Leaky filling cuasing repeat infection

[toothymctoothy]

Hi, I'll try to be as brief as I can...

About 2 months ago I started to get a very sharp pulsating pain in and around my molar (the one in the pic) as well as sensitivity to hot and especially cold stimulation. After an emergency appointment to a dentist (not my regular practice), I was prescribed some amoxicillin 500mg and some Colgate Duraphat 5000. By day three the pain from the infection had cleared up, but the sensitivity remains.

After a repeat of the first lot of pain a few weeks later I followed up with my regular dentist (managed to get an emergency appointment) who did some xrays, and found a cavity on the side of my wisdom tooth. I have no pain or sensitivity from that tooth at all. Or any pain in the gums surrounding it. He has said that the wisdom tooth needs to come out, which having seen the xray I agree with, there appears to be a hole in the side of it, but no pain or problems from it.

I insisted the pain was coming from between the molar and the tooth next to it, (both the filled teeth in the pic) and it feels like I could almost touch the site of the pain with my fingernail between the teeth. See the pic for the orange arrow pointing to where I mean. He applied some kind of fluoride paste to the surrounding area and the pain was gone almost immediately, but only lasted for a day or two.

Third attempt at my regular practice after a few days of the pain returning in force, I had to insist that the infection had come back. Another course of amoxicillin and some duraphat and pain gone after a couple of days. Still waiting for the extraction, but now the addition of a root canal treatment on the molar. With a reluctance to do anything until the wisdom tooth is out.

After a bit of research, I believe that the filling is leaking, and from images I've seen on the Internet the green arrows are showing darker areas where the filling looks like the reference images I've seen from Google indicating the filling could well be leaking.

There's also a dark line on the tooth next to the one where I feel the worst of any pain (red arrow, im running out of colours haha). Is this another cavity and could that be the cause of the infection and pain?

The fillings in both teeth must be close to 20 years old by now. I feel a root canal is a bit of overkill if it's a leaky filling. And following an nerve vitality test (and the pain that came with it) I can confirm the nerve is present and very aware at the moment.

I think that removing and re filling the two teeth would resolve any symptoms.

I appreciate without the xrays it's very hard to see the complete picture, but I can't get a copy of them. I'm hoping my explanation and picture will be enough for a reasonable assessment.

Thanks for reading this far and I hope to get this sorted ASAP! I just want to turn up at the next appointment better informed.

Thanks again,
ToothyMcToothy

 

[dentalexplorer123]

Hi, I'll try to be as brief as I can...

About 2 months ago I started to get a very sharp pulsating pain in and around my molar (the one in the pic) as well as sensitivity to hot and especially cold stimulation. After an emergency appointment to a dentist (not my regular practice), I was prescribed some amoxicillin 500mg and some Colgate Duraphat 5000. By day three the pain from the infection had cleared up, but the sensitivity remains.

After a repeat of the first lot of pain a few weeks later I followed up with my regular dentist (managed to get an emergency appointment) who did some xrays, and found a cavity on the side of my wisdom tooth. I have no pain or sensitivity from that tooth at all. Or any pain in the gums surrounding it. He has said that the wisdom tooth needs to come out, which having seen the xray I agree with, there appears to be a hole in the side of it, but no pain or problems from it.

I insisted the pain was coming from between the molar and the tooth next to it, (both the filled teeth in the pic) and it feels like I could almost touch the site of the pain with my fingernail between the teeth. See the pic for the orange arrow pointing to where I mean. He applied some kind of fluoride paste to the surrounding area and the pain was gone almost immediately, but only lasted for a day or two.

Third attempt at my regular practice after a few days of the pain returning in force, I had to insist that the infection had come back. Another course of amoxicillin and some duraphat and pain gone after a couple of days. Still waiting for the extraction, but now the addition of a root canal treatment on the molar. With a reluctance to do anything until the wisdom tooth is out.

After a bit of research, I believe that the filling is leaking, and from images I've seen on the Internet the green arrows are showing darker areas where the filling looks like the reference images I've seen from Google indicating the filling could well be leaking.

