One prevalent issue that we come across in dentistry is tooth pain and its management. The majority of patients that we treat are not in pain but come to us for routine dental work (cavity fillings, crowns, cleanings, etc.). Occasionally we will treat someone who was pain-free but will return in a few days mentioning discomfort on a tooth that was recently worked on. Before we dive into a look at this, it’s important to discuss some terminology.
- Pulp – the vital nerve and vascular tissue in the middle of the tooth that
- Pulpitis – inflammation of the dental pulp
- Caries – the term for the bacterial infection that causes cavities on teeth
allows the tooth to feel hot and cold sensations
When the nerve becomes inflamed, it becomes much more sensitive to sensations like hot, cold or biting. This type of pain is typically characterized by a sharp pain that goes away soon after the stimulus is removed. This is often caused by moderately deep caries that are getting close to the nerve and producing a pain response. However, even large cavities don’t always cause pain. This is where we come to our issue:
In our efforts to remove the decay, we can create pulpitis.
This is one of the reasons why patients can sometimes come in saying “My tooth felt fine, I saw you for a filling, and now it hurts!”. This is the reason our drills use so much water; we are trying to keep the tooth cool while we work to not inflame the nerve. This is most commonly encountered with large cavities where our drill gets very close to the nerve. However, it can happen with smaller cavities as well.
The good news is that this typically will resolve on its own. The bad news is that it can take 2 weeks to 3 months. This leads to a followup question that we sometimes get “Well then why even remove the cavity? It doesn’t hurt”. My usual response to that is “not yet”. Our goal with treating cavities is to stop them from worsening, infecting other teeth, and ultimately infecting the pulp. Once the pulp is infected things can get much more severe and potentially life-threatening. In addition, once the pulp is infected the tooth either needs a root canal or to be extracted. We’re trying to prevent all of that by removing the decay and placing a filling, and rarely we can have pulpitis occur.
This is a reason we like to do regular check-ups. If cavities are caught while they are small, it is much less likely the tooth will develop pulpitis. There are still other reasons that a new filling may be sensitive, but we’ll address that in a later post.
West Peaks Dental