Minh Nguyen

Preventing Postoperative Sensitivity After Dental Fillings

Postoperative tooth sensitivity in composite restorations relentlessly continues to be a common, yet unpredictable, problem in dentistry. Such complication is even more unforgiving when the extreme sensitivities occur on teeth that were not sensitive before the restorations were placed.

A composite filling generally requires only one visit, during which the tooth is prepared and restored. A benefit of composite fillings, as compared with other dental restorations, is that they require less of the healthy part of a tooth to be took away to hold the filling in place. This is because of composite materials' ability to fuse to teeth adhesively.

Postoperative tooth sensitivity in composite restorations relentlessly continues to be a common, yet unpredictable, problem in dentistry. Such complication is even more unforgiving when the extreme sensitivities occur on teeth that were not sensitive before the restorations were placed. Despite meticulous use of dentin bonding agents, dentists and patients are faced with the sensitivity problem daily. Sometimes the dentist needs to rework these restorations. In rare instances, the dentist has to perform root canal therapy on the painful teeth. Practitioners have gradually developed many preventive methods to overcome the sensitivity challenge. When postoperative tooth sensitivity is expected, combining two or more of the following "desensitizing" techniques may be necessary. Numerous combinations of the methods have been described and supported by clinicians. The combination technique that I have used with nearly 100 percent success follows:

• Use of self-etching primer (such as Kuraray SE Bond, Kuraray America, New York City);

• Applying tooth-desensitizing (GLUMA) solutions on the tooth before filling placement;

• Laying a thin (about one-half millimeter–thick) resin-reinforced glass ionomer liner on deepest cavity surfaces; and

• Inserting a sheet of resin-based "flowable" composite between the tooth and the final filling.

Sensitivities can be also induced by other key events not related to composite placement. For examples:

• Accidentally burning the pulp during cavity preparation, especially when the remaining dentin is less than 1.

5 millimeters thick and when there is inadequate water coolant sprayed during cavity preparation;

• Not removing all decay; and

• Bonding failure because of water and saliva contaminationComposites are preferable for obvious cosmetic reasons.

Your dentist may recommend another material or restorations, if the decayed area is large or is subject to heavy chewing pressure. Other types of white fillings include composite inlays and porcelain inlays and onlays. Inlays and onlays are used to restore teeth that are badly damaged by decay or wear. They may be placed on the chewing surfaces of the back teeth when aesthetics are of concern.

White fillings are more expensive than other dental materials. However, most patients find these natural-looking restorations well worth the extra cost. White fillings, like other dental materials, may need periodic replacement. If the edge of the filling eventually pulls away from the tooth, bacteria can get between the filling and the enamel and eventually may cause new decay underneath the existing filling. Few people may experience some sensitivity to hot and cold temperatures in the newly filled tooth for a few days or as long as a week. If the sensitivity continues beyond that time, please contact your dentist. About 1% of those persistent sensitive teeth will require root canal therapy.

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