Do heavy grinders require special bonding agents for fillings? (I cannot chew from pain, pls help)

abctooth · Apr 21, 2018

Hello everyone,

A month ago I had 7 filling replacements done at a new dental office. 3 molars have been giving me pain around the top of the tooth when chewing and flossing. Shortly after I developed moderate hot and cold sensitivity too. They have been hurting for a month now with no signs of improvement. I've never had pain like this before after a filling. Because the pain is on both sides I'm not chewing and I've been going on pureed food for a month now. Please help! I'm worried about the future of my teeth and my dental office doesn't seem very knowledgeable about the issue. Any help is much appreciated!

5 days ago another dentist at the same office replaced one of the painful fillings that dentist #1 had done. He took longer doing it and applied the light gun more times, which makes me think he may have used a different bonding agent and/or technique (perhaps incremental cure?). The new filling is giving me the same pressure pain, but lower intensity (50% compared to the first) and not much hot and cold sensitivity so far.

Neither dentist used a dental dam when doing the fillings.

Both dentists mentioned that 'microgaps' are likely to blame for this pain. They said the microgaps can't be seen on the x-ray and they don't know why they are there. I told them both about my grinding problem and even asked dentist #2 directly if grinding could be the reason why the bond isn't holding. He shrugged and said no. Both dentists have about 10 years of experience.

My question: could I be getting this pressure pain because (1) I'm a heavy grinder and (2) the grinding has affected the internal enamel structure of my molars (perhaps akin to craze lines), (3) making it more difficult for the filling to bond to my tooth?

I am a heavy night grinder. I've been wearing a hard plastic night guard on my top teeth regularly for several years. By now there are grooves worn into the guard from the bottom teeth but no holes. I often wake up with tenderness in my jaw. The molars with the most painful fillings are the third from the end on each lower side (i.e. tooth #6 from the center), exactly where I grind most heavily.

I found this quote on Reddit:

Composite is something that binds to the tooth on a very fine level, as such, stressing the bond by having sharp angles and undercut areas in the enamel, you can have an unfavourable result and have a poor bond. Polishing it and making sure the enamel is supported by dentine is the best way to make sure this doesn't happen.

Could it be that grinding force over the years (even with nightguard) has caused 'sharp angles and undercut areas in the enamel', perhaps similar to craze lines on a micro scale? I'm a big guy (6'1) and the dentist who made my nightguard told me I have a very powerful jaw.

Another person suggested avoiding anything but 4th generation bonding agents:

Make sure to get it done with a rubber dam, and a good bonding agent, if they use an all in one binding agent or prime and born NT run. ... I favor 4th generation prime and bonds like optibond FL. If the dentist knows what I mean by a rubber dam and a 4th generation bonding agent, you are in good hands.

I'm assuming this is because the two-in-one (or all-in-one) combinations make for a weaker bond especially where there are structure issues with the enamel.

Someone else said to use incremental cure instead of bulk cure:

Worst case, have him do the filling again and ask him to "incremental cure" the filling rather than "bulk cure". Dental terminology, but he'll understand.

Is incremental cure related to the generation of bonding agent or is it a separate aspect of the filling procedure?

This pain is interfering with my life and makes me worried about the future of my teeth. I want to find out the cause of this pain so I know what to do from now on. Could the poor bonding in these fillings really be caused by the effects of grinding (perhaps also by cheap bonding agent and quick procedures used by dentists #1 and #2)? Is it likely that the rest of the 7 fillings will give me pain in the future? Are there any special procedures that grinders like me should ask for when getting dental work done?

Any input would be helpful. Thank you!

Busybee · Apr 21, 2018

I'm a heavy grinder but the only time I've had similar symptoms to yours is when a dentist tried to build up my bite without really know what they were doing. It could be that your fillings are too high and need adjusting. I also thought that it was down to poor material or technique but they are settled and I rarely have sensitivity or pain now. So my hunch would be that it's your bite & the trauma. Seven fillings will change your bite and it's a lot of trauma for the teeth too. They do etch with acid and that can go all over the place. In my experience any filing can give sensitivity up to three months but can be even longer. If they have not been done carefully enough it will carry on as there can be pockets where the nerve is too close as filling material didn't cover the area properly. I had one such area fixed with a blob of composite and it's fine now. Otherwise they settled with adjustments. The sensitivity can vanish just as suddenly as it appears. Give it more time.

NB I don't personally think dental dams make much difference. They just pacify the patient.

MattKW · Apr 22, 2018

Composites shrink on setting with the light, therefore bulk fill is poorer than incremental fill.
All-in-one bonding is usually quite weak on enamel, which is where you need it most.
Composites shrink less than early days, but still some shrinkage (compared to amalgams), and bond can deteriorate. Therefore, more likely to get post-op sensitivity with comps than amalgams.
Rubber dam is ideal, but can be managed without in selected cases.
Every time a filling is replaced, the nerve is damaged, and you go thru post-op pain again, and likelihood of nerve settling diminishes.

Why did you have the fillings replaced anyway?

