Does pain while chewing mean I need a root canal?

May 10, 2010 9:06 AM

Pain when chewing with a composite filling. Will I need (yet another) root canal? And what's up with my teeth, anyway?!

Since last autumn (see this previous question) I've had a series of about a dozen fillings done, all on my bicuspids and molars. My current dentist was the one I went to for a second opinion; the first dentist suggested expensive onlays, not fillings, to treat my cavities--which I've seen both in the mirror and on my X-rays--but when I went to get a second opinion, the second dentist suggested that none of the cavities were deep enough to necessitate an indirect restoration. I felt much more comfortable with the approach of the new dentist (more conservative, it seemed), not to mention the cost, so he's been slowly filling my cavities over a course of several months.

His office only does composite fillings. The vast majority of those composites have been fine. However, three of the cavities were in teeth with existing amalgam fillings. He drilled out the amalgam and replaced them with composites. These three teeth have been problematic, to say the least. One flared up into a terrible toothache that was both heat and cold sensitive with a gum fistule above it. With another--a lower molar--the bite felt off. He readjusted it twice, but my jaw felt increasingly achy and eventually became heat sensitive and started waking me up at night. I asked my asked my dentist for a referral to an endodontist, who tested both teeth and determined they needed root canals. The root canals were painless and I now have temporary fillings in both; I'm returning to my dentist on Thursday to get started with the permanent restorations.

The third tooth, also a lower molar, was the only tooth with any sensitivity before the fillings were done (to sweets). I now have sharp pain when chewing on food on that tooth--the pain seems to radiate from the center of the tooth, and is worse if there's a piece of food stuck on it. However, it doesn't hurt or have any other sensitivity at any other time. There's no acheyness with cold or heat. There's no pain when biting (only chewing on food!). I asked the dentist to readjust it once, but the sensation hasn't changed at all. I'm using sensodyne and gelkam, which hasn't seemed to make any difference.

I know you are not my dentist--but, since I'm going to speak to my dentist on Thursday anyway, I'm planning on asking him about it. Google results seem to suggest that either the filling needs to be redone or that I need a root canal. However, the sensation with this tooth is so different from the other two infected teeth that it seems strange to me that a root canal would be required. I was wondering if any Mefites had similar problems with composites when they replaced amalgams, and if they had any relief from just getting the filling redone--or if I'm just doomed to have another root canal (since I'm out of my dental benefits, and I know this tooth would need a crown too, you can imagine why I'm reluctant!). I'm also curious as to what I should ask for from my dentist--an x-ray of the tooth? Tests to see if it's cracked? A sedative filling placed?

Also, as a follow-up question: from the above, you'd probably think I have terrible oral hygiene. Though I probably was a bit lazy about taking care of my teeth in, like, middle school, that hasn't been the case since my late teens. The longest I've ever gone between cleanings was nine months. I brush 2-3 times a day (sometimes with an electric toothbrush, though I've been using a manual toothbrush since I got the temporary fillings in) and keep floss at my desk and floss constantly. Right now, I'm using both gelkam and an ACT fluoride mouthwash (fluoride city). More than one hygienist has commented that my teeth seem very clean, and that it's clear that I floss. One dentist a few years back casually mentioned that I might have acid reflux, though I've never noticed it, from the color of my molars, but when I mentioned it to my current dentist, he just shrugged and suggested I need to brush more (!). I'll admit I have a bit of a sweet tooth, but I'm doing my best to cut back and always, always brush. Bad (British) teeth do somewhat run in my family, but I'm sort of at a loss as to how I can keep my teeth from getting any worse--and I'm only 26! Am I missing some sort of holy grail of dental health? Should I visit a gastro about acid reflux, or start aking vitamins, or something?

Sorry so long. But clearly, I'm flummoxed.

posted by PhoBWanKenobi to health & fitness (7 answers total)

Addendum: I actually missed two cleanings back when I was 22, and had to have about six fillings done (also all in molars and bicuspids) at the time. Otherwise, I've been religious at it, even when I didn't have dental insurance.
posted by PhoBWanKenobi at 9:26 AM on May 10, 2010

I'm sorry, I can't help with your query. But I have the SAME teeth as you and I too brush regularly, I don't drink fizzy drinks, I don't smoke, I don't do anything which would kill my teeth apart from a slight chocolate habit.

