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Pain After White Composite Filling

 


Question:  Why does my tooth hurt after it just received a new white filling?  It did not hurt before!

Answer:  Your tooth should obviously not hurt after the filling, especially if it did not hurt before.  In this practice I do not have patients complaining of pain after white fillings are placed.  If you are experiencing pain, here are some reasons why:

  • Polymerization Shrinkage:  Composites (white fillings) shrink a little when they harden.  Generally the dentist will place the material into the cavity in a liquid to pasty form and then use a strong light (LED or Halogen) to instantly harden the material.  If the composite material is placed incorrectly or in bulk then the composite will shrink enough to either allow a little gap to form around the filling, or it will actually pull the tooth together.  Either way the tooth will become sensitive to hot and cold.
  • Too Large Composite:  Composite is a great material, in small fillings.  Once the filling reaches a certain size (1/3 the distance between the cusps or more than 2 surfaces) then it generally is not strong enough to function correctly.  Composite material is not strong enough to function exactly like tooth structure.  The tooth will bend, the composite will wear or fracture, and eventually failure is inevitable.  When the filling fails it will then require a much larger restoration or worse.
  • Fractures in Tooth: Often old silver mercury fillings, amalgams, are removed and replaced with white fillings for various reasons. These amalgams have too many issues to list here (let’s see if any ADA dentists complain), but the main one is that the expansion and contraction as well as compression over time results in tooth fractures. Removing these fillings and not recognizing the fractures (visually) will result in trouble. A fractured tooth should not receive a white composite filling!
  • Other Issues:  The two scenarios above are fairly common.  Often I see patients that have super large composite fillings (patches), and that is usually a warning sign to the quality of dentistry found in all the other teeth.  Composite material is great if used correctly.  It is not a cure-all.  It can have bubbles in it, fail to bond correctly, not cure all the way, etc.  Composite is very technique sensitive and is often placed without enough care.  This is where experience becomes important!

So, to answer this persons’ question – Your tooth could hurt for many reasons, none are good.  Talk to your dentist about this problem and see what they say.  If the answer is “wait and it will get better”, then seek out a second opinion.  Unfortunately Kentucky is not known for its quality dentistry (we are 49th and 50th in the US when it comes to number of teeth in adult mouths and oral health), so do your research and find a top dentist.  I suggest you look at the AACD (American Academy Of Cosmetic Dentistry) as one of your sources.  Select an accredited member as they have gone through some of the most rigorous training in the world and must live up to their reputation (there are several in Lexington and I am the only one in Louisville).

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posted in Announcements, Blog, Cosmetic Dentistry, General Dentistry

369 thoughts on “Pain After White Composite Filling

  1. Erin

    Two and a half weeks ago I had a crown and two fillings done (one of which was deep) on the lower right back three molars. Since, I have had a throbbing pain especially at night and slight sensitivity to hot and cold. I have been alternating Ibprofuen and Tylenol as recommended and it helps. I have gone back to the dentist twice. First he adjusted my bite. That didn’t help. He also prescribed an amoxicillan in case I was developing an infection of some type. The second time, he did a tap test, extreme cold test, xrays, and checked my bite again. Nothing felt off to me. He couldn’t get a conclusive diagnosis as I couldn’t pinpoint exactly which tooth it was. Today, I believe I have narrowed it down to the tooth with the deep filling. Is it possible it is just taking a while for the deep filling to heal? I’ve had this type of work done before and normally bounce right back. My dentist is great and I appreciate that he isn’t rushing into any unnecessary procedures to try to fix a problem he can’t see.

  2. Dr. Chris

    Hello Erin. Sounds like a clear case of a dying tooth. If the amoxicillin makes it feel better then you will most certainly need a root canal as the pain will return after about 2 weeks. Sorry. The root canal treatment will solve you issue.

  3. johnnie Hewettle

    Hi,
    I had a filling done two weeks ago and I feel a throbbing sensation in my jaw. I called my dentist and the dentist prescribed some antibiotics and 800 mg Ibuprophen and it still throbs. Why is that?

  4. 4APK.RU

    The technique for doing white composite fillings on back teeth is very demanding, and many general dentists aren’t properly trained to do this. The pain after a new filling could be because of improper technique.

  5. Dr. Chris

    Hello Johnnie, sounds clearly like a root problem. Antibiotics will mask the pain for about 2 weeks if it is a root issue. Ibuprofen will manage inflammation and pain for a limited time. Neither “solves” the issue and only prolong the problem. This is a very common practice and if not followed up with a root canal evaluation is futile. The tooth is in destress due to many reasons and the dentists needs to put his/her thinking cap on and actually come up with a solution, not a bandaid fix. If your dentist won’t see you to figure out the “reason” behind the problem then you will need a new “doctor”, not someone that just prescribes medication without finding the cause.

  6. Lou joe

    I had a old mercury filling replaced. They used white composite never an issue for 2 months. 2 days ago super sensitive to hot and cold and pressure. What could it be? Thanks

  7. Dr. Chris

    Hello Lou. Since your problem is new after 2 months I would say it either is a fracture or decay. If the white filling replaced a large amalgam then it is highly likely that the tooth had fractures in it already. The general rule is that the white filling should be less than 1/3 the distance between the cusps. Most are much larger. If it is beginning to fracture then you would need a crown or onlay. Decay on the other hand would be at the edge of the white filling and a dentist should be able to determine that.

