How much pain during drilling (ie for filling or crown) is normal?

G

Goldzircstein

I saw a dentist a few years ago to have an old filling replaced. The dentist injected what I assume was the usual freezing painkiller and proceeded. I honestly wasn't always in much pain but I felt it more than I expected. I tried to man it up telling myself it's probably impossible to have a totally pain-free procedure but I had tears streaming down my face the entire time due to the pain. Is that normal? I'd had other fillings done in the past without anything close to that kind of pain, so I was surprised that it was so painful. Is there an explanation aside from what seems like the obvious one: I wasn't given enough pain killer? I didn't return to that dentist and had another filling done by a new dentist without difficulty. I guess it doesn't matter at this point since I don't plan on going back to the painful dentist but I'm still curious about why that even happened.
 

Dr M

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It sounds like the nerve might not have been fully anesthetized. Everyone's anatomy is different, and even the most experienced dentist can sometimes fail to fully numb a tooth on the first try. It is important to let your dentist know if you can still feel pain.
 

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G

Goldzircstein

Thank you so much for responding. It is extremely helpful to be able to ask a dentist some basic questions. There are so many unexpected factors for the lay patient.

I am also wondering something about a current situation. I switched dentists recently because there was a communication breakdown with the old one. I was prepped for a pfm crown on a molar but decided to get a gold crown instead. The new dentist who will be putting the gold crown in wants over an hour to smoothen the tooth that was prepped for the pfm and make a new mold impression. Is that normal? Maybe it's a new technique and there can always be details whose potential importance I might not even be aware of but it would be so reassuring to know if you or other dentists could identify a reason right off the bat.
 

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MattKW

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A PFM prep is a heavier reduction than for gold, so there should be no extra removal/drilling needed. After all, a PFM is really a metal substructure (usually a gold alloy) covered with porcelain. No additional smoothing is necessary unless you were changing to a ceramic crown.
It's possible he wants to make some minor modifications, and he would need to see the previous preparation before taking a new impression, and he doesn't have the temporary crown impression that the original dentist has.
It takes me 60-80 mins for a crown prep and impression on a fresh tooth, so in your case it would probably take 40-50 minutes unless I found something unexpected.
As regards numbing (LA), sometimes lower molar teeth are more difficult to numb completely with just a single "block" injection and you may need additional LA with "infiltration" or rarely even "intraligamental" LA. However, ask the dentist to check for numbness before he starts - this is as simple as putting some very cold spray on the tooth.
 

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G

Goldzircstein

Thank you so much for your response.

I guess I will ask for a breakdown of the procedure and ask for the reasons for the smoothing. If this new dentist is somehow mistaken I could end up loosing even more tooth unnecessarily. Is there a consensus about the respective disadvantage and advantage of sharp or smooth preps? He hasn't seen it yet so I don't even know why he thinks the original prep was "too sharp". Is there a way of observing how sharp or smooth the prepped tooth is from photos/x-rays?
 

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MattKW

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You would not get much useful info about a prep of a temporised tooth from an Xray. I would have to remove the temporary (usually no anaesthetic required) to give a definite opinion, maybe allow 30mins, but I would have to charge for my time.
As I said earlier, I'd give give you 40-50 mins and if there was something terribly wrong underneath then I'd re-temporise and have a chat with you. Then I've only wasted 40-50 mins rather than 1hr 20mins. I think he may just be preparing for the worst case scenario.
 

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