There's also a dark line on the tooth next to the one where I feel the worst of any pain (red arrow, im running out of colours haha). Is this another cavity and could that be the cause of the infection and pain?

The fillings in both teeth must be close to 20 years old by now. I feel a root canal is a bit of overkill if it's a leaky filling. And following an nerve vitality test (and the pain that came with it) I can confirm the nerve is present and very aware at the moment.

I think that removing and re filling the two teeth would resolve any symptoms.

I appreciate without the xrays it's very hard to see the complete picture, but I can't get a copy of them. I'm hoping my explanation and picture will be enough for a reasonable assessment.

Thanks for reading this far and I hope to get this sorted ASAP! I just want to turn up at the next appointment better informed.

Thanks again,
ToothyMcToothy

If there is microleakage, the dental practitioner must reopen the filling and reseal it using a material that can form stronger bonds with the dentin. If you notice sensitivity to hot and cold stimuli, it's conceivable that your cavity is near the pulp or too deep. Traditionally, this would necessitate a root canal treatment. However, due to recent advances in dental techniques, it may be possible to avoid a root canal procedure.
The dentist can use a base liner technique, which involves applying a combination of ingredients such as glass ionomer cement or Biodentine using a layered approach, either directly onto the pulp, or indirectly, if the pulp chamber is not exposed. A final layer of composite resin can then be added on top to seal everything firmly in place. This significantly reduces any risk of leakage into the pulp chamber and also aids in regenerating lost dentin.
It's crucial to note that these techniques only work if the decay has not reached the pulp chamber (tooth nerve). If it has, you may consider trying a strong antibiotic like clindamycin and amoxicillin, which could potentially eradicate the infection without necessitating a root canal. In cases where the infection persists, root canal treatment might be unavoidable.
A recent dental study on Tibetan herb Padma 28 (while not conducted in a mainstream setting) has purportedly found it may help prevent root canal infections.

 

[dentalexplorer123]

If you're concerned about secondary infection or whether all decay has been removed, your dentist will likely recommend taking an X-ray for further assessment. If there is not enough remaining healthy tooth structure for a traditional crown or onlay, your dentist might recommend building up the tooth with a post. But from looking at the picture, I think using a layered approach with Biodentine or GIC in the depth, and then sealed with composite filling or ceramic filling, would be a good enough options, as opposed to using a post and core buildup / onlay.

 

[dentalexplorer123]

By utilising a 2-layered or 3-layered base liner approach with GIC or/and Biodentine, and composite resin, you can create a strong, long-lasting dental restoration while minimising the risk of complications such as sensitivity or microleakage, and potentially avoid root canal.

 

[toothymctoothy]

If you're concerned about secondary infection or whether all decay has been removed, your dentist will likely recommend taking an X-ray for further assessment. If there is not enough remaining healthy tooth structure for a traditional crown or onlay, your dentist might recommend building up the tooth with a post. But from looking at the picture, I think using a layered approach with Biodentine or GIC in the depth, and then sealed with composite filling or ceramic filling, would be a good enough options, as opposed to using a post and core buildup / onlay.

Thank you for your detailed reply, I appreciate you taking the time.

I will ask the dentist more questions before the drill sinks in now. Hopefully that approach will be covered on the NHS in the uk.

Thanks again for your time

Best regards

ToothyMcToothy

 

[dentalexplorer123]

Biodentine isn't available on the NHS, but numerous private dental practices do have it. Biodentine comes with a considerable expense tag, owing to its efficacy. As an alternative, Glass Ionomer Cement can also be used as a base and still get the job done satisfactorily, all while being readily accessible on the NHS. Looking at the image if this tooth was to undergo root canal therapy, there's a fair likelihood that it could be even more susceptible to fracture due to considerable loss of healthy tooth structure in the very center of the tooth, which would compromise its integrity, and wouldn't have a good prognosis in withstanding external pressure.