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Pulpitis: What’s the Difference Between Reversible Pulpitis and Irreversible Pulpitis?

Toothache - It Could be PulpitisThere are lots of different reasons why you might feel pain coming from your tooth.  One of the more common reasons is called pulpitis.  Pulpitis is an inflammation of the dental pulp.  Dental pulp is the portion of your tooth that has blood vessels and nerves in it.  It is the core of your tooth that nourishes the hard parts of the tooth.  If you want to see a diagram of the anatomy of a tooth, click here.

Normally when parts of our body get hurt, they get red.  This is a process called inflammation.  Our body sends blood and defense cells to the site of injury so that our body can begin the healing process.  This works great on most parts of the body.  However, sometimes it's not so good when it happens inside our teeth.

When the dental pulp gets irritated, our body responds by sending extra blood and defense cells to the pulp.  When inflammation occurs on any other part of our body, there is room for expansion.  For example, if we hurt our finger, our finger gets a red and puffy as it starts to heal.  When we irritate our teeth and the pulp gets inflamed, the pulp doesn't have anywhere to go -- the pulp is surrounded by a very strong and hard tooth.

This increase in pressure can push on the nerves that run inside the dental pulp.  Since the nerves in the pulp are only capable of sending the signal of pain our brains, we feel pain.  The inflammation also makes our teeth more sensitive.  Things that normally wouldn't hurt a tooth all of the sudden start to cause pain.  For example, breathing in cold air, drinking hot drinks or chewing food can cause pain. 

This is pulpitis, an inflammation of the dental pulp. There are two types of pulpitis, irreversible and reversible.  I describe each one below.

Reversible Pulpitis

Reversible pulpitis is simply a mild inflammation of the dental pulp.  It can be caused by anything that irritates the pulp.  Some common causes of reversible pulpitis are:

  • Cavities that haven't reached the nerve yet.
  • Erosion of the tooth that reaches the dentin
  • Drilling done by a dentist when doing a filling or crown preparation on the tooth
  • A fracture of the enamel layer of the tooth which can expose the dentin
  • Getting your teeth cleaned (scraped!) by a dental hygienist, especially when they clean the roots if you have periodontal disease.

The symptoms of reversible pulpitis can range from nothing at all to a sharp pain when they are stimulated by things that otherwise wouldn't cause pain to your teeth.

When you eat ice cream, and the cold causes a sharp pain in a tooth that quickly goes away when you swallow the ice cream, chances are that you have reversible pulpitis.  Unlike in irreversible pulpitis, the pain usually goes away a few seconds after the stimulus is removed.

Luckily, reversible pulpitis gets its name due to the fact that it is reversible - it can go away if the cause of it is taken away.  For example, if you brush, floss and use a restoring mouthwash, you could re-mineralize the cavity that is just beginning and heal it.  If this was causing your reversible pulpitis, then the reversible pulpitis will go away.

All you have to do to cure reversible pulpitis is to find the cause of the inflammation, and get rid of it.

Irreversible Pulpitis

Irreversible pulpitis is a severe inflammation of the dental pulp.  Irreversible pulpitis is often occurs after reversible pulpitis when the cause of the pulpitis has not been removed.  So, irreversible pulpitis can be caused by everything that causes reversible pulpitis and the following:

  • When a dentist needs to remove lots of dentin due to big cavities and gets really close to the pulp.
  • When the blood flow to the pulp gets decreased or removed.  This could be caused by orthodontic treatment, such as braces, that makes the tooth move so fast that the blood vessels can't keep up and the pulp's blood supply gets cut off.  It could also be caused by trauma that severs the blood vessels and slowly kills the pulp.
  • Very deep cavities that go through the enamel and all the way through the enamel right into the pulp.  The bacteria then cause inflammation in the pulp.  The more the body tries to fight off the bacteria, the higher the pressure gets inside the tooth until the pressure may strangle the blood vessels and cause the pulp to die.

The symptoms of irreversible pulpitis can range from no symptoms at all to an excruciating spontaneous pain.  The tooth can be very sensitive to the slightest temperature change, such as breathing in room-temperature air.  The pain usually lingers as well.  For example, if you're eating ice cream and the pain stays for longer than five to ten seconds after you've swallowed the ice cream, it could be a sign of irreversible pulpitis.

Back in February 2007, I had a bad case of irreversible pulpitis.  I had a deep cavity that the dentist filled, but it was so deep that a little bit of bacteria had made it into the pulp.  At first, my tooth was slightly sensitive to cold.  It would hurt in the morning when I would drink orange juice.  After a few weeks, it got so bad that I woke up in the middle of the night with a throbbing pain in my mouth.  A few days later, I went to an endodontist and had a root canal performed.

Once you have irreversible pulpitis, there's no cure.  The only way to fix it is to have a root canal treatment performed (wehre the dentist or endodontist removes the dead pulp and fills it up with a rubber material) or to have the tooth extracted.

Conclusion

If you start to feel pain, it is best to get in touch with your dentist.  A small amount of pain (like that seen in reversible pulpitis) is normal following a filling or deep cleaning.  If the pain persists, you may want to meet with your dentist to try to figure out the cause of the pain before your pulpitis progresses to irreversible pulpitis and you have to have a root canal treatment or get the tooth extracted.

Have you ever had pulpitis?  If you have any questions about it, feel free to let us know in the comments.  Thanks for reading!

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336 Comments |  Leave A Comment

  1. thank you for the informative article
    I had to fill a cavity in my teeth, the Dr filled it first with temporary one and gave me an appointment 6 days later for the permanent one, following the filling I had constant agonizing pain for about 2 days, relieved temporarily by taking Paracetamol,the pain is so severe that interrupting my daily activities

    I guess I have to check with the Dr again to see what is wrong ..

    • Thank you for the comment, Jaffar. Here's what likely happened:

      Your dentist wasn't sure if your tooth had reversible pulpitis, or irreversible pulpitis. Rather than do a root canal, and remove the pulp, the dentist decided on the conservative treatment and put in a temporary filling with some medicine to try to help the pulp heal.

      If it started to feel better, then it would have been reversible pulpitis and the dentist could have simply placed a filling, and you could have avoided the root canal.

      However, since you still seem to be in agonizing pain, it is probably irreversible pulpitis, and a root canal might be the best choice.

      If it had've been reversible pulpitis though, your dentist could have saved you the hassle of getting a root canal treatment.

    • thanks for the information , it helped me alot since i have an exam next sunday and ineeded to know the difference between these two..would u send me a table that describe the differences in cause-symptoms-diagnosis- response to vutality test &treatment ,iwill be very thankful.

      • Hi Sara - I don't have a table handy that I could send to you, but here's some information that I emailed to someone who had a similar question on the difference between pulpitis and its relationship with apical periodontitis:

        Pain in pulpitis is due to an inflammation of the pulp. If you have pulpitis, you should see your dentist as soon as possible to have it diagnosed and to figure out the CAUSE of the pulpitis. Once you figure out the cause, you can eliminate that and hopefully keep your tooth healthy. For example, if a high filling is causing your pulpitis, the dentist would trim the tooth down so that the pain goes away. If a cavity is causing the pulpitis, the dentist can fill it with a sedative filling to help calm down the pulp.

        Periodontitis is a term used for inflammation around the tooth. It is most commonly known as gum disease -- when the gums and bone surrounding the tooth start receding due to lots of bacteria irritating them.

        Periodontitis can be linked with pulpitis. For example, if you have a tooth that has pulpitis and the pulp eventually dies, you can get an infection around the tooth. The pain in pulpitis would be sensitivity to hot, cold, or sweets. The pain in apical periodontitis (the inflammation around the outside of the tooth due to an infection) would happen when you chew on that tooth or put pressure on it. Another example would be a high filling. That can irritate the ligament that holds your tooth to the bone and cause an inflammation of the ligament.

    • Me hice un tratamiento de carillas en los dientes para que se vean mas bonitos y rectos, después de ponerme las carillas definitivas comencé con dolor en los dientes, cada día mas y mas, aparece sin ninguna razón y dura mucho tiempo solo a veces me lo calma el paracetamol, mi dentista me mando una pasta dental para dientes sensibles pero no me hace nada, por la noche es insoportable y no me deja dormir.
      Estoy leyendo información y por los sintomas parece una pulpitis irreversible.
      Quiere decir que la única manera de que termine este dolor diario es con un tratamiento de conducto??? Yo noto dolor en los dientes incluso de abajo que están sanos, supongo por reflejo, como se determina que diente tiene la púlpitis si te duelen todos los de adelante y refleja en los de abajo?
      Puede ser reversible? Que prueba determina la pulpitis y la localiza? Gracias estoy muy preocupada.
      Daymar

  2. hi,
    I have pain, (reading your blog above - pain that is unstimulated in my top 2nd back molar) i am currently in africa, and can't get to a good dentist for 4 weeks. I have been to the doctor here who has given me antibiotics.. if i keep taking these antibiotics for 4 weeks, should that help prevent anything really bad happening in the interim of being in angola, and being able to get to a dentist in 4 weeks time?

    or could the situation become lifethreatening and should i look at leaving now??, what is your opinion from a dentists point of view?

    .. i have been given pencillen and ibuproen for the pain..

    thanks
    lorraine

    • Hi Lorraine, Tooth pain away from home is never fun. It sounds like you have irreversible pulpitis in that molar. I had the same thing in my upper right second molar a few years ago and got a root canal, so I know that the pain can be excruciating.

      Dentists often prescribe antibiotics for irreversible pulpitis, although a published review of the literature concluded that it doesn't help pain at all. It might help the infection, however. Over the counter pain killers will hopefully take care of your pain.

      Since everyone is unique, I can't give you a clear answer as to whether or not you should leave. If I were you, I would find a dentist and get a "Periapical Radiograph" (an x-ray that will show the root) of the problem tooth. This will be able to help determine if there is an infection at the bottom of the root.

      If untreated, it can turn into a dental abscess - this article on Wikipedia appears to be a fairly accurate description of an abscess.

      I hope you have a great time on your trip and that everything goes well with your tooth. Thanks for your question!

    • Hi Lorraine - I've studied for my quiz in my endodontic (root canal) class on Monday and went over some information you might find useful. Here's what the book (Endodontic Principles and Practice by Torabinejad) says:

      "The irreversibly inflamed pulp is still vital and immunocompetent, with the ability to resist bacterial infection. Antibiotics, therefore, are definitely not indicated in cases of irreversible pulpitis. Unfortunately, old habits die hard, and some practitioners still prescribe antibiotics inappropriately, as in the case of irreversible pulpitis."

      Good luck with your tooth!

  3. Today I had a root canal. My tooth broke off below the gumline and I had crown lengthening procedure done, then saw my dentist who began work on the tooth and placed a temporary crown on it. The temporary crown was very sensitive and pain was continuous for about a week, after which it subsided, with only temperature change and pressure aggravating it. This morning I had my root canal. Am now wondering if I had reversible pulpitis vs. irreversible?... your thoughts?...

    • Hi Lise - I am assuming it was just a small part of your tooth that broke off below the gumline. If it was the whole tooth, then you may have exposed the pulp and that would have caused irreversible pulpitis.

