“About six months ago I went to the dentist and he did some kind of drilling. He put a [filling] behind my tooth in the front row on the bottom.   After getting the drilling done, I couldn’t eat or drink anything! It hurt so bad. A month later the pain was basically gone. It’s starting to come back again. But even worse[than before]. I don’t want to go through anything painful, (filling, etc,.) The tooth mostly hurts on the top and whenever I drink cold milk or hot coffee. Or eat something hot or cold. I am totally scared of the dentist. I have got a filling before, they numbed me and stuff, but it still hurt! I DON’T WANT TO GET ANOTHER ONE  HELP ME!”

Answer:

There are several reasons why dental drilling may be necessary. These include:

• Dental drilling to remove decay and then place a filling in that area
• Dental drilling to prepare a tooth or teeth for a cap (crown)
• Dental drilling to clean and fill the pulp if a tooth needs root canal therapy

The description you gave sounds like you received a front tooth filling. Sensitivity to cold sometimes indicates the beginning of tooth decay. There are two areas of a tooth that a dentist may have to go through when doing dental drilling, in order to treat your front tooth cavity. These are enamel (which is the outside area, what you see when you look at your teeth) and dentin (which is directly below the enamel). Dentin has holes in it and fluid which when disturbed carries pain sensations to the pulp (the center of the tooth that has nerves and blood vessels).

Reasons that you may have a tooth sensitive to cold include:

• A tooth with a cavity/decay. Decay that may go deep into dentin and be the cause of a tooth sensitive to cold
• Filling is close to the pulp. A filling that is placed in the area where the decay has been removed, if the decay was deep. This sometimes results in a tooth that is sensitive to cold, and may be prevented by placing a dental liner over the dentin before filling the tooth.

From the details of your question, your tooth pain that occurred after your filling may have been due to the fact that your front tooth cavity was deep and close to the pulp.

What is a Solution to Pain After a Filling?

Tooth pain after a filling is not at all uncommon, however prolonged pain may be an indication that a liner may have helped. A dental liner is a thin layer of material that a dentist places under the filling so that your tooth won’t be sensitive to temperature.  It insulates the nerve of the tooth and protects it.  It would be a good idea to get a new radiograph (x-ray) of the tooth to see if there are other issues, and have it addressed from there on.  Your dentist may choose to either re-do the filling, or if the decay is deep, perform a root canal.

Remember, don’t allow your dental fear to stop you from taking care of your oral health. No dental treatment should be painful.  If you feel any pain during a procedure, don’t hesitate to let your dentist know that you need more anesthesia.  We hope this helps you!

Question:

“I have two root canals one on my upper left and the other on my upper right.  I have experienced episodes of pain in both since having the procedures done ~5 yrs ago. The most recent episode was a continuous sort of throbbing pain that persisted for three days before I decided to go to my dentist.  Each time one of these pain episodes occur my dentist takes x-rays and pokes around but is unable to provide an explanation and prescribes antibiotics.  A few days after taking the antibiotics the pain has dulled and goes away.  I no longer feel that this is an effective method in dealing with a persistent problem.  Antibiotics are discontinuing the pain, antibiotics attack and eliminate bacteria, so bacteria are a likely culprit to causing the pain.  Is a pain causing but not so severe bacterial infection able to be seen in an x-ray?  Should I request that my dentist remove the crown for a more thorough examination or is episodes of pain treated by antibiotics a part of the territory of living with a root canal? Lastly, am I supposed to even feel anything being that the pulp tissue is removed?”

Answer:

To specifically address your question, if the problem is alleviated by antibiotics, that’s a sure sign that there is a bacterial re-contamination.  This can be caused by a number of reasons that are outlined in our older article, called Failed Root Canal.  However, it is not normal for you to be feeling pain 5 years after a root canal.  The purpose of a root canal is to completely remove the source of infection, thus removing the source of pain.  It sounds like there may have been a missed canal (lateral canal, or a small canal at the apex), or a leaky crown, but the bacteria has found some kind of way to reinvade and re-infect the area.  It may be best to visit an Endodontist to have him/her reassess your tooth.  The Endodontist specializes in only root canals and has the technology to more closely examine your tooth condition.  Below we have detailed information regarding root canals.

What is a Root Canal Treatment?

A root canal treatment (also called root canal therapy) is a procedure that is done in order to attempt to save a tooth, usually after it has become badly decayed or infected. If the affected tooth is not treated, the infection or decay will usually spread to the tissues surrounding the tooth, including the bone.

Does a root canal hurt?

