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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

218 thoughts on “Pain After White Composite Filling

  1. hahndds

    This sounds more and more like a fracture! Let me know what happens on Friday :)

  2. hahndds

    While it is not good to use expired material, I would not be worried about that so much, assuming you are talking about a white filling material. The expiration date really is far beyond what the date on the tube says :) The material only gets harder to work with and dries out, at which point it cannot be used any longer.
    Dr. Chris

  3. hahndds

    If you have pain and you don’t agree with what your dentist says then I suggest you get a second opinion. There is always a chance that the filling was deep and large which could have resulted in the tooth dying. Often people don’t feel pain but have large areas of decay…

    Dr. Chris

  4. hahndds

    Dear Hannah,

    First, go back to the dentist and see if the “bite” is perfect.
    Second, if that does not solve it contact me again with more details about the pain etc. :)

    Thanks,

    Dr. Chris

  5. sukun

    Im facing d same problem, and it hurts terribly.

  6. K

    To Dr. Chris,

    Hello again! I’m the one who commented a few days ago with the possible fractured tooth. I went again to the dentist, and I’ll try to write what happened to the best of my memory, hopefully without too many mistakes. Thank you again for reading and giving your opinion, it’s very helpful and reassuring even if you aren’t able to confirm things in person! :)

    I asked whether the hurting tooth could be fractured, and my dentist said she didn’t think it was likely, but more that the previous silver-coloured filling had put pressure on the tooth that wasn’t replaced when she replaced it with the composite filling. She filed it yet again, and put a coat of varnish on it. In the morning when I tried to floss, there was the pressure pain on one side, but when she finished varnishing and did the after floss there wasn’t really pain/there was improvement. However, now that I’ve been able to eat, it feels as if the pain is still there but now spread out a little over the surface, if that makes sense? Again, not in the whole tooth or any time it’s touched, just in parts. She said that we would give it another week or so, and if things didn’t improve, she would suggest a root canal. I’m terrified at the thought :(

    I apparently also need my upper right wisdom tooth either fixed (filling), or removed. It had no issues coming in, and doesn’t have problems now besides the decay, but it is at an odd angle which makes it hard to clean even with the smaller toothbrush heads. I don’t mind having it removed-not as if I am using it!-but it is probably more drastic that way. What would you think? If the tooth is already out and in place, can it be pulled like any other tooth?

    I also had a filling in molar 7 on the bottom right, and it needs to be filed further (which I will have done next week), but it feels as if it’s causing my bite to be misplaced as one of my front lower incisors is now pushing on the top left one, including when I chew which isn’t ideal. Hopefully that will be fixed with a filing? I have a small jaw so had to have a lower incisor removed followed by braces when I was a teenager, so I’m very worried about them being pushed out of place again.

    Finally, we’ve been having problems with the anesthesia every session. Yesterday I had five injections, four on the same side for that lower molar, and still only my cheek and lips went numb. My tongue/gums/etc didn’t at all, and when she drilled down the tooth for the filling, I felt it and it was very painful. We tried three times inject/wait/file, but it didn’t take. In the end I said to get it over with, rather than come back, and she did but it was awful and hurt a lot. She said that it might be because I am so nervous (and this doesn’t help) but surely it has to work at some point regardless? :D This additionally makes me terrified of a possible root canal-they have the reputation for being painful, and if anesthesia doesn’t work, well… do you have any advice there either please?

    Thank you again for reading and replying, it’s really nice to have a second opinion/additional thoughts :)

    -K

  7. Austin

    I recently went in to get a cavity filled and received the composite filling. The pain and sensitivity after the novacaine wore off was brutal, especially to cold and extreme pressure. After going in to get the resulting bite checked out a few days later, the dentist suggested that shrinkage may have occurred (no one likes shrinkage) and he re-did the filing with amalgam or whatever the temporary filling is. It has felt much better since he did the procedure, so luckily it seems a root canal will not be in my near future.

  8. hahndds

    Dear Austin,

    Glad it worked out for you. Composite restorations are an amazing filling type but do require meticulous attention to detail and technique. Sounds like you had a bad experience there…hopefully in the future you can have that amalgam filling replaced with a proper white filling to prevent the tooth from fracturing.

    Cheers,

    Dr. Chris

  9. maxine

    I went to the dentist he said my fillings where leaking. So he replaced them. My right sided teeth where still hurting to bite on as well as to cold, so I waited about 3 days, I went back he did the freezing thing and it hurt bad. So he said they needed to be adjusted and said he was going to put basically so sort of installation before. It has been almost a week since and my jawline near my my ear and up to my ear is hurting as well as my tongue it feels as if I was biting it. The pain comes and goes but I cant tell if its my teeth still or my jaw still sore.

