Pain after temporary filling in preparation for onlay

I just had my first onlay (in teeth 18, 19).  I learned that my previous fillings were not adequate to prevent cavities and I needed an onlay.  For my first appt. the doctor removed the previous fillings (amalgam) and prepared my tooth with a temporary filling. After that due to a high filling, i had to have it filed down.  I did see that the filling was also cracked if that matters.  The temporary filling was also accompanied by off and on pain (intermittent).  The pain isn't terrible but it is annoying and it is in that tooth area (i have never had any pain before this there).  THe pain only came after the temporary filling. I went back after 10 days for the onlay today. I explained what had been happening and the dentist told me this would calm down over time - b/c the process had agitating the area?! Anyway after the onlay today, I can still feel this on-off pain.  It is not predictable. It comes and than can be gone for many hours and then it reappears.

Any thoughts?

[Jerome Tsang, DDS]

Sometimes with dental work, the heat and vibration caused by the dental drill can traumatized the tooth and irritate the nerve (hence the agitation).  Normally this resolves by itself.  Has the pain improved since the day that the prepartions were done?  

If the pain persists after 4-6 weeks from the day of the prepartion (drilling), I would recommend you go back to your dentist.  It may possibly need a root canal.  Was there a cavity or decay underneath the filling?  Its possible that there was an infection in that area and it may have been close to the pulp (nerve) inside the tooth and already infected it.  

[girlygirl77]

The doctor did an xray afterwards to make sure things were fine and it looked fine from there.

[girlygirl77]

Well I have had it once since the onlay was put on today.  There was a little drilling again today.  Thankfully, it hasn't happened again since this afternoon.  Before the treatment today it would happen 1-3 times a day and last as little as 20 min but even up to an hour.  I am hoping that it resolves itself. When it happens, it is a dull ache (with a 3-4 level if on a scale of 1-10).  I have no problems while sleeping and the pain is never intense.  Before I had the onlay treatment, my previous dentist did not consider it a candidate for a root canal and this dentist did not either due to the depth (though it was a big filling).  He wasn't concerned that the pulp was affected today. I'll cross my fingers. have you seen similar symptoms in your practice?

[Jerome Tsang, DDS]

Yes.  Unfortunately it happens which I always feel terrible about.  Sometimes a large filling is fine and never bothers a patient but large fillings can always potentially fracture.  Large fillings weaken the tooth and it can be unpredictable to how it will fracture.  Sometimes the fracture can split the tooth and it can't be saved.  Doing an onlay reduces the risk of a bad fracture but it can also cause post-operative pain such as yours.  

Hence why no one likes doing to the dentist! =)  But in all seriousness, sometimes things feel fine and its regretable that by performing a service, you can cause more discomfort in an individual.

[girlygirl77]

Do my symptoms sound like what happens to the patients you have had with a significant post-op issue? Or does it sound more ordinary and a case which should resolve itself?

I guess I am a bit ticked that I had already mentioned these things when I had a temporary filling and the doctor really wasn't so much phased. He went ahead with a gold onlay. So if I need any additional help for these teeth, this will be serious work versus if the temporary filling was still there.  These are also very expensive procedures and I cannot afford to do this twice.  I guess I am asking, if a patient mentioned my symptoms after the temporary filling - would you have waited or just gone ahead with the onlay?  

I woke up today and i had a slightly duller ache today, again it doesn't affect my sleep.

[Jerome Tsang, DDS]

I can't speak for your dentist in how he approaches dentistry.  But in private practice, there is a tendency to get things done as quickly as possible.  Sometimes patients do not come back after you place a temporary so doctors tend to be more aggressive in placing it.  I don't own my own practice but where I work, we have like 20-30 cases of crowns, inlays, dentures that people never came back for and its been there for months to years.  Sometimes it hard to believe that people can have their teeth worked done and never come back for the final product.

As for your symptoms, it sounds like a typical irritation that occurs from dental work.  As I said, if the pain isn't too bad and its improving, that's a good sign its more trauma from dental work and not something else.  If it helps, you can take some over the counter pain medication that's safe for you to help alleviate some of the inflammation in the pulp.  Again, the pain should be gone in 4-6 weeks from the last time they drilled, which would have been when they placed it.  

[girlygirl77]

Thanks for your info. I am very surprised some people never come back.  Perhaps they are scared or perhaps they went elsewhere.

Thankfully today it has only occurred once, in the morning - so I'm keeping my fingers crossed and appreciate your comments.

[Jerome Tsang, DDS]

You're welcome!   Hope things turn out good.

[girlygirl77]

I thought i might have been out of the woods. I didn't have any ache today at all except starting close to 7pm! Now it has come and go two times (and it lasts a little over an hour when I have it).  So I'll have to ride it out.  I'm going to be out of the country for 2 weeks (work, then pleasure), so I hope it reduces. It's more annoying than paralyzing - but I hope it reduces over time.

Since the dentist drilled a little on the second visit, then I can only start counting my recovery from then (versus the first visit) right?

[Jerome Tsang, DDS]

Yes, I would assume so.  If he drilled in the deepest part near the nerve, then it can re-traumatize the nerve and cause it to become irritated.  If you'll be out of the country, you can have your dentist write you a prescription (or call in one) for some pain medications in case you have some pain while traveling.  If not, you should bring some ibuprofen along if its safe to take for you, as I'm not aware of your personal medical history, or any other pain medication you would normally take for a headache.

Also, it may help to just avoid anything that may irritate it.  Perhaps chewing on the other side, avoiding too many extreme temperatures such as hot or cold liquids, and maintaining good hygiene will help.

Have a great trip.  

[girlygirl77]

I returned from my trip.  The pain subsided and now is less intense but it still happens at some point during the day. I guess I'm glad it has lessened but is it strange that it still is there?  Hot and cold liquids do seem to bring it on for a little bit as well, so i'm keeping that side of my mouth less involved in chewing/eating/drinking.

[Jerome Tsang, DDS]

How severe is the sensitivity on a scale of 1-10?  What was it before?  10 being the worse pain.

Also, how many weeks has it been since the placement of the onlay?  If its been less than 6 weeks, I would say that with the symptoms improving, you're doing well.  You may want to bring it up at your next checkup.

[girlygirl77]

The onlay was 2 days before I posted here (~July 21st).  I would say it was a 5-6 on that scale earlier and now the pain is probably more like a 2-3.  

I hope it goes to 0;)

[Jerome Tsang, DDS]

Sounds like the pain has improved and its only been 4-5 weeks.  I would say 6 weeks is the cut off period and it definitely seems like you're going to be in the clear.  That doesn't necessarily mean that you may not need a root canal in the future but at least not in the immediate future.

There's no way to predict whether it'll last one month or four years.  Just cross your fingers.  Wish you the best.

[girlygirl77]

Thanks for your help and thoughts. Ok this weekend has been good. I have had 2 days of no pain (0).  So I am going to cross my fingers and I hope this lasts!

[Jerome Tsang, DDS]

Sounds great!  Glad things are working out.