In most cases, the procedure is not painful, though there may be some sensitivity afterwards. Most cases of discomfort are felt if there was pain before the procedure (it goes away as the tooth heals), or if there is any complication such as a missed canal. One of the wonderful things about a root canal treatment is that the source of the pain is removed, the canal(s) thoroughly cleaned and disinfected, and the canals filled to prevent re-invasion of bacteria. Many patients retain their root canal treated teeth for life.

It’s important to note too that in most cases where there is discomfort after, the source is not in the tooth itself but in the periodontal ligament (PDL) surrounding the tooth. The infection in the tooth often spreads to the PDL (and in some cases the bone), which by itself is the cause of much sensitivity and discomfort.

What to do after a root canal

The root canal procedure has a success rate ranging between 68-95%. It is a welcome procedure for patients who have the opportunity to try and save their tooth or teeth. After the procedure is completed, a few things to know and expect:

• If there was tooth pain or an infection before the procedure, you may have some sensitivity for a few days after. This is because the tooth is healing from the tooth inflammation that was present before. Your dentist will most likely prescribe NSAIDs for the pain and inflammation. Antibiotics are used to treat oral bacterial infections, in cases where a tooth or teeth may have developed an infection.
• Avoid chewing on the tooth being treated until a permanent crown is placed. This will help you to avoid damaging or re-contaminating the tooth.
• Ensure that you complete the procedure by having a crown (cap) placed over the tooth. This helps protect the tooth from being exposed again to bacteria, and provides structural support and protection for a tooth that is no longer as strong on its own.

Pain years after root canal

Though not very common, there can be root canal pain years later. Reasons for pain after a root canal procedure include:

• Tooth fracture.
• A failed dental restoration (usually a crown) that has allowed bacteria to invade the tooth, causing a re-infection.
• The material sealed inside the canal(s) break down, allowing bacteria to recontaminate the tooth.
• Missed canal – not all canals were located, cleansed, and sealed during the procedure

Failed root canal

After root canal pain, a dentist will re-examine the tooth including the crown to determine the condition of the tooth and what needs to be done. It is sometimes tricky to isolate the problem, but two common approaches to relieving the recurrence of inflammation and infection include:

• A root canal retreat. Re-treatment is sometimes successful, and involves thoroughly cleaning and refilling the canals.
• Endodontic surgery may be needed in other cases. The most common endodontic surgery used to attempt to treat this is an apicoectomy (also called root-end resection or root resection). Basically, the tip of the root and the infected tissue around the root tip are removed. A small filling may be placed at the root tip to seal the root canal.

In extreme circumstances, the tooth may be non-restorable and will need to be extracted. Comprehensive evaluation is necessary for diagnosis and treatment of each patient’s case. Depending on the extent of the infection, changes are sometimes seen on a dental radiograph (dental x-ray) that indicate the presence of an active infection.

We hope this information was helpful to you!

“What procedure is done to fix reversible pulpitis”

Answer:

Causes of Tooth Pain

Whether it’s on and off, lingering or thumping, tooth pain is really uncomfortable and sometimes makes it hard to do anything else while the pain persists. Tooth pain causes are outlined in the article. Brushing at least twice a day and flossing daily, along with regular dental visits, are sure ways to prevent tooth decay (cavities). The modified bass technique is an effective brushing technique.

What is Pulpitis?

Pulpitis is an inflammation of the dental pulp. It’s primarily caused by bacteria that enter the pulp. The bacterial infection itself begins with tooth decay. Pulpitis may also be caused by any other type of injury to the pulp. Symptoms of pulpitis range from very mild to very severe. There are two types, and the pulpal diagnosis of each differs based of factors explained below.

What is Reversible Pulpitis?

This means that the tooth inflammation can be reversed, and the tooth symptoms relieved. The tooth therefore has a chance to heal and recover. The inflammation is usually secondary to decay, but may also be due to pulpal injury. Reversible pulpitis symptoms include:

• Tooth discomfort from contact with anything cold or another stimulus.
• Tooth symptoms that are relieved when cold or other stimulus is removed.
• Symptoms that gradually get better.
• Usually the discomfort experienced can be relieved by over the counter pain medications.

Treatment for Reversible Pulpitis

If a tooth has caries (tooth decay) and symptoms of reversible pulpitis, a dentist will remove the decay and replace the lost tooth structure with a dental filling. This reversible pulpitis treatment is usually sufficient to reverse the process. The symptoms normally improve over time, gradually disappearing.

What is Irreversible Pulpitis?

When the pulp tissue (nerve of the tooth) is damaged beyond recovery, this is known as irreversible pulpitis. The pulp will eventually die, and if the tooth isn’t treated soon enough, a tooth abscess (tooth infection) may occur.