      If it was just a small part of your tooth, two things could have happened:

      1 - Irreversible Pulpitis - Your tooth was traumatized from having part of it break off and the pulp got inflamed and was hurting you constantly. Finally, the pulp died and the pain went away. You still felt pain on pressure, because the ligament that holds your tooth into the bone became sore due to the dead pulp.
      2 - Reversible Pulpitis - Your tooth was traumatized from having part of it break off and the pulp became inflamed (when it was very sensitive), and then it was able to heal and then you didn't fell any pain.

      I am leaning towards irreversible pulpitis because you stated that the pain was continuous. One of the main features of irreversible pulpitis is constant pain that continues without any cause.

      I am guessing that the pulp started dying and most of the pain went away but you could still feel pain to temperature change. Had the pulp become completely dead, you wouldn't have felt any more sensation from temperature change.

      I hope that helps. If anything wasn't very clear, let me know and I'll try to clarify it. Keep in mind this is just my best guess based on what you've told me. Since I never saw you in a dental chair, I can't make any definitive statements. Thanks for your comment!

  4. Hi there,

    I have had pulpitis going on eight weeks now. It is on a veneered tooth (done 1.5 years ago), but there is absolutely nothing wrong with the tooth. I have had the dentist check it out and he has done x-rays, and all the tests, and there's nothing wrong with it. It happened after I chewed on dried fruit using the veneered tooth for three nights in a row.

    It definitely has gotten better, but I'm still can't breath in a lot of cold air, and I can't drink cold drinks through a straw. Everything else has gotten better though - I used to not be able to eat sweet or hot things, but that went away.

    Now I'm left with the slightest pain, only on contact with very cold air or drinks. Since it is going on eight weeks and has gotten better in that time period, should I continue to wait for it to go away?

    Thanks!
    Taya

    • Hi Taya - Personally, I try to be conservative and wouldn't do anything unless a patient really needed it done. In your case, if you've had a dentist check it out and there doesn't seem to be any problems, I would let your body do its thing to help the swelling in your pulp (pulpitis) go down. If it were my tooth, I would wait for it to heal on its own. I hit one of my front teeth on a metal object about a month ago and it was pretty sensitive for a few days, but it's gotten better now.

      What may have happened is that the pulp got a little traumatized when the whole front surface of your natural tooth was cut with a drill when the veneer was done. Big procedures like these usually irritate the pulp to some degree. There are studies out there that show that cutting a tooth all the way around for a crown can traumatize the pulp so much that about 1 in 6 teeth cut for crowns need to have root canals done.

      I hope your tooth feels better soon. Thanks for your comment!

      • I left a comment the other day, but it didn't get published so I am leaving another one.

        I just wanted to update on my reversible (?) pulpitis.

        After three months the tooth with pulpitis got completely better.

        Unfortunately, one week ago after a dental cleaning the pulpitis came back. I've had it for a week now, and I have to say it's already getting slightly better. However, the dentist said that I should probably get a root canal anyway.

        There is still no abscess, nothing on the xray, all the tests are negative. The pain does not linger, only lasts for a 1-2 seconds and only with stimulus. Never spontaneously.

        I was hoping to just leave the tooth and see if it would go away again. What are your thoughts on this? I don't have any classic symptoms of needing a root canal, that's what I am hesitant to get one.

        Taya

        • Hi Taya - Sorry the comment didn't post. I don't remember seeing it in the spam folder, but I usually run through those pretty fast.

          If your dentist says your tooth looks normal when he/she examines it and everything looks normal on the x-ray, then I personally wouldn't have a root canal done if you feel like it's getting better. I hope that helps - thanks for your question!

  5. hi tom,i have edge to edge bite,as a result i m suffering from attrition,what will be my treatment
    choice,orthodontics or light cure filling,i m a1st year dental student

    • Hi Adil - I'm looking into this and doing some reading in my occlusion textbook. From what I've read, each case would be different and there are a lot of factors to consider. Treatment might involve orthodontics to move your teeth into a normal relationship. You would also have to take into account your jaw relation to make sure this would be possible. My advice for you would be to talk to some of your prosthodontic instructors about your mouth and see what they recommend. Sorry I couldn't be too much help, but this isn't an area of expertise for me. Thanks for your comment and let me know if you have any other questions.

    • .....just to chime in you may need a night guard made by a dentist or you can get a cheap one(temporary) from CVS or Walgreens store.

    • Thanks for the helpful information. I have a couple of questions/worries about a similar situation.

      I had a cavity filled 6 weeks ago that was under(?) an old filling. The dentist described the new composite filling as deep. Immediately after, I had sensitivity to cold (extreme), hot, sweet and sometimes to biting pressure. Occasionally it would ache slightly and fleetingly for no apparent reason. The dentist told me to wait a month. After a month the pain was basically the same (a bit less to hot and pressure). At week 5 the dentist checked the height of my bite (fine) and painted something to seal the tooth and told me to see if that helped it. Since it remained sensitive (only a small improvement), the dentist removed the filling today (week 6) and placed a temporary filling that I can taste has eugenol. He said he's trying to see if the problem is with the filling or with my tooth. So if things improve with the temporary filling in 2 weeks, he'll place a new permanent filling in the tooth. If not I suspect that means a root canal.

      - Is he trying to see if the pulpitis is reversible by doing the temporary filling?
      - If drilling deep in the tooth causes the pulpitis, why does this plan of action involve so much more drilling (i.e. take the filling out, put a temporary one in, take that out, put another in)? Won't all that drilling just make it worse? What is the logic behind the temporary filling?
      - Given all the drilling, should we have waited longer to see if the pain would go away before taking out the filling?
      - What kinds of problems with the filling (versus my tooth) could cause this kind of sensitivity?

      Many thanks,
      Allison

  6. Hi,
    1 month ago I had a cavity filled in one of my wisdom teeth. It seemed to go well until a couple of days ago when I started to get a serious pain in my tooth. I think it was set off by me grinding my teeth which I occasionally, sub-consciously do. I was told by a dental nurse that I have textbook Pulpitis. My symptoms are excruciating pain which comes and goes when I drink hot and cold drinks, eat hot or cold food or even go into a hot room in my house. The hot causing far more pain than the cold.

    She told me that I need to see the dentist and make sure the dental surgeon doesn't prescribe me antibiotics for it as they won't work.

    Anyway, I went to the dentist and he insisted on trying antibiotics before his other option of removing the tooth. I'm 24 hours into my treatment of antibiotics and so far the pain has not subsided. I can sometimes go for two or three hours with just a little throb but sooner or later it flares up again and hurts lots.

    I was wondering if trying antibiotics is pointless or do I leave it for a little longer to see if kick in and start working?

    • Hi Rob,

      According to my endodontics (the science of root canals) textbook, the antibiotics won't work. See my comment above for a quote from the book, which basically says that some dentists still prescribe them because "old habits die hard."

      At my dental school, we don't prescribe antibiotics for pulpitis. Your best bet is probably to remove the tooth or get a root canal done (usually wisdom teeth are harder to keep clean and most dentists recommend removing them when you get problems like these rather than doing a root canal.)

      I hope that answers your question. Let me know if you have any other questions. Thanks for commenting!

  7. I was so happy to find this site. It has helped me to understand so much about irreversible pulpitis and answered my questions.

    I have a back molar that has been crowned for years. Recently, I started to feel mild sensitivity to cold. Weeks past and it became much worse. Now, highly sensitive to hot, cold and sweet. The pain lingers and it is becoming worse.

    I've never heard of a toothache with a crown, but I'm guessing if a root canal was not performed, then it can result in irreversible pulpitis, since the root is still there.

    I have an appt with my dentist this week. I just wonder if it's reversible? or irreversible? With the amount of lingering pain, I'm guessing irreversible pulpitis. OUCH! I hope doing a root canal with a crown does not create more problems for that tooth.

    Thank you again for your very helpful information.

    • Hi Cindy - From the symptoms you describe, it would seem that you have irreversible pulpitis. The lingering pain is usually the giveaway for that. I'll address the other points you bring up in your next comment.

  8. QUESTIONS.....I do have questions about reversible / irreversible pulpitis.

    :: Should'nt a crowned tooth have a root canal prior to the crown?
    :: Is it common for this to happen to a crowned tooth?
    :: Is a root canal on a crown tooth possible without removing the crown?
    :: Or - will the crown have to be replaced with a new one?
    :: Is Pulpitis the same as an abcess tooth?
    :: Can irreversible pulpitis cause you to feel ill? fever, fatique? nauseated?

    Thank you - Thank you - Thank you for any help you can provide.

    • Hi Cindy - I'll do my best:

      :: Shouldn't a crowned tooth have a root canal prior to the crown?
      Not necessarily. If the tooth decay never went to the nerve AND there is enough tooth structure left to hold onto a crown, then you wouldn't need to have the root canal done before the crown is placed.

      :: Is it common for this to happen to a crowned tooth?
      It is fairly common. I don't have my endodontics textbook on me right now, but if I remember correctly it is somewhere around 15 to 30% of crowned teeth end up needing a root canal. This is usually because of the trauma that is involved in cutting a tooth to receive a crown. If you think about it, the dentist had to cut around the whole crown of the tooth that is in your mouth. Sometimes this irritate the nerve so much that it eventually dies and needs to be removed with a root canal procedure.

      :: Is a root canal on a crown tooth possible without removing the crown or - will the crown have to be replaced with a new one?
      Yes it is possible, but it depends on a number of factors. For example, if you had a cavity that formed under the crown, then the crown would need to be removed and replaced. I have seen patients come in who have had root canals done by simply having a hole cut in the top of the crown and performing the root canal through the crown. I think that ideally the crown would need to be replaced, but I can double-check on this as well.

      :: Is Pulpitis the same as an abcess tooth?
      Pulpitis is simply an inflammation of the pulp which can cause pain and sensitivity. If pulpitis is not taken care of, usually the pulp ends up dying and the bacteria take over. If a root canal is not done (or the tooth is not removed) and infection can develop in the pulp that travels down to the roots. This infection that builds up around the roots can sometimes cause swelling inside the mouth and is called an abscess.

      :: Can irreversible pulpitis cause you to feel ill? fever, fatique? nauseated?
      From what I've learned, pulpitis would not cause you to feel ill, get a fever or feel nauseated. The excruciating pain might cause you some fatigue, but that may be more subjective. Once the pulpitis has progressed to an active infection in the bone at the roots of the tooth (an abscess), then it is a bodily infection and can cause fatigue, illness, and nausea.

      I hope that helps! I'll try to remember to look up the crown replacement with a root canal when I get home today. As far as I know, this is determined on a case-by-case basis, but if you have had the crown for a while, your dentist might want to replace it to make sure the remaining tooth structure stays healthy and solid.

      Thanks for your comment! I'm sure there are many others who have the same questions so hopefully this will help them out as well.

      • Thank you so much Tom for all your help and great information!!!

      • In my personal experience, yes, pulpitis can make you feel very ill, even if there's no evidence of abscess. If the tooth is infected, the bacteria can leak out into the bloodstream without actually forming an abscess. This can happen especially if the immune system is compromised. I've had infected teeth where the pus slowly and continuously drained from the root into the oral cavity, so most of the time no abscess showed on x-ray because the body didn't need to form an abscess since it found a path to drain the infection. Eventually, one showed a small abscess, but for years prior, did not, and make me very sick with chills, joint aches, weakness, facial swelling and extreme pain. Be careful and persistent if you think a tooth is making you sick. Most dentists are uncomfortable addressing the issue if the x-ray looks normal and don't want to deal with illness unless they see proof. However, if you go to a medical doctor they have no choice but to send you back to the dentist for what they believe is an infected tooth because they can't treat it themselves.

