal.

There are alternative treatments to root canal therapy, such as pulp capping, where a protective dressing is placed over the pulp to encourage healing. However, this is only viable if the pulp is not severely compromised. If the pulp is exposed or if there are signs of infection, root canal treatment may be the only option to save the tooth.

Next Steps
1. Monitoring: Continue to monitor your symptoms. If the pressure pain becomes more frequent or severe, or if you develop spontaneous pain, it’s crucial to return to your dentist for further evaluation.

2. Follow-Up Appointment: Schedule a follow-up appointment with your dentist to discuss your symptoms. They may recommend further diagnostic imaging, such as an X-ray, to assess the health of the pulp and surrounding structures.

3. Consider a Specialist: If your dentist suspects that the pulp is compromised, they may refer you to an endodontist (a specialist in root canal treatment) for a more detailed evaluation and treatment plan.

4. Pain Management: In the meantime, if you experience discomfort, over-the-counter pain relief medications may help manage your symptoms, but consult your dentist before taking any medication.

In conclusion, while the absence of spontaneous pain is encouraging, the pressure sensitivity you are experiencing warrants further investigation. Your dentist will be able to provide the best course of action based on a thorough examination and any necessary imaging. Thank you for your kind words, and I hope this information helps you feel more at ease regarding your dental care. Please don’t hesitate to reach out with any further questions or concerns.

Best wishes for your recovery,
Dr. Liu

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