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Pain After Broken Tooth Repair

User Level:
Patient
Posted by: pjbren  (3 years ago)
Hi Everyone,

There's a bit of history to this question: I had pain in a lower molar when chewing on certain foods for about 2 years. The pain became progressively worse, and I saw 2 dentists in attempt to find the cause. They guessed it could be a small crack in the tooth, but were unable to replicate the pain by doing various tests. The pain started to get quite a bit worse about 2 months ago. I saw an endodontist who was able to replicate the pain and determine which tooth had the crack (tooth #30). He recommended seeing my dentist and having either a full crown on onlay put on the tooth to hopefully fix the pain issue without need for a root canal. I made an appointment with my dentist, but my tooth broke while I was eating, just a few days before my appointment. Pretty amazing timing considering I'd had the crack for about 2 years! It wasn't a huge break, basically a part of a cusp fractured off. I saw the dentist the next day, and she said she could try to restore the broken area with a filling. We made an appointment for the next week.

While the tooth was broken, it was less sensitive to chew on, but if I touched inside the broken area, even with my tongue in the right spot, there was a very sensitive pain. The dentist had taken an x-ray and saw no decay or inflammation, but the fractured off area looked like it was pretty close to the pulp.

After having the (composite) filling placed last week, I am very discouraged to find that I again have regular pain when chewing food with that tooth, enough so to cause me to only chew on the other side of my mouth. It's not as severe of a sharp pain as before the cracked piece broke off, but it actually happens more easily (less force needs to be applied to cause the pain). The dentist said that the tooth would likely be sensitive for a month or more, but this seems like more than post-operative sensitivity. It's not actually sensitive to cold or hot at all, only the pressure. Even just pressing lightly on the filling area with my finger causes pain.

I guess my question is: what seems the most likely cause of this continued (but different) pain? Is there another hairline crack extending through part of the tooth (maybe a continuation of the crack that caused the cusp fracture, or a separate crack)? Is the composite filling pressing on a sensitive, thin layer of dentin above the nerve and transmitting pain when pressure is applied? Maybe the filling wasn't well placed?

It's seeming like a full crown is probably going to be needed to get this tooth to stop hurting during chewing. I was actually glad when the cusp broke off because I figured that was a good way for the crack to reveal itself, and that maybe a filling would be enough, but it seems like there is still a problem.

Thank you in advance for any input, similar experiences, or advice!

User Level:
Dentist
Hi Everyone,

There's a bit of history to this question: I had pain in a lower molar when chewing on certain foods for about 2 years. The pain became progressively worse, and I saw 2 dentists in attempt to find the cause. They guessed it could be a small crack in the tooth, but were unable to replicate the pain by doing various tests. The pain started to get quite a bit worse about 2 months ago. I saw an endodontist who was able to replicate the pain and determine which tooth had the crack (tooth #30). He recommended seeing my dentist and having either a full crown on onlay put on the tooth to hopefully fix the pain issue without need for a root canal. I made an appointment with my dentist, but my tooth broke while I was eating, just a few days before my appointment. Pretty amazing timing considering I'd had the crack for about 2 years! It wasn't a huge break, basically a part of a cusp fractured off. I saw the dentist the next day, and she said she could try to restore the broken area with a filling. We made an appointment for the next week.

While the tooth was broken, it was less sensitive to chew on, but if I touched inside the broken area, even with my tongue in the right spot, there was a very sensitive pain. The dentist had taken an x-ray and saw no decay or inflammation, but the fractured off area looked like it was pretty close to the pulp.

After having the (composite) filling placed last week, I am very discouraged to find that I again have regular pain when chewing food with that tooth, enough so to cause me to only chew on the other side of my mouth. It's not as severe of a sharp pain as before the cracked piece broke off, but it actually happens more easily (less force needs to be applied to cause the pain). The dentist said that the tooth would likely be sensitive for a month or more, but this seems like more than post-operative sensitivity. It's not actually sensitive to cold or hot at all, only the pressure. Even just pressing lightly on the filling area with my finger causes pain.

