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Tooth is sensitive

About over a year ago I had what my doctor called a "small" cavity filled on my back upper left tooth because I was feeling sensitivity. For months I had pain and had sensitivity to cold and hot but then went away for about 6 months. Fast forward to the present and my tooth hurts when I eat or drink hot or cold, the tooth is sensitive when I tap on it, the pain does linger but isn't constant. Do I need a root canal? I am missing a bit of gum around the tooth. Could it be exposed dentin?
Poster
  • 30 years old
  • Complaint duration: 5 days
  • Medications: hydrocortisone suppositories
  • Conditions: colonoscopy 2 years ago

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Featured Answer

2 UpVoted this answer Rick Liftig, DMD, F.A.G.D. Dentist, West Hartford
Hi. If you're using sensitive toothpaste and it's working, then it's likely a receded gums issue (thanks for the great side picture. If the filling is breaking down, it can also be leading to some sensitivity. As others have mentioned, please visit your dentist of choice to do some testing for which part of the tooth is the problem. At your age (although age is not always relevant) you should really not have too much recession damage. Are you grinding? Overaggressive with brushing? Had previous orthodontic work? Have sleep issues? An overall solution can be attained to help reduce further gum and tooth problems; to achieve a long lasting solution. All the best!
2 UpVoted this answer Vasant Ramlaggan, D.D.S., H.B.Sc. Dentist, Toronto
The answer is "maybe, maybe and maybe."

Tooth aches are funny things. They can fool you, but when you have one, you know it. A real toothache will wake you out of a dead sleep. There will be referred pain to other parts of the jaw. When you tap on it, it's not just sensitive, but you jump. And when something really cold hits the tooth, you say, "yeow!"

So there are other possibilities here: grinding and clenching frequently contributes to these symptoms (have you been sleeping well? Do you have a lot of big stuff happening in your life right now? Also, allergies and sinus issues can be a contributor (the tooth roots reside in the floor of your sinuses). If you really want to worry, you could have a cracked tooth and need the tooth extracted! But that is unlikely.

Give your dentist a call, of course. My guess, considering your age and the duration of the problem is that this is garden variety sensitivity, but as always, it can't be diagnosed over the Internet.

Hope you have a happy holiday.

Best,

Dr. Rick Liftig
1 UpVoted this answer Vasant Ramlaggan, D.D.S., H.B.Sc. Dentist, Toronto
Teeth like this one can be tough to diagnose. Your dentist should take an x-ray and some gum measurements around the tooth to get a better assessment of what is going on. Being able to reproduce the symptoms in the office exactly as you are experiencing them will help a great deal in getting to the bottom of the problem. You should visit your dentist and discuss the possibilities.
Franz Weyandt
1 UpVoted this answer David J. Darab, DDS, MS Oral and Maxillofacial Surgeon, Hickory
If the tooth is painful upon tab or bite, it could be infection and would need root canal. Worse case scenario is fractured root which the tooth needs to come out. Also there is a possibility if perio problem meaning bone loss which could be caused by smoking and/or not getting regular cleaning which could create all the symptoms you described. X-Ray and clinical examination will determine the problem. Good luck.
Payam Haghighi
The sensitivity could be because of a note issue or the small cavity you had repaired was close to the nerve. Sensitivity to both hot and cold is usually indicative of a root canal problem. Have an endodontist evaluate this situation for you.
James A. Vito
There is a possibility that after the filling was placed, the filling was "high" (your occlusion or bite could be off). Over time of constant biting, the tooth can become "bruised" causing pain in the tooth. Over time this will cause the ligament around the tooth to become inflamed. It can actually kill the nerve over time due to trauma. A root canal could be needed. The symptoms that you are having at the present time all lead to root canal treatment. I would recommend adjusting your bite, having an endo consult, and a X-ray. All of these diagnostic tools will help lead the dentist and the patient to a true diagnosis of the tooth.
The nerve could have been irreversibly inflamed and a root canal could be indicated. The only way to know for sure is to properly test the vitality of the nerve. This can be done at your dentist or an endodontic specialist. Other possibilities could relate to the filling or the self-described exposed root. Have the tooth looked at and they will make a differential diagnosis that will tell you for sure. Good luck.
Went to uncle who is a general DDS. He was perplexed why I had symptoms and why they weren't getting better. He asked if I wanted to change the filling to a temp with medicine in it and adjust the contact. I said yes because at this point what did I have to loose. Well while he opened up the tooth he found little extra decay, no biggie. He then proceeded and doubled checked if all the decay was gone. On the the second glance he noticed one of nerves was exposed. He then started an emergency RCT. While he started the RCT he said that he knew my dentist must have nicked the root because there was no blood or signs of vitality while the other two roots had blood and vitality. This would explain the sensitivity on the outer part of my tooth and how I experienced partial symptoms.
Poster
Finally got some resolution to this issue. Went to my uncle (general DDS) He was perplexed because when he looked at the filling it seemed fine and the xray had the filling in a safe distance from the nerve. He suggested he redo the filling with a temp with active medicine and check the bite. While doing the filling he noticed some extra decay which he took care of and then noticed that my dentist had nicked the root of the nerve closest to the outside. This would explain the extreme sensitivity on the outer part of the tooth and no pain when biting. My uncle decided to start the RCT and he explained that he could tell my dentist nicked the nerve 8 months ago because the verve was exposed and usually when root is exposed there is blood but this one had zero blood but the others had healthy amounts of blood and vitality. Had part one done and the second half will be in a week. He prescribed me antibiotics and painkillers. With this being said a RCT was defiantly needed Just scary how an xray missed this and how it took someone to open up the tooth to full diagnose and fix (hopefully)
Poster
The most common cause of hypersensitivity to temperature coupled with tenderness to pressure is occlusal (BITE) trauma. You are already wearing a night guard but these wear out their protection over time. Overstressing the teeth can cause the teeth to rock back and forth in the bone and this can cause the bone and gums to recede causing exposure of dentine which has nerve endings in it. This exposure may be the source of your temperature sensitivity. Your dentist should be able to tell you whether it is a failing filling or abscessed tooth that will require more extensive treatment. In all probability a simple bite adjustment or adjustment of your night guard and some simple desensitizing procedures is all that might be required. You must however, see a dentist to eliminate the more serious possibilities.