        • Hi Cindy - You do bring up some good points. When we can't see an abscess on the x-ray and we don't see where the infection is draining inside the mouth, it can be easy to not catch the fact that the tooth is causing an active infection inside the body (and causing other problems - since the teeth are connected to the whole body).

          Thanks for your comment, Cindy!

          • Hi
            i was searching on google for inflamed tooth pulp when i found your site, because for 3-4 months i was really ill, it was like having a constant hangover combined with recovering from the flu, i was extremely tired, exhausted and generally felt quite ill with no specifics. my whole life changed i had to stop gardening and was literally just managing to go to work and had given up all social activites. My gp sent me for various blood tests which all came back negative but within a week of having my front lower tooth drilled and filled with the molten rubber i started to feel better and this has slowly continued, I would not say 4 weeks later that I am about 50% back to normal and getting better every week. I feel this is too much of a coincidence not to be connected to my tooth problem, my dental surgeon told me there was no obvious cause but the pulp becomes inflamed and has no where to go except through the enamel of the tooth. I just wondered what your thought are on this, has anyone else felt ill with this problem.
            kind regards
            Janie

      • Can irreversible pulpitis caused by cutting a tooth for a crown result in an abscessed tooth, if no bacteria were able to get into the tooth, and it merely became inflamed due to the cutting?

        Because, when the root dies, where do the bacteria that cause abscesses come from?

        • Hi Dave - In order to get an abscess, you need to have bacteria. In the process of cutting a crown, much of the enamel is stripped away from the tooth exposing the dentin. The dentin has tiny tubes in it that connect it to the nerve of the tooth. It is possible for bacteria to enter in there and cause an abscess if the pulp was damaged from cutting the crown.

          I hope that helps - let me know if you have any other questions.

  9. This is such a helpful site!

    I had my 2nd upper right molar extracted mid December. On January 7th my dentist began work on my bridge, did the shaving, and put in the temporary crowns. During the whole 2 weeks that I had the temp crowns, there was a gum pain that was bothersome, but it wasn't sharp pain, or hot/cold sensitive. When I went back on January 21st to have the permanent bridge installed, and told her about the pain from the temp crowns she noticed a redness, and said that I may have been allergic to the cement or the acrylic from the temp crowns. Well, unfortunately the bridge didn't fit and she had to take new impressions and send out for a new bridge. This meant that I would need the temp crowns again! The plan was to put the same white temp crown on the one closer to the front, and use the silver cap crown on the back tooth. Once she put on the white temp crown it was clear that I am definitely allergic to some part of it because I experienced immediate pain. She ended up putting the silver temp crowns on both teeth.

    Soooo.... here is my issue/question. Right after the anesthetic wore off after I left the dentist I felt very substantial pain in the back molar. I had to take 800 mil of Ibuprofen. I didn't think much of it, since they had just done so much work. The next day I started to have some sinus issues, and a twitch in my eye (both of which have not stopped since). I don't necessarily think that the sinus issue is related, just bad timing. It's been over a week now and I still feel intermittent pain in my back molar that has the temp. The pain is enough that I need to take Ibuprofen, which always helps. Last Monday I went in because she was supposed to install the new bridge. After I told her about the pain, and she saw I was dealing with really bad sinus issues, she said that the pain could be caused from the sinus. We decided to wait the put the bridge on until my sinus is cleared up to see if the pain is resolved. My problem is that my sinus is sort of cleared up now, but I still feel the pain intermittently. It's not sharp, just bothersome, and I do usually end up taking Ibuprofen which always helps. I am supposed to have the new bridge installed on Monday, but I just don't know what to do! I would really like to avoid a root canal if at all possible. However, if I end up having pulpitis, wouldn't it be better to do a root canal BEFORE the bridge is put on? What do you think? If the pain is intermittent do you think it's possible that the tooth is still just recovering from A. having been shaved down, B. having been allergic to the temp crown for 2 weeks, and C. the sinus issue?

    • Hi Stacy - When you are allergic to something inside the mouth, I think it is more common to have swelling or redness develop rather than pain. That leads me to believe that the initial pain was probably caused by the trauma from cutting the tooth or because the temporary bridge didn't fit quite right and was irritating the gums. Just a guess!

      You are right in that if your tooth needs to have a root canal done, it should be done before the bridge is cemented. That way you can avoid having your dentist cut through the bridge to perform the root canal treatment.

      Sinus problems can cause a lot of pain in your teeth. I've been to more than a few lectures where the teacher shows us the x-rays of a bunch of upper teeth that had unnecessary root canals done, when the real problem was just the sinuses. My guess is that your tooth is still recovering from the trauma of being cut, the bridge, and like you stated the sinus problems.

      It looks like I got back to you a little late - it's already Monday! Let us know what ended up happening. Thanks for your comment, Stacy!

  10. Hi,

    I just switched to a different dentist recently and have been having some cavities filled.

    On Tuesday, I had a cavity filled on back of tooth #7 with a composite filling. While he was drilling, I felt pain a couple of times that made me flinch and groan in the chair. As soon as the numbness wore off, I now have EXTREME temperature sensitivity in that tooth. Anything hot or cold sends a flash of pain instantly through the tooth, even just breathing indoor air gives me pain. It feels as if the inside of the tooth is exposed. The pain only lasts a couple of seconds and the tooth does not ache otherwise without a stimulus. I don't have any pressure sensitivity either.

    I had no pain or sensitivity at all in this tooth before the cavity was filled. I called the dentist today and he said I should give it a few more days to see if it gets better. If this is pulpitis, how long does it take to calm down? I have only been 2 days with this and the pain seems the same, no better or worse. This is causing me large amounts of anxiety.

    Thanks for your time.

    • Hi Chris - Sometimes a tooth won't hurt at all until the cavity gets into the nerve. I'm guessing that you had a cavity that wasn't quite to the nerve yet, but then when the dentist went in with the drill to remove the cavity, that probably disturbed the nerve a little bit! I wouldn't worry, as this is a fairly common occurrence after getting a filling.

      I would agree with your dentist and probably give it a week or two. If you start getting pain for no reason and the tooth starts throbbing, that's a sign that it is becoming irreversible pulpitis.

      I hope that helps - let me know if you have any other questions.

      • Thanks very much for the response, Tom, that makes me feel a little better. I guess I'll just bear with it and hope it goes away. I still have to go back for a few more cavities also, hopefully I won't have anything else to cry about. I'll let you know how it turns out.

        • My sensitivity is gradually fading. It is still a little sensitive after almost a month, but it's about 60% better. I guess it takes time. The rest of my work was done without any complications.

          This is a great site. Thanks again.

      • Thanks Chris! I'm glad to hear that it's getting better.

  11. I had a crown put on the far back molar on left side right in front of my wisdom tooth on Nov. 30. No root canal done. The first couple weeks I had a lot of pain in my jaw and sensitivity to hot and cold. The pain even caused an earache but that went away after a couple hours. Now, I am less sensitive to hot but still sensitive to cold, but it goes away after a couple seconds. The pain in my ear is gone, but there is still a slight pressure in my ear and a feeling of tightness in my jaw. I do have a history of clenching my teeth. It is driving me crazy wondering if my face and tooth will get back to normal. It feels better when I sleep and when I get up in the morning it feels almost normal, but after being up and awake the pressure and tightness returns. I went back three times for a bite adjustment that helped a little. Although at one appointment the tooth on top of the crowned one was grinded a bit for the bite adjustment. That tooth has a little sensitivity now too. The dentist told me that with the crack I had in my tooth and the work that she did on it preparing it for the crown it could take a couple of months to heal. Any thoughts? Thanks.

  12. Hi Leigh - It sounds like it's getting better!

    Sometimes the grinding can affect your bite especially now that you have a crown since the crowned tooth will now wear away at a different rate than the rest of your teeth.

    My guess is that your tooth is still recovering from the trauma of being cut down for a crown. The fact that you're grinding on it probably isn't helping much. Have you asked your dentist about getting a "night guard" or "occlusal guard"? That could help with the grinding symptoms and might even help your tooth start to feel better faster.

    I hope that helps - Thanks for your question, Leigh!

  13. 2 weeks ago I felt something near or around my front tooth (not pain or sensitivity) just kinda of aware of it. Several days later I had a cup of hot tea and my front tooth was extremely sensitive, even to warm, but not cold. Two days after that I noticed that my tooth looked slightly darker.

    I went to the dentist and an x-ray showed nothing and they asked about trauma to the tooth, which I haven't had. They told me the tooth may be dying and a root canal may need to be done, but not to rush as I didn't have enough symptoms (no aches, or pain when I bite). I was so upset because I take excellent care of my teeth. I haven't had a cavity in over 10 years.

    I went to another dentist for a 2nd opinion. They took a digital x-ray and again I was told there was nothing. The Dr. said it was a virgin tooth with no decay and asked about trauma. Since neither was a factor he said if may be from braces.

    I had invisalign done. They were on for 11 months and have been off for just over a year and I wear a retainer nightly. Could this be the cause? If so would it take a year to die or have symptoms? Can this happen to other teeth?

    The 2nd dentist did a sensitivity test with cold on the two adjacent teeth, which I felt and I didn't feel it when applied to my front tooth in question. I was told it was irreversible pulpitis & am scheduled to have a root canal Friday. The plan is root canal, internal bleaching and build up with white filling since tooth is in good shape (best case scenario).

    However, to add to my confusion, the next night I had ice cream and I felt sensitive to the cold. Should I go back and get additional testing on the nerve, perhaps electrical? Could the nerve heal or is it irreversible? Any insight to my situation would be appreciated. I just want to know I am doing the right thing as root canal is permanent. Thank you

    • Hi Pam -

      I looked through the three main books on root canals today and I found a couple of quotes worth sharing with you. Normally moving your teeth through orthodontics shouldn't cause any problems with the pulp. However, sometimes when the teeth are moved fast, it can cause problems and in rare cases can cause the pulp of the tooth to die, necessitating a root canal.

      Ingle's Endodontics states, "Orthodontic tooth movement of a routine nature does not cause clinically significant changes in the dental pulp...The heavy forces used to reposition impacted canines frequently lead to pulp necrosis..."

      Cohen's Pathways to the Pulp says, "Most if not all of these effects [on the dental pulp] are due to circulatory changes and the consensus is that they are transient, provided the movement forces are not excessive. It was recently shown, however that pulp necrosis of teeth that had suffered trauma prior to undergoing orthodontic treatment was significantly increased."

      The take-home message is that normally moving your teeth will not cause any problems with the pulp, but it can, in rare circumstances cause the pulp to die especially if the teeth have had any trauma in the past.

      In your case, I would lean more towards the opinion of the first dentist in that there's probably not a huge need to rush anything if there are no signs of infection on the x-ray and the tooth is not spontaneously hurting you. The fact that you felt sensitive to cold is a sign that the nerve is still living inside the tooth. You make a good point that a root canal is permanent. If I were in your shoes, I would give the tooth every chance I could to try to heal itself before getting a root canal.

      I hope that helps, Pam. Let me know if you have any other questions. Thanks for your comment!

      • Thank you Tom for getting back to me. If my pulp were to heal, would my tooth lighten up again? It is noticeably gray. Also I have heard if you wait to get root canal the tooth will continue to darken, but I also heard once you have a root canal the tooth will get darker. Which one is true?

