Conservative dentistry
This question is more than six months old, so the information in the answer may no longer be accurate.
Visitor asks:
Hello,
Two months ago my dentist treated caries on a molar that had never caused me any problems. On the X-ray the caries did not look large, but after the procedure the dentist commented that it had been extensive and had reached almost to the nerve. He removed a lot of enamel and made a large filling. The invoice for the service states: I.K. (MTA), MO comp.pl..
For a month the tooth was extremely sensitive—to cold, heat, air, and sometimes it would suddenly hurt sharply for no apparent reason. Half of my head hurt—from the jaw to the top of my head—and I also had a burning sensation around the eye.
After three weeks the dentist checked the filling, said it was sealed, the tooth did not hurt on percussion (and still does not), checked vitality and says the nerve is still alive (he had to move the device around for some time before I felt a slight jolt). He advised me to wait another month or two and, if it does not settle down, he will remove the filling and devitalize the nerve.
The situation did slowly begin to settle, but a few days ago the problem returned. There is no longer sensitivity to temperature changes and the tooth does not hurt on percussion, but there is constant pain, which today again spread across my face to the cheek, ear and top of the head.
Do you think I should wait a little longer or see the dentist? Is devitalizing the nerve really the only option? Is there a way or substance that can simply calm and heal the pulp rather than destroy it?
Dentist Tomaž Rotar answers:
Dear Sir/Madam!
I myself would proceed in exactly the same way in the situation you describe. A tooth is irritated by every procedure. The degree of irritation depends mainly on the amount of work required to remove the carious tissue. The density of dentine (the size and density of the dentinal tubules) also determines the extent of the effect on the dental pulp. If the irritation is excessive, the pulp will respond with a pre-inflammatory condition (hyperemia), which clinically most often presents as hypersensitivity to certain stimuli (sharp sensitivity). If the tooth becomes sensitive to percussion, this means that the pre-inflammatory condition has changed into inflammation of the pulp (an irreversible condition), which requires its removal (root canal treatment). The pain you describe (across the face) seems to me more similar to an atypical facial pain (perhaps neuralgia), which I believe is not closely related to what is happening in the tooth itself.
Have a nice day!
I myself would proceed in exactly the same way in the situation you describe. A tooth is irritated by every procedure. The degree of irritation depends mainly on the amount of work required to remove the carious tissue. The density of dentine (the size and density of the dentinal tubules) also determines the extent of the effect on the dental pulp. If the irritation is excessive, the pulp will respond with a pre-inflammatory condition (hyperemia), which clinically most often presents as hypersensitivity to certain stimuli (sharp sensitivity). If the tooth becomes sensitive to percussion, this means that the pre-inflammatory condition has changed into inflammation of the pulp (an irreversible condition), which requires its removal (root canal treatment). The pain you describe (across the face) seems to me more similar to an atypical facial pain (perhaps neuralgia), which I believe is not closely related to what is happening in the tooth itself.
Have a nice day!
✦ This content was translated from the original with the assistance of an AI translation system.
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