Archives for May 2021

My dentist delayed my Invisalign treatment because of an issue with a filling that broke and led to more problems. I had the same dentist for 15 years until my dental insurance changed. Unfortunately, my former dentist was not a plan provider for my new insurance. So in January, I saw a new dentist for a complete exam. She told me that the x-ray showed I had a cavity that needed a filling.

Although I haven’t had a cavity since childhood and felt no pain, the dentist showed me a spot on the x-ray that she said “looks bad” and needed attention. I agreed to fill the cavity. Although I had no tooth pain before, the filling hurt from the day my new dentist placed it. It hurt for weeks, she adjusted it again, and it continued to hurt. Before I was able to return to her office, the filling broke.

I decided to switch back to my former dentist and use my healthcare savings account for out-of-pocket costs. My long-time dentist told me that the spot on the x-ray that the new dentist thought looked bad was there for 8 years and did not need a filling. But since the other dentist dug out some of my tooth for the filling, my former dentist removed and replaced the broken filling. After the numbness wore off, the tooth was sore and got worse. This second filling broke. My dentist replaced the filling again, but the tooth is still painful and sensitive to heat and cold. I saw my dentist two days ago, and he recommends oral steroids, which I do not want to take. And if that doesn’t work, an extraction is next. I am afraid to return to my dentist if my tooth does not feel better next week. What should I do next? Thanks. Alexander from NM

 

Alexander,

Thank you for contacting our office. We see that you live in New Mexico. Otherwise, Dr. LeSage would love to examine your tooth, filling, and x-ray to see what happened. Unfortunately, it seems that neither dentist helped you. And you may develop lingering issues with your current dentist that further delay your Invisalign treatment.

Why Does a Tooth Filling Break?

A tooth filling can break if it is worn, weak, or poorly made:

• Worn – Fillings wear over time from chewing and pressure. If they are not maintained, they will eventually break. Your dentist should monitor the condition of fillings and replace them before they break.
• Weak – If the seal between the filling and your tooth is faulty or breaks down, the filling can weaken and break.
• Poorly made – A poorly made filling can weaken under the pressure of chewing and grinding and eventually break. Composite fillings require advanced training for a dentist to make and bond them to last.

Concerns about your diagnosis and treatment

We have several concerns about your dentist’s diagnosis and treatment options:

Dark spot on your tooth x-ray

If you had a dark spot on your  tooth x-ray for eight years, your first dentist should have told you about it, even if it did not look threatening. It does not seem that your new dentist was dishonest. But your long-time dentist should have investigated to ensure your tooth is healthy.

Tooth sensitivity to cold and heat after filling repair

Although temperature sensitivity after a new filling is common, it should not linger. And replacing a filling should be even less irritating. When sensitivity remains, you probably have a tooth infection.

Steroids for tooth infection

Steroids are not suitable for tooth infection because they block your body’s response to inflammation and infection. So if you have an infection, steroids will make it worse.

Extraction for a sensitive tooth

We would be cautious about a dentist who recommends extraction for a tooth that is painful and sensitive. The dentist’s goal should be to save your tooth. And many treatment options exist before recommending tooth extraction, including replacing the filling, root canal treatment, or a porcelain inlay or onlay. A skilled cosmetic dentist will review your case and recommend the appropriate treatment.

Based on your experience and your dentists’ challenges with your tooth, we recommend the following:

• Find a new dentist for an exam and accurate diagnosis.
• Please do not let your insurance prevent you from getting quality care.
• You should not lose a tooth over a cavity or a faulty filling.
• Look for an advanced cosmetic dentist who understands composites and bonding technology. Although almost any cosmetic dentist with post-graduate training can help you, look for an accredited cosmetic dentist if you are uncertain.

Best wishes for a smooth recovery and successful Invisalign treatment.

 

Brian LeSage, DDS, an accredited Fellow of cosmetic dentistry in Beverly Hills, sponsors this post.