  10. hahndds

    Dear Maxine,

    When you do an ice test on a tooth you are looking for specific results:
    1. Quick response to cold and goes away quick = normal
    2. Quick response to cold and lingering = irritated tooth
    3. Slow, building response with aching = dead or dying tooth

    So, there are many issues that could be at play here. How large is the filling? Was it a silver mercury filling before?
    Adjusting the bite is always the first step. If that does not work the filling may need to be redone or a larger type of restoration such as a onlay or crown could be indicated.
    Send me more info and I will try to help more :)

    Keep smiling,
    Dr. Chris

  11. A.

    Dear Dr. Chris,

    This past June I had four amalgam fillings replaced with some kind of composite, on the four right-side molars, above and below. They were very old fillings (around 25-30 years old) but I had never had problems, never any pain or unusual sensitivity with them. It was my own initiative to replace them, purely out of concerns about mercury toxicity (of which I have experienced many of the known symptoms, for all the years since the fillings were placed).

    The dentist I found said it would be a simple procedure to have all these amalgam fillings replaced, no problem. I believed him: I had no idea that it could be in any way a complicated procedure. He followed all the best protocol for replacing mercury fillings, as far as I could tell, and has many years of experience with replacing amalgam fillings in his mercury-free holistic dentistry practice.

    After the new fillings were done, I went back once to have the bite adjusted, but then I continued to have sensitivity on that side. Throughout the following months I was not able to chew at all on that side, and even just drinking water hurt. But I read that sensitivity was typical, that the teeth needed to “settle”, so I did not worry too much. And the receptionist at the dentist’s office did not seem to think it was a big deal or cause for concern. But after three months began very severe pain, and one of those teeth (#2) has now died. It had the largest and deepest amalgam filling. The other three of those right-side molars are all still sensitive, and after trying the ice test I believe the back right molar below is also dying.

    Perhaps I can find a new dentist who has a deeper level of understanding and skill in these matters… Do you believe that every AACD-accredited dentist really has a similar level of expertise as you? There a few here in my area, and even an “accredited fellow”. Initially I had hoped to get the four left-side molars done as well (which are full of old amalgam fillings too), but now I have become very concerned about the whole thing, as you can imagine.

    I would like to find someone who understands as much about all this as you do, as I fear otherwise I may lose all the rest of my molars. Perhaps it would be best for me to come to your practice in Louisville. It is very far away, but the idea of losing all of my molars is a terrible thought.

    Any help or suggestions you might be able to give would be much appreciated.

    Thank you so much,
    A.

  12. Tony

    Hello Dr. Chris,

    I had a 26 year old amalgam filling replaced on my 2nd lower-left molar, with a composite filling, about three weeks ago, and I wish I never had done so. After the first week, the entire left-side of my face was is pain. A week later, the pain moved to the upper and lower left teeth, left-side of my jaw, and left ear. I am now on the third week, and the pain comes and goes, it normally starts a few minutes after I eat and brush. When I do get these occurrences of pain, it now only affects the left-side of my jaw. The tooth on which the filling was replaced, does not hurt, though it is sensitive to cold; it feels more like the nerves all along my jaw flare up, and cause the pain in my jaw.

    I have been taking one Advil twice a day; in the morning, and before going to sleep, but I can’t be on this drug forever. My question is, since the area of pain has been reduced, should I expect for all of the pain to eventually go away? I did revisit my dentist about one week ago, and she took x-rays, and said that all looked okay. She told me to wait another week, since the composite filling may need some time to settle (contract and then expand to it’s settled state). She says that this could definitely be the cause of the pain, since the composite filling is pulling on the tooth. I also noticed that this tooth has hairline fractures which are visible around the bottom , just before the tooth meets the gum.

    I would truly appreciate any recommendations, and thanks.

    Tony

  13. hahndds

    Dear Tony,

    I am sorry to hear about your experience… Here are my thoughts:

    1. Composites don’t need time to “settle”. Every material expands and contracts, including composite, but the composite material should be cured completely after placement.

    2. The reason we place composite in small increments (less than 2mm at a time) is to minimize polymerization shrinkage. The way we build the filling also is designed to minimize this. If the filling is not built correctly then it can put too much stress on the tooth.

    3. Silver mercury amalgams always crack a tooth, eventually, as they continue to expand and contract 3 times more than tooth structure. When you replace a amalgam you need to expect and look for these cracks. Often a “filling”, no matter what material (gold, porcelain, composite) with continue to put pressure on that crack and make it worse. Think of it like splitting wood. Once the axe has hit the wood it only takes a little more pressure on top of the axe to split the whole log in half.