        Tom, is there any special care I should take to protect the rest of my teeth? Thank you.

        • Hi Pam - In my article on discolored teeth, I quoted the following from a pediatric dentistry textbook (kids are the ones who usually have trauma to teeth!)

          "Although the [dark color] is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period. In cases of this type, there is some chance that the pulp will retain its vitality."

          Unfortunately, there really isn't an answer in your case. If you've never had any trauma to the tooth, then my only thought is that the invisalign somehow injured the pulp enough to cause the pulpitis that you're experiencing.

          From what I've learned in the root canal courses we've had, most teeth that have darkened due to the pulp can be whitened if a root canal is done by placing a strong bleaching agent inside of the tooth and whitening it from the inside. I would think that should get your tooth back to its normal shade although I can't say it will with certainty. Sometimes teeth can darken after root canal treatment, but usually the dentist can re-open the tooth and place bleach inside to lighten it again.

          My guess is that this just happened by chance and I can't think of anything special that you could do to protect your other teeth. I'm guessing you just had a stroke of bad luck.

          I hope that helps, Pam. Thanks for your comment!

  14. Tom,
    First off, thanks for being so dedicated to answering all these questions!

    After reading through this and other websites, I seem to have all the symptoms of irreversible pulpitis, except for one thing... It's getting better.

    I had a very large filling in one of my lower molars (#19 I believe) that my current dentist didn't like the look of. Neither did I, I don't recall the whole tooth looking so gray. He suggested the size of the filling didn't leave much structure and I should replace it with a crown. I said OK, as the tooth was starting to bother me at times. I had the crown buildup done mid-February and had a temporary crown for a couple of weeks.

    After about a week with the temporary crown, my tooth would start hurting without any reason until one day I woke up and could hardly even think straight. I took 4 advil and an hour later started to feel better. My jaw was even sore for a day after that pain. I started taking about 2-3 advil every 12 hours to keep up with the pain, and over the next week, I needed less and less advil to calm the pain. By the time I got my permanent crown put on (I now realize I probably should have used temporary cement) I was down to maybe 3 advil a day.

    Now that I've had my permanent crown for a little over a week, I still need maybe 1-2 advil a day to keep the annoying pain down, but I'm still a long way off from actually using the tooth to chew. Every time I use the tooth I get a dull ache for a 2-3 minutes, depending on what I've chewed. I also have a history of grinding and I sleep with a mouth guard. Some heavy-griding nights seem to set me back in the recovery a bit though, where the annoying pain turns into actual pain. At this point, no matter how much pain I'm in, one advil takes care of it in about 20 minutes, and lasts half the day. As advil is an anti-inflamatory, besides helping with the pain, would taking it help prevent reversible pulpitis turning irreversible?

    I'm going to go back tomorrow to talk to my dentist, but I wanted a second opinion of sorts. I see some people need to wait months for the nerve to 'calm down', and I'm fine doing that. However, if it is irreversible pulpitis, I don't see the point in waiting. I trust my dentist's dental skill but I'm not so sure I trust his communication skills.

    Thanks in advance,
    Jesse

    • Hi Jesse - Since I can't see you in person or see your x-rays, I can't tell you exactly what's happening, but I'll let you know what I believe is going on given what you've stated.

      Many times when people get crowns, the trauma to the tooth is enough to push the nerve "over the edge" so to speak, and it develops irreversible pulpitis. The symptoms that you described sound exactly like irreversible pulpitis. In reversible pulpitis you DON'T get spontaneous pain that wakes you up at night. Once you get the spontenous pain, it usually means that the nerve dying. Over time, the nerve will eventually die (called pulp necrosis) and this causes many people to think that it's getting better because the pain can go away. After the nerve dies, many people feel fine, but an infection develops at the very bottom of the tooth root called an abscess. If not taken care of by either an extraction or a root canal treatment, the infection can get large and cause lots of problems.

      It sounds like the nerve is going through the final stages of irreversible pulpitis and may eventually stop hurting. In order to get all of the nerve out and help your tooth heal, you would need to have a root canal treatment done.

      I haven't heard anything about Advil or any other ant-inflammatory drugs helping to prevent irreversible pulpitis. Once the pulp has decided it's going to die, there's usually no turning back.

      I hope that helps - let me know if you have any other questions. Thanks for your comment, Jesse!

      • Well, as an update, I went to the dentist and he took an x-ray. He also adjusted the bite a little as he said that the side-to-side grinding was still causing an interference. With the adjusted bite I can feel the tooth in front of my crown is the one making contact now, but since that one is all original, I'd like to avoid grinding it down. I didn't see the xray and he didn't comment on it, so I'm not sure if he saw anything positive or negative in it.

        Strangely, a couple days after he adjusted the bite, my pain is 90% gone. I guess it could be a coincidence and that my nerves have just died, but I hope that's not the case.

        What are the chances the bite interference was causing the pain? As a grinder, it wouldn't surprise me much if my waking-up-in-pain was a result of the grinding rather than pulpitis.

        How long would it take for the nerves to die by themselves? Also, if they did kick the bucket, should I go back to the dentist for a vitality test soon? Or could I wait until my next checkup in August?

        Thanks again for all the help!
        Jesse

        • Hi Jesse - From what you've said, it does sound like the pain was from grinding. Sometimes there aren't any high spots when you tap your teeth together, but when you grind them side-to-side, the dentist is able to detect the high spots and relieve them.

          Since you just had the crown cut, the nerve was probably slightly traumatized. Add that to the fact that you were grinding, it could have simply irritated the nerve enough to make it hurt pretty bad!

          A main sign of irreversible pulpitis is when the tooth hurts a lot for NO reason. Since you think that you were grinding, that may well have been what was irritating the pulp.

          It sounds like your dentist thinks everything is fine - so there's probably no need to go back sooner than your next checkup unless your dentist wants to monitor the tooth.

          If the nerve is going to die, it can take anywhere from days to several months - it all depends on what exactly is irritating the nerve, and how severe it is.

          I hope that helps. Hopefully it was simply caused by your grinding and everything will be perfect from here on out! Thanks for your comment, Jesse - let me know if you have any other questions.

  15. Hi Tom,

    I actually have a similar situation as Jesse, with a minor difference...The pain

    I had my tooth prepared for a crown 3.5 days ago (saturday morning).

    My dentist shaved down the molar and placed a temporary crown. As soon as the numbness wore off that day, I felt a throbbing pain which went away after a couple of hours. Later on when I ate, I chewed with the temporary crown and a few minutes later it was throbbing again for about an hour then went away.

    A similar but less severe pain has been sporadically present since the day of the preparation. The pain seems to come back when I either chew with it or bite down on it but does not go away right away - it stays for a little while. It's has never been excruciating, just dull and annoying but sustaining during its flare-ups.

    Should I too be worried about irriversable pulpitis?

    Thanks,
    Mike

    • Hi Mike - After we do any drilling on teeth, it is normal to feel spontaneous pain for the first few days. Right now it sounds like you're only getting pain when you bite down on the tooth. It's possible that you have irreversible pulpitis, but your dentist will be able to let you know for sure. It's also possible that there is a problem with your temporary crown, it might be too high or maybe it is pushing down into your gums when you bite.

      I wouldn't worry, just hope for the best. It is common to have crown preparations traumatize the pulp so much that a root canal is needed. A major sign of irreversible pulpitis is when you get throbbing pain that just comes out of the blue.

      I hope that helps. Thanks for your comment, Mike. Let me know if you have any other questions.

  16. I had a very large filling done two days ago. I was given two shots of local anesthetic, left alone for about 10 minutes (to give the anesthetic time to kick in), and then the dentist started drilling. I thought I was numb, but after a few seconds my tooth felt hot and very painful. The dentist stopped drilling and gave me two more shots (lord, how I wish he would have offered me nitrous oxide too!... but no suck luck). Not surprisingly, I was very very anxious and tense as he started drilling again.

    Fortunately, I did not feel anything the second time, but the dentist said I made him nervous and he wasn't able to concentrate as well as normal while he was doing the filling. :( Unfortunately, he created a large gap between my molars, and the edge of my tooth around the filling is very sharp. I'm worried about getting food caught in the gap and about cutting my tongue on the tooth.

    The first two days, my jaw hurt and I had quite a bit of sensitivity to cold air, drinks, and pressure. Thankfully, the sensitivity to cold has gone away almost completely today, but I still have a sharp pain when I bite down on anything crunchy (I've had problems with cereal). Soft foods and gum seem okay, and the pain with biting on harder things is intermittent. It is very sharp and goes away completely within a second.

    Should I be concerned about the pain I'm still having? I've read that reversible pulpitis pain should not last longer than two days and that it usually involves cold sensitivity. Since I'm no longer experiencing cold sensitivity, does this mean the pain with biting must be caused by something more serious than post-op sensitivity, such as a cracked tooth? Is there a possibility that, given a few more days, the biting pain may still go away, or is pain with biting not associated with reversible pulpitis at all?

    If it might still be something reversible, is there anything that can help heal the tooth? I'm currently using ACT fluoride rinse twice a day (I've been using it a couple time per week regularly for several years) along with MI Paste. Would ibuprofen help? What about a prescription strength fluoride? If you have any other suggestions, they would be much appreciated! I don't want a root canal (this is the only tooth I've had filled in my 30 years... so, even though I know a root canal is not the end of the world, it does seem like a major procedure to me). I'm really really scared, though, that it may have to be extracted if it is broken. Am I worrying too much?

    • BTW, there was absolutely no pain before the dentist started drilling. He even commented during the procedure that, "the good news is, you definitely aren't going to need a root canal", so I do not think the pulp was damaged before I had the filling.....

    • Hi Kristin - It sounds like you had reversible pulpitis right after the filling and that went away. It could be more serious, but since your dentist commented that you wouldn't need a root canal, I'd put my money on reversible pulpitis.

      The gap between your molars needs to be corrected. At my dental school, if we end up leaving a small gap between two teeth after a filling, we re-do it for free. On the national dental boards (you have to pass to become a dentist) if you leave a gap, you fail. You should have the gap fixed because you will probably end up pushing food into the space and damaging your gums in the long-term if it's not corrected. Also, you should have your dentist take care of the sharp edges so you don't cut anything inside of your mouth.

      As for the pain, it sounds like it could either be a cracked tooth or apical periodontitis (caused by a high filling)

      If it's apical periodontitis caused by a high filling, your dentist should be able to adjust the height of the filling and the pain should subside within a week or two. If it's a cracked tooth, then depending on the size of the crack you may need a crown (with possible root canal) or extraction of the tooth.

      I hope that answers your questions. Let me know if you have any other questions - Thanks for your comment, Kristin!

      • Well, I know it's not a high filling because my teeth are hardly touching (they didn't touch very well before the filling because my mandibular incisors overlap, causing my lower front teeth to hit my upper front teeth before my molars can touch. I had braces when I was a teenager, but my orthodontist died in a plane crash. We lived in a rural area, he was the only ortho in town, and we could not get to another one easily, so I couldn't finish the process). One of the reasons (one of many) that I'm terrified to get a crown or implant is that I really want to get braces again once my husband finishes grad school at the end of this year and has a long-term job, and I don't know if I can have them if I'm missing my real teeth. :(

        It sounds like a cracked tooth. How often do cracked teeth have to be extracted? I still have sharp pain with biting crunchy things, but it seems to be happening less frequently than yesterday... Is there any chance at all that this could just be minor nerve inflammation? My husband is out of town for two weeks, and I don't have transportation, so I can not get to a dentist until then, and I think we may be looking for a new dentist, because the one who did this filling refuses to see me again unless I get a prescription sedative from a doctor, and I do not have health insurance either.