Busybee · Apr 22, 2018

Matt just out of interest why are dental dams necessary? It's just that most of my dental life I had no dental dam and everything was fine after dental work. Recently all dentists are using them. I first came across them in the early 90s but it was a one off and I didn't see them again until a couple of years ago.

They make me feel claustrophobic, I feel like I'm gagging (cannot swallow) and I can't communicate. It feels like a barrier between dentist and patient.

MattKW · Apr 23, 2018

Dental dams are manadtory for RCTs because of risk of dropping fine instruments down the throat. They are useful for general work as:

For the dentist, keeps the tongue, cheeks, saliva away from the work. Reduces risk of filling material going down back of throat during removal or replacement. It's rare to lose something down back of throat as most patients keep closed, and have good reflexes, but I've had a few which worried me at the time and had to send off for chest Xrays (don't want stuff in lungs, OK for tummy).
Composites are sensitive to moisture when being placed, and there is a school of thought that that even the moisture in the patient breath can interfere with the bonding.
Most patients rather prefer dam as it leaves their mouth cleaner during the procedure. But some don't like it. Communication is more difficult, and some people just like the chance to sit up occasionally and rinse.

I always use dam for RCTs, and occasionally for other treatment when I have difficulty in keeping the area dry. That said, I place amalgams still where I think the patient will be better served, and amalgams are almost unaffected by moisture. Younger dentists are being trained more for use of dams as everyday treatment.

Busybee · Apr 23, 2018

I can understand for root treatment but for routine stuff it's nice to be able to rinse and breathe through the mouth in between stages. Particularly when your throat feels numbed up too. I prefer amalgam fillings but most private dentists have stopped doing them.

abctooth · Apr 23, 2018

MattKW said:
Composites shrink on setting with the light, therefore bulk fill is poorer than incremental fill.

All-in-one bonding is usually quite weak on enamel, which is where you need it most.

Composites shrink less than early days, but still some shrinkage (compared to amalgams), and bond can deteriorate. Therefore, more likely to get post-op sensitivity with comps than amalgams.

Rubber dam is ideal, but can be managed without in selected cases.

Every time a filling is replaced, the nerve is damaged, and you go thru post-op pain again, and likelihood of nerve settling diminishes.

Why did you have the fillings replaced anyway?

Thanks Matt, I appreciate your input. They were old fillings and the dentist (dentist #1) found cavities underneath. He put in a filling 3 weeks ago which immediately gave me chewing and flossing pain. Dentist #2 took out this new filling and put in a second filling. This is giving me the same pain but not as strong. It's not going away 1 week later but seems to be getting worse. Both dentists mentioned "microgaps" may be the reason for the pain in the fillings. I'm trying to figure out why these microgaps are there and why the bond isn't strong.

Do you think that teeth grinding could be creating these microgaps (which then are making the bond weaker and giving me pain)? I've been a grinder for years and often have jaw sensitivity in the morning. I read that grinding can cause craze lines. Can it can also cause small fissures/gaps in the molar enamel that affect the bonding?

Another thing, if the bond with the enamel isn't tight does this mean bacteria will be seeping through and causing decay inside the tooth?

I really want to get to the bottom of this so I can keep my teeth. I'm in my early 30s, lots of dental problems in my family. My uncle lost all his teeth before his 50s.

abctooth · Apr 23, 2018

Busybee said:
I'm a heavy grinder but the only time I've had similar symptoms to yours is when a dentist tried to build up my bite without really know what they were doing. It could be that your fillings are too high and need adjusting. I also thought that it was down to poor material or technique but they are settled and I rarely have sensitivity or pain now. So my hunch would be that it's your bite & the trauma. Seven fillings will change your bite and it's a lot of trauma for the teeth too. They do etch with acid and that can go all over the place. In my experience any filing can give sensitivity up to three months but can be even longer. If they have not been done carefully enough it will carry on as there can be pockets where the nerve is too close as filling material didn't cover the area properly. I had one such area fixed with a blob of composite and it's fine now. Otherwise they settled with adjustments. The sensitivity can vanish just as suddenly as it appears. Give it more time.

NB I don't personally think dental dams make much difference. They just pacify the patient.

Hey Busybee, I know what you mean about the bite adjustment. I needed an adjustment twice so far for these new fillings. I felt pain in my jaw, even running down the neck and up into the ear (as if I have an ear infection). The teeth above where the bite was high also got sensitive.

But here's the issue. I have pain in my tooth on the right side, where the bite never needed an adjustment (the bite was high on the left). The dentist spent a lot of time on the right side bite and made it almost perfect. But the pain in the tooth on the right (when chewing and flossing) is still there. This makes me think that it's not the bite and that the bond may be the problem. That's why I've been looking into bonding agents and the link between grinding and the filling bond (through "microgaps" and such).

MattKW · Apr 23, 2018

Any chance of Xrays from the dentists?

abctooth · Apr 27, 2018

Hi Matt, I just got the x-rays. I'm attaching what I received from the dental office. They have no labels unfortunately. I believe these were taken after the fillings were done. I'm sorry I can't narrow it down any more, I simply don't know what is what in these images. The main problems are in 36 and 46. I think 27 may be problematic also.

Thank you.