Anyway I just wanted to say that unfortunately bad teeth are hereditary in some people and there's just not that much you can do about it, just take the best care you can of them, and not eat sweets if you can help it. Incidentally sweets which you suck are the worst apparently - they marinade your teeth in sugar. Avoid those.

Solidarity - I feel your pain, literally. But I resent the "British" comment!


PS. My parents both have terrible teeth (mine are their fault dammit!) and they've still got all of their own at 50 and 60. Even with a lot of fillings and a crown/root canal here and there, you can still make them last if you set your heart on it.
posted by greenish at 9:33 AM on May 10, 2010 [1 favorite]

Thanks, greenish--it definitely helps to know you're not alone! Of course, the British bit was meant as a joke (my non-British mother had just as many cavities as my British dad, though, to be fair, her teeth were straighter!) and no offense was intended!
posted by PhoBWanKenobi at 9:45 AM on May 10, 2010

For the nutrition point: You can always start a regimen of Calcuim + Vitamin D supplements. Check with your doctor that there isn't a reason (specific to you) why you shouldn't do this.

Also, you might try using a fluoride + calcium-in-suspension mouthwash to "re-mineralize" any proto-cavities that don't demand drilling yet. You can get it through your dentist, but talk to him about the suggestion. There are plenty of dentists who don't believe that it's effective, and yours might be one of them.

As to whether you need a root canal, only a real good x-ray can tell. Often, a drill-and-fill can relieve the pain. But, since this tooth has been worked on twice, there just might not be enough to support the structure after another drilling. Maybe get another opinion on that tooth, possibly from an oral surgeon?
posted by Citrus at 9:46 AM on May 10, 2010

Oh, man, I too feel your pain - I've got the same kind of bad teeth. And I'm not even British!

A few years back when I replaced all of my amalgams with composites, at least three of them went bad shortly after getting the filling replaced, requiring root canals (I've had a grand total of 11, lucky me.) I don't have any real evidence to support this, but at that point my dentist decided it was better to leave well enough alone in my case rather than continue to replace old fillings - her thinking was that the procedure caused just enough trauma to necessitate the root canals. Apparently it's not entirely uncommon.

As for the tooth that's bothering you - I would skip the dentist entirely and go straight to the endodontist. The endo can test the tooth and give you a yes or no answer as to whether a root canal is necessary, whereas a general dentist doesn't always have the same diagnostic supplies to do so.

When you see your general dentist, one thing to get checked is your bite. The filling on the tooth that's giving you trouble might be too high.
posted by chez shoes at 10:32 AM on May 10, 2010

One big difference between composite fillings and amalgams is that the old amalgams were soft for about 24 hrs after being placed, so even if you were numb and couldn't feel the high spots in the chair, the filling would 'grind itself' into the correct bite during the first few hours. Composites are very hard right away, and getting the bite adjustments right is key to avoiding the type of discomfort you've got. That's where i would start...get the bite right and then re-assess. Try to have the adjustments done, or at least mark the teeth, without being numb.
Google results are NEVER the place to go for medical/dental advice.
PM me if you have more specific concerns or want to give more info.
Good luck.
posted by OHenryPacey at 1:35 PM on May 10, 2010

Listen to Dr Pacey, he's good! (Hey Dr P, I'm going to be in your neighborhood week after next, you need any help in your office?) If it's an issue with the bite being high, meaning you are knocking the hell out of that tooth every time your mouth closes, adjusting the occlusion by grinding it down just a touch may help. It may help slowly though, be prepared to give it some time. You are looking for improvement in the sensation, even if it in tiny increments. As long as the pain is improving and not getting worse, it's a good sign.

There are also sealers and fluoride varnishes that can help in these situations. I know you have Sensodyne and GelKam, which are great, but you can boost their effectiveness on a specific tooth by using your finger or a Qtip and putting a nice glop onto the tooth and rubbing it onto the tooth and don't rinse away. Give it lots of contact time.
posted by Jazz Hands at 5:07 PM on May 10, 2010 [1 favorite]