        • Hi Kristin - I'm sorry to hear about your bad experience with braces as a teenager, that sounds frustrating!

          As for your tooth, it could be nerve inflammation (pulpitis.) Also, since you mentioned a gap between your teeth and a sharp edge, it could be that the tooth wasn't filled properly and is causing sensitivity.

          Since the pain is going down, your dentist may want you to wait and give it some time to calm down after the filling that was done.

          It's probably too early to jump to any conclusions and since you say that it's getting better, it may resolve on its own - the only way to be sure of what's going on is to visit your dentist.

          I hope that helps - thanks for your comments!

          • Thanks, Tom.

            I will hold out for a few more days. *keeping fingers crossed*

            The really weird thing is that the biting pain seems slightly worse each night but is better again each morning and then becomes progressively more noticeable throughout the day. I've never had tooth pain of any kind before (other than dry sockets after having wisdom teeth out). What a bummer.

            • Huh. So here is what has happened over the past two weeks:

              Still NO hot/cold sensitivity whatsoever! Pain with biting continued. In fact, it got much much worse one night to the point where lightly touching the tooth sent shocks through my entire head. Jaw hurt on both sides, neck hurt, shoulders, face, head... well, you get the idea. The next day - nothing. No pain (I didn't even try chewing with anything on that side, so it didn't hurt). Two days later: went back to chewing with that tooth and it gradually became more sensitive to touch. This time, however, along with #19, #13, 14, and 24 developed shooting pain with pressure. Eventually, #8 and 9 also developed pain. The only tooth this entire time that has had any lasting pain is #24, oddly enough.

              #24 developed a dull continuous ache with spontaneous shooting pains (without applying any pressure to the tooth). The pain was bad enough to wake me up in the middle of the night and lasted about 2-3 hours at a time. Stranger yet, whenever this happened, both my ears also started ringing, the intensity of the sound varying with the intensity of the pain in #24. It was like all the nerves in my head were going haywire. I had three of these episodes involving the same tooth over two weeks. After each episode, the pain eventually subsided.

              Again, remember, I had absolutely not pain in any of my teeth prior to having the filling in #19 redone.

              So, I finally was able to get into see a different dentist. X-rays showed no abnormalities on any of the affected teeth. Bite test on #19 revealed no pain on the part of the tooth that was previously treated most aggressively (the distal part) where the filling was deepest, nor was there any pain in the center of the filling. Sharp pain occurred when the dentist pressed hard on the mesial buccal cusp where the filling was most shallow. Scraping that area produced mild localized discomfort.

              The dentist determined it is extremely unlikely that the tooth is infected. He said there's a slim possibility that there is a very fine crack under the affected cusp that could eventually cause another cusp to break but is unlikely to split the tooth in half. He said the most likely explanation for the pain in #19 is an improperly prepared filling - basically a gap between the filling material and the existing tooth. Although he says a properly done filling probably would have been okay and that it is possible for him just to replace the one I got two weeks ago, he said replacing the filling would require him to remove more tooth structure. He said that removing more of the tooth at this point may make it more fragile long-term and recommended a crown. He basically left the decision up to me. As much as I hate the idea of having my natural tooth worn down to a stub, I guess a split tooth would be worse. At least it doesn't sound like I will need a root canal. Although he couldn't guarantee 100% that I don't need one, he said he really would be willing to bet money that I'll be okay without one.

              What's really frustrating, though, is that the dentist who did the filling two weeks ago seems to have messed up in so many ways. Not only was I not numbed up before he started drilling and was the filling improperly prepared, but - get this - he actually drilled a hole in the side of my tooth where there wasn't even any decay! He didn't even mention the mistake. The dental assistant had to tell me that he accidentally drilled out an area of slight staining where no cavity existed, further damaging my already fragile tooth! The open contact has lessened, but my new dentist agreed that it was a big mistake for the other dentist to leave it like this. Further, you were right about the filling needing a bite adjustment. In fact, my bite was so out of whack that it appears that the pain in all the other teeth, including #24, is probably a direct result of the malocclusion and will most likely resolve once the crown is fitted. If not, in addition to the $200 I've spent in X-rays, the $250 for the messed up filling, and the $1400 I will have to pay for the crown, it sounds like I may be looking at $500 for a bite guard and who-knows-how-much for Invisalign down the road. :(

              Good thing my husband has student loan money because he's not allowed to work a second job, his grad student stipend barely covers rent, and I can only work part-time (when I have transportation - can't afford a car) as a substitute teacher, and substitute teachers in this state actually make LESS than the federal minimum wage! (because we're paid daily, not hourly!) I can not tell you how much better it was when I was teaching in the Midwest!

            • Wow Kristin - It sounds like you've been through a lot! Thanks for the update. Many times the bite guards do help immensely with pain caused from grinding.

              I hope everything works out with your teeth and you can enjoy chewing your food again!

            • Hey Tom,

              Went in and got #19 crowned today. I was really worried that I would have pain after the prep and need a root canal, but both dentists in the office said they thought it was extremely unlikely that there would be any further problems wit the tooth. My dentist said that he could see a small fracture in the mesial buccal cusp above the gumline and that he had eliminated it completely during the crown prep. He also said the crack really wasn't close to the nerve at all. X-rays showed no signs of infection / abcess in the tooth root.

              Well, after the novocaine wore off, first I could tell the back of the temp was a little too high. I called the dentist and asked if I could get in to have it adjusted on Monday, since they do not work on Fridays. He agreed that the temp was probably a little high, and he wants to make a special trip into the office to check it out tomorrow.

              Since I talked to him earlier this evening, I've begun to notice more pain. It's only occurring with pressure, but it is a sharp pain that occurs in the front part of the molar, near the location of the old crack. The part of the filling that feels high is near the back. The pain is very similar to the pain I had prior to having the cracked cusp ground off.... only more pronounced. I have no sensitivity to hot or cold... only sharp pain when releasing pressure on that part of the tooth. I have not chewed with that side of my mouth today, but I can press on the top of the tooth with my finger, and it hurts when letting up.

              Is this likely to just be nerve irritation from the crown prep procedure I had done earlier today (that I assume will probably go away again in time), or does this sound like the crack is still there???

              Although I plan to see the dentist again tomorrow, and I will ask him about it........ I just wondered if you had had any experience with the kinds of pain people sometimes have after getting a crown. Part of me is afraid that my dentist will confirm my fears that the tooth is damaged much more than anyone thought. However, I believe the most likely situation is that he will tell me everything is fine because he can't see anything else wrong with it (he is kind, but sometimes he strikes me as being a little overly optimistic), and my tooth will continue hurting and/or get worse.

            • Hi Kristin - Usually nerve pain from cutting for the crown takes the form of a dull aching or sensitivity to hot and cold. Since you describe it as pain that occurs on pressure, it could be either due to the crack or the high crown. It is possible that there is still a crack in your tooth, and that can be confirmed through a couple of different tests.

              He strikes me as optimistic as well - thinking that it would be extremely unlikely that there would be further problems with the tooth - even without a crack, a sizable percentage of teeth that are cut for crowns do end up needing root canals due to the trauma of being cut for a crown.

              I hope that helps - Let me know if you have any other questions. Thanks for your comment, Kristin!

            • Thought I would add a final comment, since this whole ordeal with my tooth has been so crazy.

              So, the dentist talked to the endo, and changed his mind three weeks later and decided to do the crown without a root canal. Unfortunately, the permanent crown did not fit well, so they had to grind down my top tooth quite a bit to make room for it. Once it was on, though, there was significantly less biting pain. I noticed a difference almost immediately. However, my tooth was instead extremely sensitive to cold. I had never had cold sensitivity up to this point.

              My tooth was very temperature sensitive and still slightly pressure sensitive for about two months. Four months later, the pain is almost entirely gone. The zirconia feels really weird, and the texture still bothers me some. If I had the option of PFM, I think I would have liked it better, but my teeth are just naturally very small, and PFM would not have fit. As it is, I suppose this will do. The zirconia is very tough; I honestly think I could chew nails with this thing. It is nice not to have to worry about food getting caught in the pits and fissures of the crown and causing decay, as the ones in my natural teeth are deep and difficult to clean. I actually try to chew on the side with the crown as much as possible in order to protect my real teeth on the other side.

              I still don't understand how dentists determine whether or not to do root canal therapy. I'm glad I didn't have the root canal, but I feel like I was just lucky.... this time. All I know is, I really hope I am never ever faced with this decision again in the future!

  17. Thank you so much for this site, it's wonderful how well you answer all the questions.
    About 10 days ago, I went into get a filling done because I had had headaches for a week an thought maybe it was related to a cavity I never had filled. He said there was a lot of decay under 2 amalgam fillings, he repaired them. Now one tooth hurt when I bite on anything crispy so I've been using the other side to eat. An hour ago I had some toast and purposely tested it and I still feel a lingering soreness. I had no pain before the cavity was replaced. I went to my dentist today and he didn't see anything, I did bite paper and bit down on a plastic thing but nothing really hurt. Right now as I type it's sore when I let my top and bottom molars touch. Do you think these symptoms could be irreversible pulpitis, I'm not too sensitive to cold or air. Or a cracked tooth even though I had no pain prior to the filling 10 days ago?
    Thank you,
    Karen

    • Hi Karen - My best guess is that the cavity was getting close to the nerve (pulp) of the tooth and when your dentist cleaned out all of the decay, it irritated the pulp slightly. Over time, your pulp will build up more dentin between the pulp and the filling, which should help decrease the sensitivity. It sounds like your dentist checked to see if it was a high filling and figured that your sensitivity isn't caused by that. It could be a cracked tooth, but usually when teeth hurt after a filling procedure it's simply reversible pulpitis.

      One of the main signs of irreversible pulpitis is excruciating pain that comes out of nowhere. It sounds like it's not just hurting for no reason. Hopefully the pain will go down as more and more time goes by. If not, it could be a sign of something more serious and your dentist will be able to help you pinpoint exactly what is causing the pain.

      I hope that helps. Thanks for your comment, Karen - Let me know if you have any other questions.

      • Thank you so much, I already feel better getting your opinion, I have worried about it all so much less today. Amazing how a little pain can take over your life... I'll rest easy for the next while and wait for it to get better. I imagine the dentist did get pretty close to the pulp.
        Thanks again!

  18. Hello :)

    Thank-you for all of the information you posted~ You've given me a clearer picture of what might be going on with me.

    I have crowns on my upper four front teeth that are about 4 years old. Last week I suddenly felt pain in one of the teeth (never had a root canal in that one), when eating hot or cold foods. I was worried because after years of dental issues, (I was bulimic for years and have had several cavities and root canals over the years), I tend to know when things are about to get bad with my teeth :(.

    The pain existed only when exposed to hot and cold until three days ago when I woke up in the morning with constant, severe, throbbing pain. I had extreme pain if I accidently bit into food using that tooth. Even running my tounge or lips over it made me wince.

