Sore and Sensitivity Weeks After 3rd IPR


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I have braces for over 3 years and have gotten an ipr done 3 times on my front teeth and once on my bottom teeth. I did not feel any abnormal discomfort a few weeks after that last appointment. Maybe 3 weeks after, the teeth that have gotten an ipr done started feeling sore and sensitive. This has lasted over a month and is still currently happening. My teeth are shifting in the front and are very sore and sensitive and its not going away. This has never happened to me in my entire experience with braces and every ipr done and Im getting worried. Usually the discomfort after a procedure has been done lasts a week maximum but after the first week of discomfort, my teeth felt normal. It wasn’t until 2-3 weeks in that I felt this weird discomfort. The dentist says they don’t notice any wearing of the enamel. Since then I have tried sensitive tooth paste, flossed daily, and used a fluoride mouthwash. My teeth shifted weird and I would like to do some slight additional ipr in certain areas but Im worried this will add onto the issue. I also noticed the front two teeth that hurt the most have started browning above the gum line which is strange but idk if this is related, I just noticed this today. Can anybody please tell me what you believe the issue is and what I can do about it because this is unbearable or if this has happened to you as well. I am 18 years old and have never had any dental issues related to this.
 
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Dr M

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Good day

Do you have pictures of the teeth? It is possible that with excessive IPR, the dentine could have been exposed, leading to the sensitivity you are experiencing now. If this procedure has been done many times, the dentinal tubules could have been exposed in certain areas. Unfortunately the only solution for this would be IDS, with possible restorations after the ortho has been completed and there is space available for these restorations.
Is your ortho treatment being done by an experienced orthodontist?
 
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I was initially afraid that I had done an excess in ipr as well but I visited both my orthodontist and dentists and I was reassured that my teeth still have thick enamel based on x rays as well. I believe my orthodontist is experience and I was told that I could do additional ipr for some crooked spots if my teeth stopped becoming sensitive. You briefly mentioned an IDS and would you care to elaborate further on this? I have attached a photo of my teeth currently and would like to get some opinions. Do you believe this is a normal process of the teeth moving or is there something more to this that I should get checked out?
777499D9-D803-46FB-894E-312C1764B991.jpeg
777499D9-D803-46FB-894E-312C1764B991.jpeg713399EE-59A4-48E7-9986-26948A571670.jpeg
 

Dr M

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Sorry, the photos are a bit blurry, so it is difficult to see.
First things first, I assume that you understand why IPR was done in the first place. This is usually done when there is a minor space discrepancy. A few mm of enamel is then taken off to provide space for the teeth to move into their optimal position and allignment within the arch. There are limiting factors to this procedure such as the size of the discrepancy as well as the amount and quality of enamel present.
It could be that the sensitivity you are experiencing is only transient and will disappear with time. I have found that sometimes when I advise my patients to take a toothpaste designed for sensitivity, and then rub the toothpaste with your finger all over the affected teeth, it helps to relieve the symptoms. The key is that you have to leave it on the tooth for at least 5min before rinsing with water.
If the teeth sensitivity doesn't disappear, it might be that you exposed dentinal tubules in certain areas and then this has to be sealed in order to prevent movement of fluid, located in the dentinal tubules, that lead to the sensitivity.
IDS or immediate dentine sealing is a procedure done to seal dentine by applying a dentine sealing agent to usually freshly exposed dentine under indirect restorations. Although your IPR was done a few weeks ago, I have found some dentists achieving success by applying this procedure, before placing a resin restoration, and thereby eliminating the sensitivity. It helps to seal the dentinal tubules.
I would give it some time, to see if the the pain disappears, but if not, I would bring this up the next time you visit your orthodontist. It might be that you are reaching the limit of what is possible with IPR and that alternative methods should be considered for creating more space to move your teeth.
 
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I have attached the photos again hopefully they are visible. I really am hoping this discomfort will go away. I also am not sure if what I am experiencing is soreness of shifting teeth or not. My teeth feel this discomfort mostly when I am able to shift my front teeth with my tongue. Additonally, may I ask if it is possible to see if you have exposed dentines through dental xrays? My dentist did not see any issues with my teeth in regards to enamel when an xray was perfomed.
F990C2B3-26A5-4B5C-A9DA-8E2472E8A699.jpeg
88F90886-F30F-4AFD-9D06-03C85C61730C.jpeg
 
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Dr M

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Good day

Unfortunately it is difficult to see exposed dentin on a x-ray. It is important to note that as your teeth move, you will have some periods of discomfort. I also had braces and I had times were some of my teeth were very painful and even slightly mobile. This was only for a short while and then it stabilized again. So my advice would beto wait and see.
 
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