I guess my question is: what seems the most likely cause of this continued (but different) pain? Is there another hairline crack extending through part of the tooth (maybe a continuation of the crack that caused the cusp fracture, or a separate crack)? Is the composite filling pressing on a sensitive, thin layer of dentin above the nerve and transmitting pain when pressure is applied? Maybe the filling wasn't well placed?

It's seeming like a full crown is probably going to be needed to get this tooth to stop hurting during chewing. I was actually glad when the cusp broke off because I figured that was a good way for the crack to reveal itself, and that maybe a filling would be enough, but it seems like there is still a problem.

Thank you in advance for any input, similar experiences, or advice!



Big mistake I learned the hard way. When the problem is a fracture, NEVER just do a filling. The LEAST to do would be a gold onlay, which keeps the crack from opening.

What is happening is this. Either 1. The crack is opening under the filling when you bite down, or 2. The resin filling is leaking, which is quite common.

Best you can do is go back to the guy that placed the resin filling and tell him it did not work. Perhaps he will credit the cost of that against the cost of a crown he should have done to start with after the endodontist diagnosed the problem successfully.

Remember, porcelain crowns require a lot more reduction than metal partial coverage crowns. Ask your dentist if he still does gold onlays. If he doesn't find an older dentist who does. A lot of this esthetic stuff done today is just crap that doesn't work very well.
Posted 3 years ago
User Level:
Patient
Posted by: pjbren  (3 years ago)
Hi Dr. Henry,

Thank you very much for your reply. Since the tooth actually broke, isn't there a chance it is no longer actually cracked (the crack spread to the point of causing a piece of the cusp to fall off, and there may be no part of the crack remaining)? I think it is very possible that some part of the crack is still remaining (maybe it had branched, or the crack extends past the part of tooth that broke off). If there is no crack remaining, and the problem is a leaking filling, would it be worth trying to re-do the filling? I know that would involve further removal of tooth structure, structure that may be needed for an eventual crown. I have noticed a white line where the filling meets the tooth structure on the lingual side of the tooth. I have read that this can indicate a poorly bonded filling, but not necessarily.

If I do get a crown or onlay, I think I will go with gold. It seems to have many advantages. Would you think an onlay would be as effective as a full crown for treating cracked tooth pain?

Thanks for any further thoughts!
User Level:
Student
Posted by: AnnFair  (3 years ago)
Consult with a proper dentist..
User Level:
Dentist
I would recommend you to see a dentist soon. It is likely the tooth has become abscessed and needs to be treated. If the tooth is this badly damaged it will probably be extracted. Don't wait any longer. It will only get worse. Your dentist will take good care of you. Good luck!
Posted 3 years ago
User Level:
Dentist
Hi Dr. Henry,

Thank you very much for your reply. Since the tooth actually broke, isn't there a chance it is no longer actually cracked (the crack spread to the point of causing a piece of the cusp to fall off, and there may be no part of the crack remaining)? I think it is very possible that some part of the crack is still remaining (maybe it had branched, or the crack extends past the part of tooth that broke off). If there is no crack remaining, and the problem is a leaking filling, would it be worth trying to re-do the filling? I know that would involve further removal of tooth structure, structure that may be needed for an eventual crown. I have noticed a white line where the filling meets the tooth structure on the lingual side of the tooth. I have read that this can indicate a poorly bonded filling, but not necessarily.

If I do get a crown or onlay, I think I will go with gold. It seems to have many advantages. Would you think an onlay would be as effective as a full crown for treating cracked tooth pain?

Thanks for any further thoughts!


I do onlays all the time and they are just as effective at treating cracked teeth, and much more conservative.

Many time once the chunk of tooth breaks off, the pain on biting is replaced by merely cold sensitivity. If there is pain on biting, it indicates the crack is deeper, or possibly the pulp of the tooth is dead. It is a simple matter to test vitality on a cracked tooth. Just apply something cold to it like a frozen Q-tip. If sensitive to cold, the pulp is still alive and you will not need a root canal.
Posted 3 years ago
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