    I've been taking Advil and using Anbesol to numb the pain but until last night, it was still hurting constantly. The pain seems to have subsided somewhat today. I'm still taking Advil but the pain feels more manageable. I'm going to assume that I have irreversible pulpitis and the pulp is dying, hense the pain is calming down.

    I moved to a different city and don't have a dentist right now. I am also not prepared financially to have a root canal done, (if it's needed). I am also worried that the fact that I have a crown on the particular tooth might make the procedure more expensive.

    I am wondering if it's safe for me to put off a dental visit for a week safely so I can better-afford my dental treatment and find a dentist or am I risking my health by waiting.(?)

    I realize that the pain might still come back and I might end up desperately searching for a dentist again but I'd really like to be able to wait a few more days to take care of it :(

    Thank-you so much for your time and information.

    • Hi Jennifer - It sounds like you have irreversible pulpitis, but your dentist will be able to make sure by performing some tests on the tooth. If you live near a dental school, they can start a root canal by removing the infection. We call it a "palliative treatment" and it doesn't cost nearly as much as a root canal since we don't fill the root back up, we just remove the problem. If you live near a dental school, that could be an option for you.

      Sometimes we see people who come into the emergency clinic at my school who have waited so long to take care of a tooth that they develop swelling on one side of their face. Truthfully, if you could still feel your tooth and you're right that it is dying, it probably will take some time to develop an infection. It is simply a trade-off - the longer you wait to get it fixed, the more likely you are to develop an infection under the tooth which will damage the bone around your tooth and could eventually cause an illness throughout your whole body.

      It's hard to give you an exact answer since I can't see your tooth and get x-rays on it to see what's really going on. I hope that those general guidelines helped some - if you have any other questions, let me know. Thanks for your comment, Jennifer!

  19. Hello,

    I experienced extreme tooth sensitivity to cold with lingering pain on one of my back molar since last week. Went to my dentist earlier this week and he referred me to an Endodontist for RCT next Tuesday.

    Problem is, since yesterday, I've started to have slight sore throat and a bit of chills. However, no sign of fever. I've also noticed mild pain on the right of my neck near lumph node if I press on it. Should I call my dentist for assistance?

    I've started to rinse with saltine water this morning to ease the symptoms.

    I think I have Irreversible Pulpitis but I'm not really sure. I don't experience any constant sharp or mild pain on my tooth, but it is very sensitive to cold. Also a bit if discomfort with hot and biting.

    Thanks for your informative article and any further suggestions would help.

    Regards,
    Patrick

    • Hi Patrick - Sometimes people don't experience any pain when they get irreversible pulpitis - the nerve of the tooth can simply die without any symptoms. In your case, it sounds like your dentist is pretty sure that the nerve has either died or is dying (irreversible pulpitis) and so he referred you to the endodontist to get the root canal treatment done.

      At each "check-up" at my dental school, we feel the lymph nodes in the neck to check for possible reaction to disease in the mouth. It is possible that the lymph node is associated with your tooth - your dentist or endodontist will be able to give you a better answer since they know the state of the tooth and your medical history.

      I hope that helps and that everything goes well with the root canal. If you have any other questions, let me know. Thanks for your comment, Patrick.

    • Whoa... that sounds like it could be a systemic infection from infectious pulpitis. Chills are a bad sign. You don't need to have a fever to have an infection. Make sure your dentist or doctor gets you on an antibiotic. This isn't something to be casual about.

  20. hi tom its me maria
    i am having pain on hot drinks only that i cant drink coffee at all, went to the dentist he did a cold test on the affected tooth was negative, no pain on percussion no swelling also, it has filling in it but that was done long time, the dentist did a first session of root canal after that the pain was gone i started having coffee.. so my question is that was my tooth nonvital , that it didnt respond to cold test, but how come i am having pain on hot only! thank u

    • Hi Maria - If you are having pain to hot drinks such as coffee, it could be a sign of pulpitis. My guess is that either the dentist didn't remove all of the nerve, or there is another tooth that has pulpitis. Your dentist will be able to perform the various tests to help you determine the cause of your pain.

      I hope your tooth feels better - tooth pain is no fun! Thanks for your comment - let me know if you have any other questions.

  21. I am a retired doc (but dentistry was not part of our curriculum LOL !)
    I had a temporary crown put on my back upper molar for a superficial fracture adjacent to an old large filling. Xray was negative. The dentist said procedure went just fine, but , as I expected, I had pain immediately on that molar but ONLY when I chewed on it.. This has persisted for over 3 wks..
    I have absolutely no throbbing pain, no sensitivity to cold/hot.. only pain on one ridge of the temp crown when i bite down on food. Two days ago ( the day I was to have my permanent crown placed) the dentist decided to adjust the temp, and grinded down one part.. and told me to continue to use the other side of my mouth when I eat and return in one week.
    In my professional opinion ( Obviously your opinion is better than mine ).. I have no signs of irreversible pulpitis. rather.. inflammation of the periodontal ligament. That is what the dentist is telling me.. and that grinding at night may exacerbate things. Woulndt a root canal be worthless ? How long can this healing of the inflammed ligament go on? How about the dentist place the permanent crown , but with temporary cement instead? Your thoughts?

    • Hi Jeff - From the symptoms you describe, I would agree with you and your dentist that it appears to be an inflammation of the periodontal ligament.

      It sounds like your dentist checked the crown for high spots and relieved those, so hopefully the inflammation in the ligament will subside and you'll be able to chew on that side again. From what we've learned, it can take anywhere from a few days to a few weeks for the ligament to heal - it can be affected by grinding!

      It's usually easier to simply have the patient keep the temp on until the dentist is sure that the tooth is healthy and won't need a root canal. If the permanent crown were cemented on with temporary cement, there's a chance that it will fall off and you'll swallow it. Also, the dentist would have to clean out the temporary cement before putting the permanent cement in. During the cleaning out process, it could alter the internal shape of the crown and affect how it fits.

      Hopefully that helps - let me know if you have any other questions. Thanks for your comment, Jeff - I hope you're enjoying retirement!

  22. hi Tom!
    This is one of the most useful sites I have been to. It helped me a lot in understanding a whole bunch of stuff.
    Anyway, my problem started approximately 3 months ago. I got this "discomfort" (i wouldn't say "pain") or this feeling of "increased awareness" of my upper left 2nd and 3rd molars. it was very difficult to locate where this discomfort was coming from exactly. It would come spontaneously in bouts. it would last for several minutes until i forgot all about it.
    The feeling slowly and gradually started to become worse and started to get provoked by chewing gum or anything sticky plus cold stimuli, but not to heat. i also started to feel some pressure on my cheek from the outside in the same area as my affected teeth.
    you see, i have three things going on in that area. i have an overerupted wisdom tooth that is decayed. (its bottom counterpart was removed app. 3 years ago because it was impacted) so it is not opposed by any teeth.
    as for my 2nd molar, it was filled with amalgam app. 5 years ago and now i'm starting to feel the edge of the filling like it moved a bit or something. Also, my dentist way back accidentally drilled through the outer side of the 1st molar and so needed to do some more drilling to reshape the tooth and so now one of the cusps has become sharp and thinner than the other ones. Since that time, I have noticed that food accumulates much more in this area than before (which ie between the 1st and 2nd molar on the outside especially).
    I've never had any fever or chills and the pain has never been severe.
    So... I went to a new dentist coz we moved to a new city and according to him he can't see anything clear in the Xray. He said there are some dark shadows around both molars (2nd and 3rd) but he cant be sure if it is really something or not. The tooth structure itself seemed to be fairly intact with no tranlucencies all through the tooth structure. He advises to remove my wisdom teeth (rt. and lft.) and then check my 2nd left molar for secondary caries.
    i just want to check if removing my wisdom teeth is the only answer coz i have already removed all of my second premolars for braces as well both bottom wisdom teeth, which were impacted. my dentist at the time advised me to remove the upper ones as well and get it over with because according to him they will only cause me trouble.
    but me being me, i told him they are not bothering me right now, i'll just leave them alone.
    my questions are:
    what do u think is the cause of this pain? pulpitis due to secondary caries or maybe pressure on the second molar exerted by the wisdom tooth? (remember that they are over erupted slightly and decayed)
    my problem with removing my wisdom tooth is that i have heard that teeth can be used to be implanted in place of another missing tooth. (also useful for taking stem cells in case it is needed down the road) so what if i have a deep cavity in the second molar, assuming it does have secondary caries, i know this sounds stupid but thats why i am asking you. could a carious tooth that needs a root canal be extracted and the neighboring teeth be pushed together? don't laugh if this sounds VERY stupid. deal? coz i was thinking, the wisdom tooth is carious but not extensively so maybe it can be filled and placed in place of the 2nd heavily carious molar ?!?!?!
    or is there no other way but to extract and just stick to the 2nd molar no matter what it might need (root canal or not)
    what about the thinned cusp? can something be done to it?
    and lastly, the other (right) upper wisdom tooth is also carious but has not been a headache so far. do you think i should remove it or leave it alone or treat it restoratively?
    i know my questions seem silly but i had to ask! thanx for being patient and sorry my message is so long :S!

    • Hi Dilemma - When we find a decayed wisdom tooth, we usually remove it. There are a few exceptions, but usually wisdom teeth are removed because there is no room in the mouth for them.

      Without seeing you, it's pretty hard to tell the cause of the pain. It could be coming from your decayed third molar or it could be coming from recurrent decay underneath the first molar.

      I have read case reports where teeth were implanted in the place of another missing one, but I would say that this is pretty rare and only done in extreme circumstances (like when a child is born with congenitally missing front teeth) and it would probably be hard to find a dentist willing to do this.

      Your dentist can probably replace the filling that is in the tooth with the thin cusp and make it a lot smoother for you.

      It may be possible to extract the second molar and then use orthodontics to move the wisdom tooth forward into the second molar's spot, but you would have to ask your dentist about this to see if it is a possibility for you. I hope that helps - let me know if you have any other questions. Thanks for your comment, Dilemma!

  23. i need your opinion a.s.a.p. coz i have an appointment tomorrow with my dentist and i would like to have made up my mind when i go to see him. thx!

  24. Hello! Such a helpful site. I had a lower left molar extracted last year. On 3/29 I went in to begin work on a bridge. As soon as the numbing agent wore off, I noticed it was sensitive to bite. I went back the next day to have the bite adusted, but it really didn't help. By Thursday, the tooth began to ache, and my dentist got me a script for 800mg ibuprofen and also vicoden, thinking it needed some time to calm down. By Monday, the pain was rather continuous, as soon as the meds wear off it's almost unbearable. I went back Tuesday and the dentist recemented the temp with a medicated cement. I had two shots of numbing agent, and I could still feel the whole procedure. My tooth was in excruciating pain, I almost cried ( and I am no baby about the dentist). Since then, my whole left side of my face hurts unless I keep a steady stream of ibprofen in my system. My cheek seems a bit swollen. Sometimes it feels like the pain is from the injection site, sometimes it feels like the top teeth hurt, sometimes the jaw. It's almost like this phantom traveling pain.....not always seeming to be from the offending tooth. I still cannot chew on the tooth at all. It does not seem sensitive to hot/cold from normal eating/ drinking, but if I hold cold water on that side the pain lingers. I am scheduled to go back tuesday for the perm. What is a reasonable amount of time for a tooth to "calm down" from the prep? If it does feel better, how do I know if it is because it healed vs. The nerve dying therefore the pain is gone? At this point it's been over a week. Thanks!