A tooth vitality test is often done to confirm a diagnosis of irreversible pulpitis. The usual treatment of irreversible pulpitis is a root canal therapy. This is necessary in order to save the tooth. Irreversible pulpitis symptoms include:

• Spontaneous pain (pain that arises without any provocation). Tooth pain that wakes you up in the middle of the night is usually a sure sign of irreversible pulpitis.
• If the pain is brought on by a stimulus, it usually lingers even after the stimulus is removed.
• The symptoms generally get worse.
• Root canal treatment is usually necessary to treat the problem.

We hope that you found this information helpful!

“For about two months, been having terrible teeth pain, lower and upper left side.  Ringing and pressure in ears, along with awful headaches.  [I am] going to a second dentist tomorrow [for an opinion], with lots of dizziness.   My lips are inflamed as well as the inside of my mouth.  I have drainage in the back of my throat.  My sinuses are too clear and it hurts when I breathe through my nose.  Does anyone know what this could be?  I am suffering badly.  Thank you.”

Answer:

There are several common causes for tooth pain. Please refer to posted article. Another less well known cause is what is called referred pain. This basically means that the tooth pain may not actually come from the tooth in question, instead it is carried over (or referred) from another tooth or another area in the body (i.e. ear infection).

Causes of Referred Pain

Reasons a tooth may ache due to referred pain include:

• A tooth infection (such as a tooth abscess) that travels to another tooth/teeth
• Referred tooth pain from an ear infection
• Referred tooth pain from heart attack
• Referred tooth pain from trigeminal neuralgia, a condition where there is pain in trigeminal (facial) nerves that supply sensation to teeth.
• Referred tooth pain from a sinus inflammation or infection.

Maxillary Sinus Infection (Sinutitis)

The maxillary sinuses are located in the upper jaw and behind the cheekbones. A sinus infection can be the cause of severe headaches, discomfort or pressure in or below the (eyes), pain in the ears, and upper facial pain. This type of infection affects teeth because of how close teeth in the upper jaw are to the sinuses. Causes of maxillary sinus infection include:

• An allergen (a substance or particles that you are allergic to)
• A ‘bug’ (some kind of virus, bacteria or fungus)
• An oral infection that has travelled to the maxillary sinus

Even small oral infections (for example a tooth cavity or a small tooth abscess) can lead to a maxillary sinus infection.

Symptoms of sinus infection

Symptoms of a sinus infection include:

• Sinus headache
• Facial pain
• Toothache- this is the most common cause of referred pain in a tooth or teeth
• Cough

It is very important to have a full evaluation and proper diagnosis by a dentist to determine if any oral condition is the cause, or if they can be ruled out, and what treatment is necessary. Good luck with your search for dentists.  We are sure this information can help guide you and your health care provider along the right course towards a proper diagnosis.

We hope that this information was useful to you!

If you are interested in submitting a question with us, send it here!

About six months ago I went to the dentist and he did some kind of drilling.  After getting the drilling done, I couldn’t eat or drink anything! It hurt so bad. A month later the pain was basically gone.  It’s starting to come back again. But even worse. I don’t want to go threw anything painful, (filling, etc,.) I really hope this isn’t anything bad because the tooth mostly hurts on the top and whenever I drink cold milk or hot coffee. Or eat something hot or cold. I am totally scared of the dentist. I have got a filling before, they numbed me and stuff, but it still hurt! I DON’T WANT TO GET ANOTHER ONE  HELP ME!

Answer:

Reasons for a Filling or Crown

There are several reasons why dental drilling may be necessary. These include:

• Dental drilling to remove decay and then place a filling in that area
• Dental drilling to prepare a tooth or teeth for a cap (crown)
• Dental drilling to clean and fill the pulp if a tooth or teeth need root canal therapy

The description you gave sounds like a front tooth cavity. Sensitivity to cold sometimes indicates the beginning of tooth decay. There are two areas of a tooth that a dentist may have to go through when doing dental drilling in order to treat your front tooth cavity.

These are:

• Enamel -  which is the outside area, what you see when you look at your teeth
• Dentin – located directly below the enamel.  Dentin has holes in it with fluid located inside.  When this fluid is disturbed, it carries pain sensations to the pulp (the center of the tooth that has nerves and blood vessels).  This is what happens when teeth ache (or a single pain in tooth).

Tooth Sensitivity

Reasons that you may have a tooth sensitive to cold include:

• A tooth with a cavity/decay. The decay may go deep into the dentin and be the cause of your tooth sensitivity (caries/decay is usually the main culprit when teeth ache).