    4. The furthest back tooth in your mouth gets the most biting force, making #3 above that much more important.

    5. If the tooth has a fracture, which is think is very likely, then it needs a crown to hold the tooth together before it breaks apart. It is critical that the dentist checks for cracks with high power loupes (magnification) and light after the amalgam was removed. Did the dentist have these? I find it impossible to deliver decent dentistry without 4.5x magnification!

    So, long story short, with the level of pain you are describing I would expect the need for a crown due to a fracture is your answer. If you wait too long the tooth could fracture beyond repair, even if the dentist does a root canal treatment (which is a whole new can of worms). Don’t let the dentist put you off. Either get the crown or redo the filling checking for fractures. Historically speaking amalgam replacement often results in crowns (I call it the seed restoration – check next blog post).

    I hope this helps!

    Keep smiling,

    Dr. Chris

  14. hahndds

    Dear Tony,

    I hope the last response helps :)

    To answer the questions you had in this comment, see below:

    I am in the middle of the spectrum (in everything actually), meaning, I have no label. I am not holistic or scientific, I am me. My experiences and gut feeling coupled with what I have learned from people I respect created my life philosophy. That being said, I am not a fan of amalgams, root canals or poorly done composite for that matter. Everything has a time and a place. Everything has a price attached to it. Nothing is perfect.

    So, while I am a AACD Accredited Cosmetic Dentist I can’t say everyone has my belief system. What I can do is tell you that these dentists, especially fellows, will find cracks, place fillings correctly and give you all the options. If you like you can send me the dentists in your area and I can tell you who I would see, if I have a preference :)

    Keep smiling,

    Dr. Chris

  15. Tony

    Thank you for the response Dr. Chris.

    I went to see my dentist today, and she removed the composite filling, and coated the part of my tooth which was drilled, with a liquid that is used to allow the tooth to generate dentin, and then she refilled the tooth with a temporary filling. She performed a cold test on the tooth, and I was late to react to the cold on that tooth, so she thinks that the tooth may be suffering pulpitis, causing the nerve to die. The tooth is not infected, nor was there any cavity, this tooth just had an old amalgam filling which she replaced four weeks ago. I was also late in reacting to the cold test on other teeth as well, so I don’t know how reliable this test is, in determining a dying nerve.

    My question is, do you think that the nerve is dying due to pulpitis, which is a result of having the amalgam replaced with a composite filling? She says that she wants to see me in two weeks, and if I do not react quick to a cold test on that tooth, then she will need to perform a root canal, since the nerve is dying. I don’t want to have a root canal, because I know that it will be downhill for that tooth from that point on (brittleness, blackness, etc.). Do you think that I will be just fine having a composite filling put back in, and no root canal?

  16. KK

    Hi!

    I had a composite filling done four weeks ago on bottom molar. I went in the next day for adjustment because one side of the tooth was very sharp. Everything was good but I noticed about a week later that I had sensitivity to pressure… If I ate anything semi-hard there was a shock of sensitivity that made me cringe. I don’t have constant ache or pain and no sensitivity to temp. Went in yesterday to have the dentist look at it as he said it might be the bite… he shaved a little off the side where he said was a contact point. It feels even more sensitive to pressure now.

    After the initial filling my dentist said that he had to go a little closer to the edge of my tooth than he thought he would which made the technique different and the edge of the actual tooth thinner. The filing is also very low. Dentist said the cavity was on the smaller side.

    Should I give it some time for my bite to adjust? My dentist said the next option is a crown…is this my only other option or should I consider something else first? I’d rather not have unnecessary work done and from what I read sometimes the filling just needs to be re-done?

    Thanks for any help you can give me!

  17. hahndds

    Dear KK,

    If there was a silver mercury filling in the tooth before then the chances are pretty good that it has a fracture, which would need a crown to hopefully fix.

    If there is no fracture then it could be polymerization shrinkage which would be due to bulk filling and curing the composite. This would require the filling to be redone in small increments.

    Those are the two most likely scenarios. Other issues could be the bite, which you already had adjusted, a failed bond – technique or moisture issues, and under-polymerization.

    It is impossible to know which of these issues it is, but most of the time it is a fracture from those wonderful amalgams!

    Keep smiling,

    Dr. Chris

  18. hahndds

    Dear Tony,

    Pulpitis simply means the tooth is irritated. A late response to a cold test is no reason for a root canal treatment.

    I would do just about anything before I got a root canal treatment myself!

    No liquid “generates dentin”. They probably put down gluma (which should not be applied near the pulp) or calcium hydroxide. Either way it would take more than 2 weeks to get a decent improvement.

    I would let the temporary filling sit until it feels better or actually gets worse. Then make a call. This could be a few months.

    Cheers,

    Christian

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