  25. And some backstory: a few years ago, I had some jaw pain on that side where I could barely open my mouth. My jaw is definitely sore so it is hard to tell what degree of pain is from the jaw vs. Tooth. I have been doing some research and it seems some people get relief once the perm is on because it is a more precise fit. The past few nights the pain is worst in the morning, sometimes I have to get up in the middle of the night and take more ibprofen.

    • Hi Angela - Sometimes when a tooth is extremely painful, it can seem like the pain is coming from different places. This is a concept known as "referred pain." When you go back on Tuesday, your dentist will be able to do some tests to determine whether or not the pain is coming from the tooth (it sounds like it probably is) or from your jaw.

      While it is true that the permanent crown will have a better fit than the temporary crown, your dentist may not want to permanently cement the permanent crown on just in case you end up needing a root canal in that tooth. Usually the tooth will calm down in a few weeks, but it can be different for everyone.

      Your dentist can put some ice on the tooth to make sure that it is still alive. If you feel the cold on the tooth, you know that your nerve is alive, if you don't feel it, that usually means that the nerve has died.

      I hope that helps. Let me know if you have any other questions. Thanks for your comment, Angela!

  26. Hello, I recently had a lower wisdom tooth pulled about 2 weeks ago and ever since then the tooth next to it feels strange. I was wondering if the tooth next to it might have just been irritated by the extraction or was the pulp permanently damaged. The tooth was fine prior to the extraction but now it has this weird like throbbing feeling every now and then but its not a painfull throb. It also feels funny when I cough. I'm hoping that the tooth was just midly irritated from the extraction but im wondering if this is a sign of the pulp of the Tooth starting to die and should i make an appointment for a Root Canal.

    • Hi Tony - Sometimes you can get residual pain from the site where the tooth was extracted. Since there's not a tooth there anymore, the pain could feel like it's coming from the tooth in front of your wisdom tooth.

      Also, there very well could be a problem with the tooth that you still have. A dentist will be able to take an x-ray of that tooth and its root to see if there appear to be any problems. Some tests can also be done to determine if the nerve is healthy or not. In any case, it's usually a good idea to get your tooth checked out when it is hurting.

      I hope that helps - I wish I could be more specific, but it's hard to figure out exactly what's going on without seeing you. Thanks for your comment, Tony.

  27. Follow up on my case ( see above).. I was referred to an Endodontist to see why I was still having bite pain and now sensitivty ( not bad but there) after my permanemt crown was placed on my upper rear molar , but with temporary cement. As you may recall, my crown was done because dentist found a surface fracture during routine cleaning. Endodontist tested me and said that I definitely had reversible pulpitis..and, after doing a bite test, indicated that I most likely had a small residual extension of the fracture that was causing my symptoms ( xrays always negative, and of course fractures not often seen on the films).... What he told me next was interesting---- he said one of two things would happen.. either my pulp was capable of walling itself off from the fracture and my symptoms would subside OR... it would get worse, that I would know it. with increasing aching of the tooth and major sensitivity .There was no middle ground ... If that occurred, then a root canal was indicated. I am sure you have studied this in dental school. what are your feelings about this? I was not aware that pulp could wall itself off and thing could settle down. You have any idea what period of time we are talking about .. for either resolution or progression to needing the root canal? Also, he said that with the root canal , I would no longer have any aching of the tooth nor have any sensitivity issues. He would not rule out some residual bite pain due to periodontal ligament irritation. How on earth could I have persistent periodontal ligament inflammation that does not subside, especially considering I have had no issues with caries, gum disease or abscess? Thanks ... the retired doctor!

    • Hi Jeff -

      Cells in your dental pulp, known as odontoblasts, continue to form dentin throughout your lifetime. When the pulp gets irritated, the odontoblasts react by laying down more dentin to try to get away from the source of the irritation.

      We see this a lot when people come in with a very deep cavity on a tooth - it looks like the pulp has receded away from the cavity.

      Honestly, I'm not exactly sure how long it would take - I know we discussed this in our endodontics (root canal) course. If I'm not mistaken, it can be anywhere from a couple of weeks to many months for the pulp to try to wall off away from the irritation.

      Your periodontal ligament could be inflamed because the pulp was inflamed, because your crown was high, because of the teeth grinding, or because bacteria were able to enter into the crack and irritate the pulp. Depending on how long the tooth was cracked, bacteria could have gotten inside and started the process of breaking down your tooth.

      Hopefully that helps - let me know if you have any other questions, Jeff. Thanks for sharing your experience with others!

  28. Hey Tom,

    First, like everyone else, let me say THANK YOU for providing this source of insight!
    So here it goes:
    I had a 20 yr old metal filling that developed a crack in it. 10 days ago it was drilled out and replaced with a new white filling. After the numbness wore off, I was in some pain - random throbbing in that tooth and some surrounding it.
    I got sick that night with a sinus infection.

    The pain seemed to dissipate somewhat over the next week, but because periodic throbbing and sensitivity to cold was still present, I went back in to the dentist today.

    He adjusted the height of the filling (It was just slightly high in spots).
    When I left, my tooth and jaw were throbbing and still sensitive to cold. It did not bother me most of the day. Then on my drive home from work the pain was constant and very uncomfortable. I took a few Advil when I got home and things seem to be ok.

    Question is - because the throbbing is not related to eating or drinking, can this still be temporary inflammation from the dental procedure done a week and a half ago? The filling was rather large.
    How long should I give my tooth to heal before I consider that I might need a root canal?

    THANKS SO MUCH!

    • Hi Shannon - No problem, doing this is helping me learn a lot more than I would otherwise! I've heard of sinus infections causing tooth pain, but not the other way around. It could be a coincidence that this happened to you or just a rare occurrence.

      Whenever a filling is replaced, more tooth structure is removed. If there was a cavity under the old filling, then all of the decayed portion of the tooth would have to be removed as well. Anytime a dentist drills into your tooth, it traumatizes the nerve slightly. That's why we make sure you're numb, so you won't feel it while we're in there!

      Usually when a tooth is constantly throbbing and causing intense pain, it is a sign of irreversible pulpitis. Temporary inflammation (or reversible pulpitis) is usually brought on by hot or cold and then it goes away. Since you say that it seems ok right now, it could have been pain from the sinus infection. Since I'm not sure how deep the filling was or how close to the nerve your dentist got, I can't really give you a time-frame.

      One time I was removing decay in a patient and we ended up getting to the nerve. We put some medicine in there and it hurt that night, then he said it felt better. A few weeks later, the pain came back and he ended up needing a root canal in that tooth. It's more of a case-by-case basis. Your dentist can do some tests to see how healthy the nerve is and to determine if the pain appears to be coming from your sinuses or the tooth.

      I hope that helps! Let me know if you have any other questions. Thanks for your comment, Shannon.

  29. Thanks Tom.
    The throbbing came back strongly in the middle of the night. When I woke up this morning - my sinus infection is in bad shape. The pain moved to other teeth and then went away after I used a netti pot twice.

    Until I brushed. Now the tooth that had the filling put in is horribly painful - unless there is water on it, which soothes it.

    At this point, I can't tell whether it is a combo of sinus infection and temporary pain from the dental work or a root canal needed.
    If the pain doesn't subside within the next few hours, I will call my dentist to schedule the procedure.

    Thanks again.

    • Hi Shannon - From what you describe, it does sound like you're getting pain from both the sinuses and your tooth. Hopefully your dentist will be able to give you a definitive diagnosis regarding the nerve of your tooth.

      Hopefully everything will work out alright. Thanks for the update!

  30. Emergency root canal scheduled for tomorrow morning. Would've done it tonight if my dentist wasn't at a dental conference. A rush of excruciating pain hit in the mid day and never let up. I am now on Vicodin wishing I had recognized this when I was at the office yesterday!

    Reason to repost... If anyone is in serious pain and can't get to the dentist right away - GET TO WALGREENS and buy DenTek's TOOTHACHE PAIN KIT. There is a numbing agent in there that is stellar. Only $7 and totally worth it!

  31. That's it... though it is only 7.99 at Walgreens. A really good option to have on hand JUST IN CASE.
    Root canal was fine - it was actually in a tooth in front of the one I had refilled last week. One that was showing no signs of decay until all the pain kicked in... Anyway, glad to have it over and be pain free today!

    • Thanks for letting us know! It is a 3-pack at Amazon - they usually sell in bulk. In an emergency, I'm sure you'd want to get it at the local pharmacy anyhow. At least now people know what to look for.

      I'm glad everything worked out with the root canal! Thanks for the update.

  32. Hello....

    I was eating Jordan almonds one evening (very hard) and since then have had extreme sensitivity to hot and cold and also just breathing in air hurts. A visit to the dentist showed no abnormalities to the tooth or sinus. The dentist called it a "virgin" tooth as it never had any work done to it. I have had the pain for about 7 days now. Also my jaw aches. I am assuming I have pulpitis. My question? Will this go away on its own if there is no caries present, fracture to the tooth, etc or do you feel I need a root canal? If it will go away on its own, typically how long will it take to heal?

    Thanks...

    • Hi Lisa - Here's my best guess as to what's happening: When you were chewing the almonds very hard, it irritated your periodontal ligament (Read this article on the anatomy of a tooth). Once your periodontal ligament got irritated, it got inflamed and sensitive to biting - This article has a good diagram of that inflammation.

      Once the periodontal ligament got inflamed, it compressed the blood vessels that go into the tooth, which started hurting the pulp, which would explain the pulpitis-like symptoms.

      Usually once you remove the irritant (i.e. - stop eating the hard almonds!), everything heals up nicely. If you're still in pain, it's probably best to go to your dentist to see what else may be causing your pain. I hope that helps. Let me know if you have any other questions. Thanks for your comment, Lisa!

  33. Hi Tom!

    You are actually the 9th dentist that I'm asking regarding this problem over the last 3 months.

    I have a pain in the top right part of my mounth. According to German classification (I'm not quite sure if this is a universal one) it's teeth 1.6 and 1.7. The pain is rather deep. Until recently it came for a few days only to dissapear for a day or two. Usually it intesified in the afternoon. But since my last treatment two days ago it is more or less constant and I have to take more and more painkillers to keep it at bay.

    Having read everything that I could find online I decided it must be pulpitis. I keep saying that to each and every dentist that I visit but for some reason they ignore it. Probably because they can't find anything on the X-Ray picture (which as far as I know is rather normal in the case of pulpitis). Last Friday a dentist found a small hole in the tooth 1.7. Since then the pain has got more constant. I would assume that the reason is, that the bacteria causing pulpitis have no way to escape. That would actually be a good news, because then I would at least know which tooth is causing the problem. Until now I actually thought it was the tooth 1.6. But in the case of this tooth the nerve was already partly removed (but since the nerve seems to be rather long and twisted, the dentist told me he has to use special equipment to fully remove it which would cost a lot of money) and there is a medicine in it.

    Now I have two questions:

    1. Is it possible that a tooth, in which large part of the nerve has been removed and a medicine put into is still suffering from pulpitis?
    2. At which stage can you actually see pulpitis on the X-Ray picture? The tooth 1.7 was X-rayed two weeks ago for the last time and nothing could be found.
    3. Is my theory, that a stuck hole in the tooth 1.7 is causing the more constant pain viable?