• A filling that has been placed in an area of deep decay.  If the amount of caries is extensive, the drilling necessary may be more than if there were less caries. This sometimes results in a tooth that is sensitive to cold, and may be prevented by having your dentist place a dental liner over the dentin before filling the tooth.

From the details of your question, your tooth pain that occurred after your filling may have been due to the fact that your front tooth cavity was deep and close to the pulp. Tooth pain after a filling is not at all uncommon, however prolonged tooth pain may be an indication that a liner may have helped. It would be a good idea to get a new radiograph (x-ray) of the tooth to see if there are other issues, and have it addressed from that point.

Also, do not hesitate to let your dentist know if the filling hurts during the procedure.  You should be completely anesthetized and should not feel anything.  You run the show, and you can stop if necessary.

Remember, don’t allow your dental fear to stop you from taking care of your oral health.

We hope this helps you!

I just had my wisdom teeth removed earlier, but I misplaced my post-op instructions.  What do I need to do after a wisdom tooth removal?

Answer:

Thanks for writing in.  There are definitely some key steps that you need to take after extraction of your wisdom teeth.  Be sure to follow these instructions carefully.  Failure to do so could result in dry socket, infection, delayed healing, or even severe pain.

Post Wisdom Tooth Extraction Instructions

These instructions should be followed immediately (up to 24 hours) after the surgery.

Let’s take a look at immediate post-op instructions:

• Continue to bite down and exert pressure on the gauze (cotton squares).  This will slow the bleeding and help to form a blood clot.  If the gauze becomes saturated with blood, change it out with a new set.  The dentist will give you extra gauze to take with you in order to change as needed.  Change as often in necessary.
• DO NOT SPIT OR RINSE up to 24 hours after the surgery.  This is crucial.  Spitting or rinsing may cause you to dislodge the blood clot and delay the healing process.
• Lightly brush your teeth later on.  However, when you use the water to clean your teeth, let if drip out of your mouth, do not spit or force it out.
• Take any pain medications or antibiotics as prescribed by the dentist.
• DO NOT suck on a straw.  If you drink, only drink out of a glass or cup.  Again, this negative pressure in the mouth could possibly cause dry socket.
• Relax and don’t exert too much pressure or talk too much.  You just had a surgery so allow your body to relax.
• Do not deprive yourself of food.  However, consume a high calorie, high protein meal so that you do not need to eat as often.  Only eat soft or liquefied foods directly after the surgery.
• If you continue to have SEVERE pain and discomfort days after the surgery, return to your dentist for reevaluation.

Just remember to take it easy and light for the remainder of the day and to get plenty of rest.

Good luck,

SaveMySmile Team

Hi, I have been experiencing some weird tooth pain.  It comes as quickly as it goes and does not seem to last long( a few seconds) and has happened three times in the last 2 days.  It is not a throb pain, more a constant pain if that makes sense.  It feels like someone is touching ice cream to my tooth in the whole tooth but 10x worse, and is one of the worst pains I have ever experienced.  I am going to the dentist, I am just curious on your opinions.  Had a cavity filled in the tooth a couple months ago so not too sure why it would hurt all a sudden.  Thanks in advance.

Answer:

Thanks for submitting your question with us.  Now, the main piece of information that will determine the diagnosis of your tooth is:

Is the Pain provoked?

• Does the pain have a trigger point?  For instance, is it painful when you eat hot or cold food or drinks.
• Does the pain occur sporadically and unprovoked?  Does the pain come and goes as it pleases with no trigger point?  For example, the tooth becomes painful randomly throughout the day.
• Does the pain come when you bite down into food?  Or does the pain come when you open your mouth after biting down on food?

You’re probably wondering, why all the questions?  But believe it or not, answers to these simple questions can guide us down the right path to a correct diagnosis.  Let’s examine each answer:

Yes, the pain is provoked by eating cold/hot food or drink.

Then you have reversible pulpitis.  This means that you have slight inflammation of your pulp inside of your tooth.  This is caused by

• Bacteria/decay
• A recent deep filling without a protective base (Deep restorations need a protective layer underneath it to protect the tooth nerve/pulp)
• Recent deep cleaning

Reversible Pulpitis Treatment

Luckily, this can be easily treated by making a slight adjustment to the filling

No, the pain is not provoked by anything and occurs on its own

You may have irreversible pulpitis.  This means the pulp is damaged beyond repair.  This means that bacteria have leaked into your tooth nerve/pulp and are now irritating the tooth and needs to be removed to avoid serious infection.  Some signs of irreversible pulpitis include:

• Spontaneous, unprovoked pain
• On and off pain
• Continuous pain
• Pain lasts even after food/drink/or stimulus is removed
• Lying down or bending over produces pain

Irreversible Pulpitis Treatment

The treatment for irreversible pulpitis is a root canal treatment.

