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    Danielle Torres
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    1) The patient had a large filling done months ago near the nerve of a tooth and it became sensitive to hot and cold afterwards. Recently, the tooth became painfully but the pain then went away. 2) The dentist explains that decay near the nerve can cause inflammation (pulpitis) in the pulp (tissue containing nerves). The initial sensitivity was likely due to low-grade inflammation from removing decay. If the decay was too close to the pulp, it may have become infected and inflamed, causing severe pain for a day or two before the nerves died and the pain went away. 3) To determine if the nerve is still alive, the dentist needs to do a test using ice. If

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    1) The patient had a large filling done months ago near the nerve of a tooth and it became sensitive to hot and cold afterwards. Recently, the tooth became painfully but the pain then went away. 2) The dentist explains that decay near the nerve can cause inflammation (pulpitis) in the pulp (tissue containing nerves). The initial sensitivity was likely due to low-grade inflammation from removing decay. If the decay was too close to the pulp, it may have become infected and inflamed, causing severe pain for a day or two before the nerves died and the pain went away. 3) To determine if the nerve is still alive, the dentist needs to do a test using ice. If

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    44 views2 pages

    09 Dear Doctor

    Uploaded by

    Danielle Torres
    1) The patient had a large filling done months ago near the nerve of a tooth and it became sensitive to hot and cold afterwards. Recently, the tooth became painfully but the pain then went away. 2) The dentist explains that decay near the nerve can cause inflammation (pulpitis) in the pulp (tissue containing nerves). The initial sensitivity was likely due to low-grade inflammation from removing decay. If the decay was too close to the pulp, it may have become infected and inflamed, causing severe pain for a day or two before the nerves died and the pain went away. 3) To determine if the nerve is still alive, the dentist needs to do a test using ice. If

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    ASevereToothache:Itmaycomeandgobutyoushouldstillbeexamined

    AConsultationwithDr.BrianQuesnell June2008 DearDoctor, Ihadatoothfilledafewmonthsago.Itwasabigfillingandmydentistwarnedmethatthedecayhe removedwasclosetothenerve.Thetoothwasquitesensitivetohotandcoldforawhile.Thetooththen becameunbearablypainfulforadayortwothenthepainjustwentaway.AmIOKnow? DearRegina(Georgia), ImnotsosureyoureOKnow,hereswhy.Deepdecayinatooththatisclosetothenerve,ormore accuratelythepulpofatooth(whichcontainsnervetissues),maywellresultininflammation,called quiteliterallypulpitis.Thisinflammationisnotmuchdifferentthananyothertypeofinflammation whichoccursinourbodies,exceptthepulpisinanenclosedspaceandhasnoroomtoswellup.This hindersitscapacitytohealonitsown. Thetemperaturesensitivityyounotedatfirstwasprobablytheresultofalowgradeinflammationwhich resultedfromtheremovalofthedecay.Decaycontainsbacteriawhichmustberemovedtostopcaries, thedecayprocess,fromprogressing.Ifthedecayistooclosetothepulpitmaybetoolatetostopthe pulpfrombecominginfectedandhenceinflamed.Thismaybefeltfirstastemperaturesensitivity,butif thedefensesofthepulpbecomeoverwhelmed,itdies.Thisisfeltassevereoracutepainthattypically lastsforadayortwo.Thenthepainactuallygoesaway,becausethenervesthattransmittedthepaindie alongwiththepulptissue.Thegoodnewsnomorepain;thebadnewsitisthebeginningofan infection,whichcanbecomequitechronic;i.e.slowlyprogressiveandpainless,untilatsometimeinthe futurewhenittoocanbecomeacuteandcauseapainfulabscess. Havingsaidthis,thereisalsoachance,althoughratherminor,thatthepainrapidlygoesawaybecause thenervespontaneouslyheals.Sothemostaccurateanswertoyourquestionisthatwhathappened dependsupontheextentofthedecayandhowthepulpofthetoothhasresponded. Theonlywaytoknowwhichoutcomeoccurredinyourcaseistohaveadentisttestyourtooth.Given yourstory,itismorelikelythatthenerve(pulp)hasdiedandthereforethetoothsvitality(whetherthe nerveisstilllivingornot)shouldbechecked.Thiscanbedoneverysimplybytestingthetoothtoseeifit respondstotemperature,usuallybytheapplicationofsomeicetothetoothorothersimplemeans. Ifinfactthenerveisnonvital(thepulptissuehasdied),rootcanalorendodontictreatment(endo inside,donttooth)willbenecessary.Thisisaneverydayprocedureindentistryinwhichasmall accesscavityisopenedfromthetopofthetoothtogainaccesstothepulpchamber,thepartofthe tooththathousesthepulp.Thisallowsforthedeadpulpaltissuetoberemoved,therootcanalstobe cleaned,disinfectedandpreparedforafillingwhichsealsthecanalsandtherebypreventsfurther infection.Importantly,oncethepulpandthenervetissueitcontainsarenolongerliving,rootcanal

    treatmentisalmostcompletelypainfree. Whilesimplerootcanalorendodontictreatmentcanbecarriedoutbyacompetentgeneraldentist,itisa specialityareaofdentistry.Optimalendodontictreatmentrequiresproficiencyintheuseofmicroscopes. Anendodontistisaspecialistinthisareaofdentistrywhohastakenadvancedtraininginthediagnosis andtreatmentofthesekindsofproblems.Manygeneraldentistsperformrootcanaltreatment procedures,butmaydefercomplexcasestoanendodontist.Yourdentistwilladviseyouaboutthestatus ofthetoothandwillreferyoutoanendodontistifnecessary.Onceendodontictreatmentiscompleted, mostteethrequireacaporcrowninordertoprotectthetoothfromfracture.Thiswouldbemadebyyour generaldentist. Sototrulyfindoutwhathashappenedandansweryourquestion,youwouldneedtobereevaluatedby yourdentistoranendodontistwhocanproperlydiagnosewhathashappenedandprovidethe appropriatetreatment. Sincerely, BrianQuesnell,DDS AbouttheAuthor BrianQuesnell,DDS Dr.BrianQuesnellcompletedhisdentaltrainingthroughthegeneraldentistryresidencytraining programatUCLAandanendodonticresidencyattheUniversityofIllinois.Hehasconductedclinical researchandpublishedhisfindingsinleadingdentaljournalsthroughouttheU.S.andabroad,notably regardingthesuccessrateofrootcanalsinHIVpatients.HecurrentlypracticesEndodonticsin California.

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