  8. Dr. Chris

    Correct. White fillings are very technique sensitive. I have taught many dentists at lectures how to avoid the pitfalls but many errors are still made…it’s unfortunate.

  9. Badchi

    Hi Dr Chris,

    I had a white filling a year ago in right back bottom tooth.
    It was sore for 1 month then settled down. Then in month 3 it became sensitive to hot liquid especially if I swish / immerse the hot liquid around the tooth and the pain was sharp and painful and lingered so I avoided hot liquids and the ache eventually disappeared after over a month.

    I miss my hot drinks so I tried again ( nearly a year later) and the hot liquid did not cause a sharp pain but I felt a lot of pressure / dull ache that lasts for a day or even a few days.
    I had an X-ray and there is no sign of decay and filling looks fine , I can send you the X-ray if that helps?

    What do you advise? Avoid hot drinks and give it more time to heal or redo the filling?

    P.s it had never hurt to bite down or to eat.

    Many thanks

    Badchi

  10. Dr. Chris

    Hello Badchi. The dull ache is a pretty clear sign of a dead tooth and there should be evidence of this on the X-ray. I would be more than happy to check the X-ray for you. Send it to chahn@idealdentistry.com. Hope I can help 🙂

  11. Badchi

    Hi Dr Chris, thanks for your reply. I have emailed you the Xrays, are you able to tell if tooth is dead?

    I also went to see the dentist yesterday and he suggested replacing the white filling with amalgam with sedative layer ?

  12. Dr. Chris

    I got the X-ray. Thank you. The X-ray you sent is called a bitewing which is used to find decay between teeth. To diagnose the problem with your tooth you need what is called a periapical X-ray. If your dentist did not take one then they cannot make a decision in what is wrong with the tooth. From the X-ray you sent I can clearly tell that the filling is very close to the pulp – the inside part of the tooth. Coupled with your symptoms it seems pretty clear to me that the tooth is dead or dying. The standard of care would require the type of X-ray I mentioned. Putting in an amalgam is ridiculous especially if the dentist has not even looked at the root tips. With aching due to hot this is a basic next step. Digging further into the tooth will certainly not solve your problem. You may need a second opinion…
    Send me the periapical X-ray – your dentist needs to take one, and then I can help even more.

  13. Badchi

    Hi Chris

    Many thanks for your help so far. I wish you was in the UK then I could have come to see you with this problem I have been having for a year.

    I went to see another dentist today and took the X-ray you advised. I have emailed them to you.

    He said he can see decay under the white filling and recommended amalgam. I am temped to use this dentist as I don’t think I trust my regular dentist to do this procedure.

    Do what would be your recommendation?

    P.s the symptoms I have now is I can sort of get away with drinking hot liquid fast but if I hold the hot liquid in my mouth then that’s what’s triggers the intense pressure – maybe I am confusing this with a dull ache? And it is really just pressure? This pressure can last for days and then I have found that if I keep putting ice on it, it then eventually calms down.

    Many thanks for your help so far.

  14. Dr. Chris

    I will check the X-ray! I would not use amalgam. Have them put in a “sedative” filling like glass ionizer (Fuji 9). If the discomfort goes away then you know you don’t need a root canal treatment but just he proper filling.

  15. Badchi

    Hi Chris, the new dentist had to drill deep due to to decay and had to put on a medicated temporary filling in as he said it was close to the nerve so he wanted to see if the nerve would calm down in the new few weeks before putting on the permanent filling else may need a root canal.

    This time I have no pain after the procedure unlike last time when the white filling was put in I was in mild pain for a month before it calmed down by the other dentist. I take it that no pain is a good sign the nerve is healing? What should I be looking out for?

    The new dentist could not explain why there was decay in the old filling. If you look at the 1st X-ray I sent you the top back tooth also has a cavity under the White filling (from many years ago) but there is no pain there as not close to the nerve.

    In your experience do you know why this has happened ? Is it because my teeth don’t react good with white filling hence decay forms or did the other dentists did not perform the White filling properly?

    Thanks for you advice so far.

  16. Dr. Chris

    I hope you got this resolved with a sedative white glass ionomer filling and everything feels fine 🙂

  17. Badchi

    Hi Chris,

    I sent you a picture of my temporary filling. It looks more than 1/3 of width of the tooth. In your article you said White filling is not suitable. Does that mean I need to use amalgam ? Thanks

  18. Dr. Chris

    I am glad you are feeling better! The white filling before was hurting because it was simply done incorrectly. Since you have no pain now I feel you have a really good chance for a full recovery! This is exactly why dentists need to know how to do proper white fillings!!!!

  19. Dr. Chris

    You “never” need to use amalgam in my opinion. Amalgam is comparable to using a spear instead of a gun. It is completely outdated and should be banned as it is in many other countries.

    The size of the filling should be 1/3 the distance between the cusps, correct. Let the tooth calm down first and then “cuspal coverage” with an onlay or a crown would be indicated.

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