Monthly Archives: May 2019

Pain After a Filling

Wed, May 22, 2019 No Comments by admin

Sometimes your tooth can be sensitive after a filling, even if it was not painful before it was filled. This can be upsetting to the patient and to the dentist. Pain can be a complicated topic. I have seen huge cavities, where the nerve is still alive, but they do not hurt. Sometimes even the smallest areas of decay are sensitive. Cavities, however, need to be filled when decay has penetrated the enamel, whether they hurt or not.

Enamel is usually 1 to 1.5mm thick. Under the enamel is the dentin. Dentin is hard and similar to bone, and it is porous. In each pore, there is a very small amount of live tissue which brings pain sensations down to the nerve. If the dentist is removing decay laden with bacteria, the dentin is already infected with bacteria. The tissue in these pores is damaged, both by the bacteria and the drilling. The deeper the decay and the more drilling that is needed, the more damage there is to the dentin. This damage to the dentin can cause pain and inflammation in the nerve, called a pulpitis.

“Desensitizers” and healing coatings are applied under the filling to kill bacteria and to help calm the inflamed nerve. These applications usually work pretty well. However, like anything in health care, you do not know for sure what the outcome will be. Sometimes the new filling will be sensitive for a while, and then the nerve recovers. Sometimes bacteria have traveled far enough down the dentin pores to infect the nerve. This becomes an abscess, and it can occur even months later. The deeper the decay, the more likely the nerve will become abscessed, even after the decay has been removed and the filling placed. Obviously, the sooner decay and bacteria are removed, the better! 

Preparing for an Extraction

Wed, May 15, 2019 No Comments by admin

What Should You Know Before Coming In?

At first, the idea of an extraction is usually negative. Most of us hope to keep our teeth for a lifetime. However, if you have ever had a severe toothache, the idea of removing that tooth can sound pretty good. Even a healthy tooth can break or split in such a manner that extraction is the only option. If you and your dentist decide that extraction is the best option, what can you expect?

Probably the most important thing is to be thoroughly numb. Most people hate getting a shot. This is especially true when you are already in pain and nervous about the procedure. But when you are totally numb, it’s worth it!

An upper tooth usually gets numb fairly easily. The shots do not hurt much, and they work quickly. But, if the area is swollen from infection, you will have to wait several days and take antibiotics to reduce the swelling (so the anesthetic will work). If a swollen upper tooth needs to come out immediately, you would need to be put to sleep.

A swollen lower tooth can usually be taken out without waiting for antibiotics to work. The shot is given in the back corner of the mouth away from the swelling, allowing the anesthetic to work. However, a lower molar is often resistant to becoming totally numb from one shot, swollen or not. Small supplemental shots around the gum line usually ensure that a lower molar is totally numb.

What Happens During the Extraction?

The extraction itself does require some pressure on the tooth, but no pain. First the tooth is loosened by using an instrument called an elevator. The elevator is slipped between the teeth, and it is used to rock the tooth to be extracted. This actually expands the bone in the socket to loosen the grip that it has on the roots. Then forceps are used to apply pressure in the direction needed to guide the tooth out of the socket. Some teeth have several divergent or curved roots, These need to be separated by drilling between the roots, and then each single root can be removed much more easily.

What Happens Afterward?

After the procedure, a pain tablet is often prescribed and possibly an antibiotic. You are given written instructions, my cell number, and extra gauze in case some bleeding starts again later.

Have someone drive you home, relax, and put an ice bag on the area where the tooth was extracted. You should also eat soft food away from the socket. Do not smoke, drink from a straw, or drink hot or carbonated beverages. If you need to rinse your mouth, do so very gently. The following day, rinse thoroughly after eating to remove food particles from the socket.

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Dry Socket: What is it, and how to avoid it.

Wed, May 8, 2019 No Comments by admin

What is a Dry Socket?

A dry socket is a very painful post extraction occurrence. It is called a dry socket because the normal blood clot has dissolved from bacteria, and the bone in the socket is exposed. An extraction usually stops hurting in about 3 days, and then gets better and better. However, if you develop a dry socket, any time from the third until even the fourteenth day, the socket begins to hurt badly. There is always a bad taste and odor after any extraction, but with a dry socket, it is worse. 

How Do You Fix a Dry Socket?

The treatment is for the dentist to carefully clean the socket and pack it with a pain relieving paste daily until the pain abates ( it usually takes four to seven days). Obviously, you do not want a dry socket!

What causes a dry socket?

There are several potential factors which have been observed, that increase the chances of a dry socket.

  1. The socket is in the lower jaw. (the lower jaw has more dry sockets than the upper jaw because of less circulation)
  2. The more difficult the extraction
  3. A surgical extraction where drilling on the bone and roots is necessary
  4. The patient does not follow the post-op instructions
  5. Women taking birth control pills
  6. Smoking
  7. A history of dry sockets

All of the factors listed above make it more likely to develop a dry socket after an extraction. Unfortunately, antibiotics do not help. A dry socket is a local infection in the bone, but there is little circulation to the area, so the body cannot clear the infection normally. With little circulation, antibiotics do not get to the infection as well. The purpose of treatment is simply to clean the socket and soothe the pain, while the body slowly heals the infection and begins to cover the exposed bone. It is a very unfortunate, frustrating, drawn out, and painful situation. However, avoiding the risks listed above will help reduce the likelihood of developing a dry socket.

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