I feel pain when I bite down

Again, this indicates reversible pulpitis and can be treated by adjusting your filling.

I have pain when I open up after biting down

This indicates a fracture of the tooth.

Fractured Tooth Treatment

Treatment for this depends upon the extent of the fracture and can include anything from a new filling, or a root canal, or even an extraction.

For more information on tooth pain, check out our article here.

Also, see below for a descriptive chart of how to diagnose tooth pain.

We hope this helps and good luck,

Save My Smile Team

I had a root canal done and it abscessed. I haven’t got it finished all the way yet. Can I safely pull the tooth, and be done with it.

Answer:

Now before you think about pulling the tooth, let’s think about some other factors that will come into play down the road.  Once that tooth is gone, the tooth behind it and the tooth across from it (in the opposite jaw) will begin to slowly drift into the open space.  This will cause the other teeth to drift also, resulting in open spaces amongst your teeth.  You will eventually have to replace the space with either a bridge, implant, or partial denture which are all pretty costly.

Root canal procedures don’t have a 100% success rate, sometimes they do fail.  However, retreatment is always an option and definitely cheaper as compared to some of your other options.  Being that your procedure wasn’t finished, the pathway for bacteria wasn’t completely blocked meaning it had an opportunity to repopulate or wasn’t completely removed.

If would be best, in the long run, if you were to return to have the procedure completed or retreated.  Yea, it may be cheaper and easier to pull the tooth now, but believe us, you may regret this decision down the road.

Good luck with your decision,

SaveMySmile Team

After a tooth is pulled out (extraction) from the bone, a blood clot typically forms.  As with any other scar on the body, the blood clot is the first step to healing and serves as a framework for the replacement tissue (bone, etc).  But sometimes, this blood clot can be removed too early!  This condition, called alveolar osteitis, significantly delays healing and be an uncomfortable and painful condition.

Dry socket occurs in about 1-3% of extractions and 25-30% of surgical extractions (used if you had an impacted tooth).

Signs of Dry Socket

Most symptoms for dry socket occur a couple of days after the extraction and can last for up to 40 days if not treated.

Symptoms include:

• Severe pain in the area of the extraction
• Dull, aching pain that radiates to the ear
• Swelling around the tissues in the area
• Foul mouth odor (bad breath)
• Foul taste
• Swollen lymph nodes (only happens occasionally)

Causes of Dry Socket

• Most often unpredictable and not related to a specific cause
• Excessive trauma during the extraction
• Patients on birth control have a higher chance of dry socket
  • If you are on birth control, it’s best to have an extraction performed between days 23 to 28 of your menstrual cycle (days without estrogen supplementation)
• Smoking
• A history of dry socket in the past
• Not following the post-op instructions given to you by the dentist/staff

Treatment for Dry Socket

• Return to the dentist as soon as you experience this pain.  The following steps will be taken:
• The socket will be rinsed out to remove extra debris
• The dentist will insert medicated gauze into the opening.  The medicated gauze contains:
  • Eugenol
  • Topical anesthetic
• You will be advised to change the gauze every 24 hours for the next 3 days.
• Then change the gauze every 2-3 days until the clot forms and you do not experience anymore pain

Have more questions?  Feel free to leave a commit or submit a question to be included in our FAQ’s.

My tooth hurts whenever I eat hot or cold food or drinks.  If feels like a sharp pain, then it goes away.  What does this mean?

Answer:

This is a sure sign of a condition called reversible pulpitis.

What is Reversible Pulpitis

Reversible pulpitis essentially means that the nerve is starting to feel irritated, however it’s still fairly early and the sensation can easily be reversed by a dentist.

Exposed Dentin Causes Pain

The feeling that you are experiencing is caused by exposed dentin.  Remember that dentin is normally covered by enamel (see article on tooth anatomy), if for some reason a portion of dentin is left uncovered, you will usually feel sensations of short, sharp pain when exposed to hot or cold substances.  Exposed dentin can be caused by a cavity, a defective filling/restoration, or recent dental work.

Reversible Pulpitis Solution

The good news is that this problem can be fixed easily, the dentin just needs to be covered.  Your dentist will be able to give you a filling, simply fix your existing filling, or a pulp cap if necessary.  However, don’t wait too long.  Reversible pulpitis, if left untreated, can turn into irreversible pulpitis.  Unfortunately, irreversible pulpitis can only be treated with root canal therapy, which costs a lot more in the end.  So be sure to act now by visiting your dentist.

Good luck!