Friday, November 15, 2013

Why Does a Tooth Hurt After a Root Canal?




In many cases, root canals are performed on teeth that are either dying or are already dead. Many of these teeth are incredibly painful. Root canals are performed to eliminate pain and infected tissue within the tooth. Fortunately, pain after having a root canal is uncommon. The literature shows that approximately 95% of the time there is little to no discomfort.

If you are one of the unfortunate few that does experience discomfort, there are several potential reasons why this could occur. The tooth is not the source of the discomfort after a root canal. It is the surrounding structures of the tooth that is the source of the pain. The tooth itself does not hurt because there are no longer any nerves within the tooth.

Here are some potential reasons why:

1. Inflammation

Inflammation may be present at the tip of the root. This may occur for a number of reasons. Once the inflammation is resolved, the discomfort will dissipate. NSAIDS such as Ibuprofen will usually resolve the inflammation.


Infected tooth. A root canal is indicated
2. Infection

When a root canal is performed, the inside of the tooth is completely cleaned out of any bacteria and diseased tissue. However, a root canal does not clean past the tip of the root. In order to remove any infection past the root tip, we rely on the immune system and antibiotics.

While the infection is still present, it is not uncommon for the bone surrounding the tooth to be tender. This is exacerbated whenever the tooth is pushed on or bitten into. A round of antibiotics will most often resolve the infection.



3. High bite

After a root canal is done, a temporary filling or temporary crown is placed. If too much material is placed, then a high bite can result. This will cause the opposing tooth to hit the treated tooth prematurely. The result is excessive force and pain on the tooth every time the teeth come together.

When a patient is numb, sometimes it is difficult to assess the bite. After the numbness wears off, it is much easier to assess the bite. If the bite feels funny after the numbness wears off, do not assume that you will get used to the bite. You won't. It will start to hurt and cause bigger issues. Fortunately, a high filling is easy to correct. All that is necessary is to grind the filling down slightly.


4. A fractured tooth

Sometimes a fracture can be incrediblydifficult to see even with high magnification. An x-ray most often will not reveal a fracture either.

When a tooth has a fracture that extends into the nerve or all the way through into the root, it will die. The treatment for a dead tooth is to remove the dead tissue within the tooth. The problem with a fractured tooth however is that no matter what is done, the tooth will eventually fail and the only thing we can do to correct the problem is to extract it.



5. Persistent infection



The goal of a root canal is simple…..remove all dead and infected tissue within the tooth and seal it so that it doesn't get recontaminated.

If the canal(s) is not cleaned thoroughly, then the root canal will eventually fail. Bacteria will remain within the tooth. Antibiotics will not be able to reach the site because there will no longer be a blood supply to the tooth to carry the antibiotic to the infected site.

Accessory canals can be difficult and sometimes impossible to clean and seal.


If you experience pain after a root canal is performed, call your dentist to determine why.


Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit www.advanced-smiles.com

Thursday, November 7, 2013

Why Does a Tooth Hurt After a Filling?




It's not normal for a tooth to hurt after a filling is placed. Unfortunately, it does occur on occasion. When this happens, there is almost certainly something that has caused the discomfort. We have to put on our detective hats and figure out the true cause of discomfort. There are many potential causes of tooth discomfort after a filling is placed. Here are a six potential reasons:

1. A "high" Filling

This just means that the bite is too high. In other words, there may be too much filling material that causes the opposing tooth to hit the filling prematurely. This causes excessive pressure on the tooth and can certainly cause discomfort. Usually, this is quite simple to diagnose. If the pain is elicited by biting into the filling, then it is likely that the filling is a little too high. You may also experience cold sensitivity on the tooth.

When a patient is numb, sometimes it is difficult to assess the bite. After the numbness wears off, it is much easier to assess the bite. If the bite feels funny after the numbness wears off, do not assume that you will get used to the bite. You won't. It will start to hurt and cause bigger issues. Fortunately, a high filling is easy to correct. All that is necessary is to grind the filling down slightly.


2. Uncured filling material

A special light hardens the filling material.
Tooth colored fillings usually have a paste like consistency until it is "cured" with a special light. This light initiates a reaction and causes the material to become very hard. If for some reason, there remains material that hasn't solidified, the tooth will become sensitive to cold and biting. You may now be thinking "hey, those are the same clues as the "high filling". You're absolutely right...they are the same. There are ways to distinguish between the two. In this case, there may also be unprovoked pain. In other words it just hurts even when not biting or eating/drinking something cold. Fortunately, this is easy to correct as well. Applying the special light to the filling will usually resolve the problem. If it doesn't, then replacing the filling should solve the problem.


3. Trauma from the procedure

When any work is done to a tooth, it is a traumatic experience for the tooth. Sometimes the nerves inside the tooth get irritated. When this happens, the tooth becomes hypersensitive to cold. Again, you may wondering "hey, just like the previous two problems". Again, you are absolutely right. In this case though, there should not be any discomfort when biting. The good news is that this problem will usually correct itself within a few days. An anti-inflammatory medication such as Ibuprofen will reduce the inflammation within the tooth and will therefore also reduce any discomfort.


4. Exposed Root Surfaces

Exposed root surfaces on multiple teeth.
When the gums recede past the necks of the teeth and exposes the root surfaces, there can be some cold sensitivity. In many cases, this can be resolved with a desensitizing toothpaste such as Sensodyne.

If you have exposed root surfaces that weren't cold sensitive prior to the filling being placed, but now are, then it is likely that the inflammation caused by the procedure on the tooth will make the tooth very sensitive to cold. Just like in the previous example, Ibuprofen can help. Even if medications aren't taken, this problem will usually resolve itself within a couple days.


5. Open Margins

Open margins
This means that there is a gap between the tooth and the restoration. because of this, there is exposed tooth structure. Exposed tooth structure tends to be very hypersensitive to thermal changes. If this is the cause of the sensitivity, then by simply filling in the exposed tooth structure should resolve the problem.

If the margins are left open, then the tooth will develop decay again right at the interface between the tooth and restoration. It is imperative that the margins are completely sealed.




6. Cracked Tooth

Obvious fractures.
I've mentioned in previous blogs that I don't place any metal fillings. I haven't placed one since 1997. I've seen countless teeth that have fractures that are directly attributable to these metal fillings. Read my blog on metal fillings. A cracked tooth is sometimes a death sentence for a tooth. If the fracture stays above the gumline, then we could most likely save the tooth. However, if the fracture has spread below the gumline, there is nothing we could do to salvage the tooth.

In many cases, we often can't even see a fracture but know it is there. A good clue is that the tooth hurts only when biting a certain way. It doesn't always hurt when biting, but when the direction of the force is applied in such a way to spread the fracture, pain is elicited.



There are more reasons than these six, but these are the most common. If problems persist for more than a few days, have the tooth evaluated to determine what the problem is.


For more information on a wide variety of subjects, please visit our website at www.advanced-smiles.com