“I have had some problems with some previous dental work…
“I had a filling done a few months ago and everything was fine and then I started to get some sensitivity to hot/cold and now it’s a bit tender to bite on. I went back to the dentist and they tried me on a special toothpaste and that didn’t help.
Why is this happening when the filling is only 4 months old? Should I go back to the same dentist for this or should I get a second opinion?”
– Question from Peter from Murrumba Downs in Brisbane
Dr Darryl Marsh replies:
Like all medical procedures when problems crop up following a dental procedure there is not always a clear answer. Things could be a bit more complicated than they first appear.
The biological cost of any medical or dental treatment
With any dental or medical procedure there is a biological cost, regardless of whether it is a tooth, an arm or a heart. When you repair a tooth it will never be as perfect as a completely ‘untouched’ tooth.
In this instance, the decay and the bacteria that caused the decay have produced toxins and poisons that that can weaken the vitality of the nerve. Therefore when you introduce daily ‘wear and tear’ on any tooth, such as chewing, biting etc, this can combine with: decay, stress-cracks, the filling or other habits like grinding. It is that cumulative effect that can result in pain, abscessing or further problems with that tooth.
People often think that once they have a filling in a tooth, then everything is perfectly strong forever and this couldn’t be further from the truth.
What should you do with a reoccurring dental problem?
I would recommend going back and seeing the original dentist that you saw, if you are comfortable doing so. It is always good to give them the benefit of the doubt. They also have notes and records on the original problem.
For instance we take photos, to show our patients and for our own records. In situations like this these photos can be useful to see whether there were small cracks that we chose to keep an eye on, and that these have now become larger cracks and the source of the current problems.
If you find that you are not entirely sure about the reasoning given to you by your dentist then it is worth seeking one or more second opinions from other dentists. We often do this for new patients.
Should I go and see a different dentist?
The problems you are experiencing may not be down to the actions of the dentist you saw and in the first instance it is worth getting the original practitioner the opportunity to assess and rectify.
Every dentist that I know is well meaning and wants to do their best by their patients. They deserve the opportunity to take a look at the problem and talk to you about what went wrong and why.
Questions to ask when seeking a second opinion from a dentist
If you are seeking a second dental opinion I would ask seek that dentist their opinion as to why the new problem has arisen, whether they thought that was a common thing to happen and the recommended course of action.
It is also worth checking what you personally can be doing to prevent this happening to other teeth. If this sounds consistent with what your own dentist is saying then you can be comfortable with your own dentist’s prognosis.
Looking after your teeth in the long term: my very best recommendation
If you have problems with your teeth go and see your dentist at the earliest opportunity as this minimises the ‘cumulative effect’ and the possible repercussions this means for your teeth down the track.
I seen numerous statistics quoted that say that it is anywhere between 8-20 times more cost-effective to have regular check-ups with your dentist than solving problems when they arise.
When dealing with decay if it has gone close to the nerve, the dentist can do their best to clear that out but there is always a chance that the decay has gone to the nerve. That is something that only time will tell – the tooth may be fine for some time and then suddenly flare up.
This is always a chance for any patient and even happens to our patients. For example, I put a crown on one patient 4 years ago and then the tooth became sore and abscessed. In this case it had little to do with the quality of the crown and everything to do with the previous 20 year history of dental disease and the required treatment on that tooth.
Is there a ‘safe time’, after a dental treatment when it can be declared a success?
For instance you have small fillings in big teeth that can last a decade or you’ve got big fillings in small teeth that can last a couple of years, because what gives way in most cases is not the filling – it’s the tooth! It is dependent on so many factors such as lifestyle, habits, dental history etc.
The bottom line is to find and regularly visit a dentist that you know you can trust and rely upon their advice and opinions.