Pain after cavity filling

[girginchev]

Before a month and a half a cavity in my last molar was filled, but the pain remain. My dentist said that it is normal sensitivity in the tooth, but it was not the problem. After a month I insisted a x-ray. The photo attached shown an other cavity in my penultimate molar. It was also filled, but sensitivity still exists 4 days after the intervetion. My dentist warned me that if the pain remain probaly root canal will be required, but I am not sure that this tooth is the problem. Can you help with advice?

 

[MattKW]

Poor resolution X-ray. Looks like possible decay still under the filling in the last molar. Most likely reason is polymerisation shrinkage and weakened bonding of the composite. If it doesn't settle within 2 weeks post-op, I would either have it redone (in composite), or better still have it redone in amalgam. Composite fillings have a much, much higher rate of post-op sensitivity than amalgams. But that's not justification for a root canal; that's justification for reassessing what went wrong with the filling.

 

[Dr M]

I agree with MattKW. The X-ray isn't to great, but I would also suggest observing the tooth for the next week or so. On the x-ray it also looks like there is either calculus or excess filling material? from a previous filling on the molar next to the last one. Right in between the teeth. In some cases this could cause chronic irritation of the gum in that area, which sometimes also leads to some confusion if the pain is from the tooth or the gum.
A follow-up visit with a second better quality radiograph, as well as certain vitality tests, might give a better idea of what the problem might be.

 

[girginchev]

Poor resolution X-ray. Looks like possible decay still under the filling in the last molar. Most likely reason is polymerisation shrinkage and weakened bonding of the composite. If it doesn't settle within 2 weeks post-op, I would either have it redone (in composite), or better still have it redone in amalgam. Composite fillings have a much, much higher rate of post-op sensitivity than amalgams. But that's not justification for a root canal; that's justification for reassessing what went wrong with the filling.

I agree with MattKW. The X-ray isn't to great, but I would also suggest observing the tooth for the next week or so. On the x-ray it also looks like there is either calculus or excess filling material? from a previous filling on the molar next to the last one. Right in between the teeth. In some cases this could cause chronic irritation of the gum in that area, which sometimes also leads to some confusion if the pain is from the tooth or the gum.
A follow-up visit with a second better quality radiograph, as well as certain vitality tests, might give a better idea of what the problem might be.

Dear Dr MattKW,
Dear Dr M,
Thank you very much for your fast response. I decided to take a new x-ray photo with a higher resolution, hoping that the problem could be seen better. As I mentioned, the cavity on the last molar (down) was done a month ago and on the penultimate molar - before 7 days. I still have irritation between the two teeth and sporadic pain. I will be grateful for your opinion again if it is necessary a root canal treatment on any of the two teeth and what could cause pain for so long.
Thank you in advance!

 

[Dr M]

Good day,

It could be that the restoration on one or both teeth were also very close to the nerve, which could have cause pulpitis(inflammation of the nerve). It looks especially deep on the penultimate molar.
I would suggest doing some pulp vitality tests at your dentist to determine the pulp status of the associated tooth. It might give a better idea if a root canal treatment is indicated on the specific tooth or not.

 

[MattKW]

Replace the filling with amalgam.