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I have a question. I had a deep filing, and the doctor said…

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I have a question...

I have a question. I had a deep filing, and the doctor said I might feel some sensitivity. That was like three months ago. One week ago, I was eating cabbage and I felt something. Since that day my molar seems to hurt, and be a little sensitive but only to cold air. Cold or hot water does not trigger a response. If I bite it does not hurt unless is something hard. If I touch it with tongue I do not feel anything. I feel some numbness in the lower part of my jaw, but this has been present for more than three months. What this might be?

Doctor's Assistant: Do you have a fever? Do you have any other existing medical conditions?

No

Doctor's Assistant: Anything else in your medical history you think the dentist should know?

I feel some pressure usually on my cheeks and behind my eyes.

Submitted: 7 months ago.Category: Dental
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Answered in 10 minutes by:
11/29/2017
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago
Beth Dorian
Beth Dorian, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 22
Experience: DMD/Owner at Platteville Family Dentistry
Verified

Hello! I'm sorry to hear about the pain you're having. What we often are trying to figure out in cases like these is whether you have "Reversible Pulpitis" or "Irreversible Pulpitis"

Your pulp could be inflamed due to the recent dental work, and the inflammation could resolve and your pulp could bounce back. OR, your pulp could be in the process of dying. Or, your pulp could have some level of infection. Those things are hard to determine unless you have clear cut signs or symptoms.

A "sign" of infection ("sign" = detectable by an outside observer): is a dark spot at the tip of the root that we can see on an x-ray. That's a sure sign that your tooth is infected and needs a root canal. (I'll attach an x-ray that shows an example).

But, usually we don't get such diagnostic certainty. So, instead, we have to rely on your description of symptoms to distinguish between "reversible" and "irreversible pulpitis".

Typical symptoms of "Reversible pulpitis" are the symptoms that you're describing. The pain can be triggered by a stimulus of some sort (cold air, chewing hard things), but the pain immediately subsides after the trigger. Those are the typical attributes of "Reversible pulpitis."

Typical symptoms of "Irreversible pulpitis" are spontaneous throbbing pain. (you're just sitting around doing nothing, and the tooth is hurting). And the pain is at a high enough level to keep you awake at night. OR, Irreversible pulpitis can be triggered by a stimulus. But, when it is, the pain doesn't subside right away. Instead 30 seconds after the stimulus (like chewing or cold) you're still feeling the pain.

But these pain attributes are not always so cut and dry. Sometimes the pain can start out more like reversible pulpitis, but then go down hill and start to be more like irreversible pulpitis. But, nothing you're describing so far sounds like "irreversible pulpitis." (An irreversible pulpitis diagnosis would mean that you'd have to get a root canal). But, since the filling was deep, it could happen.

I'm not sure about the numbness in the lower part of your jaw. Something might be inflamed and compressing the sensory nerve? I would be evaluated by an oral surgeon to see what's going on there.

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Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago

Sorry, meant to introduce myself! Dr. Beth Dorian here. :) I just get right to business!

And, I meant to attach the example of the dark spot at the tip of the root that we look for (which would give us diagnostic certainty that your pulp is infected). Again, the absence of this dark spot does NOT necessarily mean that your tooth is NOT infected.

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Customer reply replied 7 months ago
your suggestion is going to the dentist to check this. When I should worry about? What symptoms are indicative of a complication?
And you don't believe the numbness is related to the toothache. Could it be related to a wisdom teeth? I'm 30, and I haven't had the bottom wisdom teeth extracted. The numbness is on the lower part of the jaw, and a little bit on the ears and temple.
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago

I wouldn't go to the dentist about the molar that was filled YET because you're not showing signs of "irreversible pulpitis." If you do (the pain symptoms I described that are more like irreversible pulpitis - spontaneous or lingering pain) then I'd go about that molar.

The numbness, on the other hand is not a symptom typically associated with pulpitis. So, that could be from something completely different. Sometimes there can be a complication from the local anesthetic that causes lingering anesthesia, but you said it had been going on prior to your dental work, so that's not it. The wisdom teeth probably aren't it either. Does one side of your jaw feel more numb than the other?

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Customer reply replied 7 months ago
Okay. How long can take for a deep filling to be completely okay, or are there fillings that never reach that point?Yes. It's on the left side of my face. It feels like ants are walking on my skin. It's not painful at all, it just worries me.
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago

Well, sometimes even with reversible pulpitis, it can take a long time (many months, a year) before the stimulus triggered pain calms down. Or, it could be a few weeks. I wish pulps behaved more consistently! The key is, if the pain gets worse, or if it is bad enough as is, that your quality of life is negatively affected, then a root canal would likely be needed.

One other possibility that I forgot to mention before is to have your bite checked. Sometimes if a tooth is hitting just a little heavy, that could cause pain as well. So, it might be worth a trip to your dentist to check for that.

The ants walking on your skin sensation should be evaluated. But don't worry! Most of this stuff turns out to be nothing major. I'll see what I can find as to some of the possible causes and get back to you.

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Customer reply replied 7 months ago
Thanks. One more question, could you please explain me the anesthesia thing? Because now I'm not sure if it was after or before the filling, but I remember to have my face somewhat swollen for more than a week. At the time I remember I thought maybe I was allergic to the anhestetic.
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago

If a tooth infection was causing the numbness, that infection would have to be pretty significant (and you're not describing the symptoms of that). That's why I didn't think that was related.

However, again, it could be related to a heavy bite. It was a big shock to me (when I was a new dentist) how incredibly painful a high bite can be. Especially if you grind your teeth at night. That could cause inflammation.

Regarding post operative anesthesia complications - yes, it definitely happens from time to time that after you are numbed for dental work you can have lingering "paresthesia" afterwards.

https://www.animated-teeth.com/wisdom_teeth/t7-wisdom-tooth-paresthesia.htm

The good news is that if you have paresthesia from the dental injection, it will almost always resolve (eventually!) Have you noticed any changes over the past 3 months? I also never use the anesthetic called "Septocaine" when I'm numbing lower teeth because it has a bad reputation for causing that sort of thing. Not sure if your dentist used that.

I'm changing my mind about seeing your dentist. :) You might want to get your bite checked. And, while you're there they'll probably get an x-ray just to see if they see that dark spot I described earlier. But, based on the symptoms you've described (regarding your tooth only) it's not behaving like irreversible pulpitis. (at least not yet!)

Yeah, it would be really good to know if the tingling pre-dates the dental work, or only developed after the work. If it's the latter, there's a good chance it's related to the injection.

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Customer reply replied 7 months ago
Okay. Thank you very much. I already schedule an appointment to check my bite. I really appreciate your time. I will wait longer for the numbness because it goes and comes. And I´ll be monitoring if there are changes in my tooth. Thanks again.
Dentist: Beth Dorian, Dentist (DDS or equivalent) replied 7 months ago

My pleasure. Feel free to respond again if you have any more thoughts or questions. I'll do what I can! :)

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