    P.S. As probably everyone else in this forum who has suffered from tooth ache I think you are doing a great job by answering the numerous comments and questions in a very simple and understandable way!!!! This is something that very few of the previous 8 dentists that I visited so far are able (or willing) to do.

    Greetings from Berlin, Germany

    Andrew

    .

    • Hi Andrew - 1.6 and 1.7 is the FDI World Dental Federation Notation. In the United States, we use what we call the Universal System, but I think that most of the world uses the FDI notation, so that makes ours far from universal! In any case, it sounds like your describing the upper right first and second molars.

      When I first read over your symptoms, I started to think of a sinus infection or a nerve disorder. However, since you stated that the pain got worse after the dentist felt around in the hole in your second molar, that leads me to believe that your pain is associated with that tooth. Moving on to your questions:

      1 - It is possible that the part of the nerve that was NOT removed is still alive and is suffering from pulpitis.
      2 - X-Rays are best for visualizing the contrast between hard tissue (bone, teeth) and soft tissue (such as the periodontal ligament and pulp). The only way that we can really "see" pulpitis on an x-ray is when we see a large cavity in a tooth that goes to the nerve, and the patient is in pain.
      3 - Your theory could be correct. The reason that the disease of dental caries is often called cavities is because it really creates a cavity (or a hole) in your tooth. Did your dentist schedule an appointment to get a filling put in that hole, or was it determined that the hole does not need any treatment?

      Thanks for your kind words - I hope that helps. Let me know if you have any other questions. Thanks for your comment, Andrew!

      • Hi Tom!

        Many thanks for the quick answer!
        I just came back from dentist - the 9th on my list:-) Now I'm even more puzzled: after boring a little bit with the 1.7. (which is the first molar I assume) he told me that my pain was caused by an old filling which was hurting the nerve. The puzzling thing is that, I had this filling for at least the last 15-20 years and the pain had only started around 3 months ago. Anyway, the tooth is still aching but I hope now it is caused by the boring. If the pain is finally gone by tomorrow I will be the happiest guy on earth!

        Best,

        Andrew

        • HI Andrew - Thanks for the update. Sometimes a tooth can slowly decay around the margins of an old filling which can cause a cavity under the filling.

          Over the 15-20 years of use you've gotten out of the filling, it's possible that the interface between the tooth and the filling became slowly compromised and allowed bacteria to leak down underneath the filling.

          The average amalgam filling usually lasts a little bit less than 15 years.

          I hope everything works out and you get out of pain. Thanks for your comment!

  34. Hi Tom!

    Here I am again... My case is getting at least fascinating as it is annoying. After around 12 visits by a dentist I do still have pains at the back right top side of my mouth. Now I'm actually sure it's the 1.7 (first molar). The interesting thing is that I had the tooth killed and the nerve removed 5 days ago. And in fact it was ok for the first three days. It was aching a little bit especially in the afternoon, but much less than before. But yesterday I have decided to eat a pineapple: a terrible decision. The pain that usually started to grow around noon, this time became much stronger and it is with me until now, around 25 hours later. It is not a strong pain and its subsides after a few painkillers. But I finally want to get rid of it.

    So here are some questions:
    1. How is it possible that a dead tooth is still aching?
    2. Is there anything else around the tooth that can react to cold drinks or fruit acids? Why doesn't the pain subside after the irritant is gone?
    3. Is there anything else I can do apart from removing this tooth to get rid of the pain?

    Many thanks!

    Andrew

    • Hi Andrew - If you are still having the exact same pain even after the root canal, then there's a few possibilities:

      1 - The nerve wasn't completely removed. You may have had an extra canal in the tooth that the dentist didn't find (sometimes extra canals can hide pretty well!)
      2 - It could be that your occlusion (the way you bite) is slightly off and that is causing the ligament around the tooth to become inflamed and painful.
      3 - You could have pain coming from a sinus infection. Sinus infections make it seem like there is pain coming from a couple (or a few) different teeth even when the teeth look healthy on an x-ray. My wife actually had her first sinus infection this weekend and said it is the worst toothache she has ever had.
      4 - You could have some sort of a nerve disorder where the nerves are sending pain signals when they shouldn't.

      If the root canal didn't take away the pain (and your dentist is absolutely sure that ALL of the pulp has been removed), then it is very unlikely that removing the tooth will take away the pain. Chances are that there is something else that is causing the pain.

  35. Hi again!

    I think I have the answer. After playing Sherlock Holmes and following all traces I come to the conclusion that the problem lies not with the nerves, but the tooth enamel. It explains the role of the pineapple and other fruits which cause the pain. In addition to that, since the pain started I tried to get rid of it by brushing my teeth immediately after eating, which made the problem even worse. The only questions that I'm now asking myself is: why is tooth still aching, after the nerve was removed?

    Best,

    Andrew

    • Hi Andrew - Tooth enamel is a solid, mineral, crystalline structure. It could be that due to your excessive brushing, your gums have receded slightly, and that the acid is irritating the root of your tooth which is not coated in enamel. Since you've had a root canal done on that one tooth, you would not be feeling any pain in that tooth from eating acids if that's what's happening.

      Do you live near a dental school? We do see a lot of patients with tooth pain that have been referred to us by other dentists that can't figure out what's going on. Many schools have highly trained oral pathologists that can usually pinpoint the cause of the pain.

      I hope that helps. Let me know if you have any other questions.

  36. Hi Tom!

    Many thanks for answering again!

    Regarding the causes:

    1. It is highly possible that the nerve wasn’t completely removed. In the second molar (1.6) it was removed only partly because it is situated really deep. I will have it removed completely next week. In the case of the 1.7, I had the nerve removed by a dentist who was taking care of two or three patients at the same time, so he didn’t really take care of my tooth (a kind of McDentist). I will have this one checked as well next week

    2. Regarding occlusion: there is no pain whatsoever when I bite. It appears mainly AFTER I have eaten something – 10-15 minutes later.

    3. I have just read about sinus infection. But apart from the tooth ache I have no other symptoms. I do a lot of sports and feel very well. That is as long as the pain killers work. By the way: sports (i.e.jogging) seem to have no influence on the pain. I think that would exclude some options.

    4. Nerve disorder sounds interesting. I actually sometimes happen to have pains on exactly the opposite side which is also hard to localize. It seems to be situated around 2.6 or 2.7. (top left at the back). It has already been checked, but not as thoroughly as the right side. I wonder if it’s possible, that the main reason for my pain is actually situated somewhere else and its simply the wrong nerves that are sending the signals…

    To sum up:

    What I know now is that the pain appears after I have eaten something. No matter what it is and no matter if it’s hard or not. Since the pain appears with some delay it must be a problem that lies deeper than the enamel. On the other hand since the nerve is (at least partly) removed it must be something in between. What I’m left with is dentin. The question is: can dentin actually hurt?

    My course of action at the moment is to keep taking Calcium and to brush my teeth very carefully. At the end of the next week I will visit a dentist, that has very good references online. I hope that will be the end of the story. I will keep you and your readers updated hoping that this will help others suffering from some mysterious pains. But if you have any suggestions I would be very grateful to hear them.

    Greetings from sunny Berlin, Germany

    Andrew

    • Thanks for the update, Andrew. Hopefully you find out what's causing the pain and can finally get it to stop! I'm curious to find out what it is. I'm leaning towards a nerve problem... I remember we did see someone in the emergency department at our school many months ago and I worked with one of the top oral pathologists in my state. We ruled out everything, and simply couldn't give him a diagnosis.

      Hopefully this new dentist you've found can figure it out! Here's a couple of sources talking about trigeminal neuralgia. Does that seem similar to what's happening?

      http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001751/
      http://en.wikipedia.org/wiki/Trigeminal_neuralgia

      • Hi Tom!

        Luckily the symptoms are much different to trigeminal neuralgia. The pain comes slowly and lasts longer than described on the websites.

        In the meantime the situation in improved, which is probably due to a very strict diet: no sweets and only water and green tea to drink and very careful brushing. In addition to that I'm taking Calcium and use a tooth paste, that should help to repair the enamel.

        In any case I will visit the dentist next week to check what is actually going on inside the tooth.

        Many thanks for your continuous support:-)

        Andrew

  37. Hi Tom,

    I recently had two crowns placed, about two weeks ago. Both were fine while I had the temporaries. Three days after having the placement, one of the teeth became sensitive to bite. It was a sharp pain, only while chewing. I was referred by my dentist to an endo for a root canal. The endo tested the tooth, and all we could find was the pain on biting - she felt that wasn't enough of a reason to go ahead with the root canal. The dentist has checked the bite and it is fine. I'm taking an anti-inflammatory and it seems to be helping somewhat, however there is still a strange pressure feeling when chewing. Today I noticed that the other crowned tooth has begun having the same sensitivity to chewing as the other tooth. What could this be from? Do they both just need to "calm down" after having all the work done? If they do need to "calm down", how long should I give it before pursuing endo treatment? Are these somehow both potentially cracked teeth? Both look fine on x-ray and the dentist says he did not notice any cracks when preparing crowns.

    • Hi Mimi - Since you say that the pain only started after the permanent crowns were put on and only when biting, that would lead me to believe that it is a problem with the height of the permanent crowns (they are too high, which causes you to hit them too soon when you chew, which causes the periodontal ligament to become inflamed and swollen.)

      It could be that they are cracked, but it seems like you would have felt something when the temporary crowns were on if that was the case. If your dentist had you bite down a few times and made sure that there were no high spots, then he also had you grind side to side and there were still no high spots, it's possible that it's not a bite problem.

      I probably wouldn't get a root canal unless I was sure that there was a problem with the nerve on the inside of the tooth. If you and your dentist are positive that it's not a high crown, then I'm really not sure what else it would be since you didn't have the problem with the temporary crowns.

      You've got me curious though! If you end up figuring it out, please leave a comment and let us know what happened. I hope that helps, Mimi. If you have any other questions, let me know. Thanks for your comment!

      • Hi Tom,
        Thanks so much for your response.
        We've checked many times, the crowns definitely aren't high. I was told by my dentist that it could just be temporary sensitivity from all the work that was done. I asked about a timeframe and was told it could take up to three months to settle down completely and be back to normal. I'm willing to wait it out, but three months seems like a long time. Do you think it sounds reasonable that this could just be temporary sensitivity? A cracked tooth has been mostly ruled out for the same reason you mentioned above - no pain with temporaries.
        Also, these crowns were bonded instead of cemented. All of my previous crowns were cemented - do you think the issues I am having could be due to the bonding? Maybe it is more irritating to the nerve as opposed to cement?
        Thanks,
        Mimi

        • Hi Mimi - I think it's definitely reasonable that it could be temporary. Sometimes inflammation of the pulp and/or periodontal ligament can last a long time. It is possible that the bonding is more irritating to the nerve vs. the cement, but I haven't looked into that.

          I hope your teeth feel better! Let me know if you have any other questions. Thanks for your comment, Mimi!

  38. I've been having pain in my second to back bottom molar for nearly 6 months. The pain is pretty constant and gets worse when i put pressure on the front left of the tooth. Chewing on the left side of my mouth has become unbearable. Now here's my background story:

    Last January I finished up braces, I had them on for 2 and a half years, I got them when i was 23 years old. As far as I can remember, the pain in my molar began around then. Just recently it has become worse and when going to the dentist, I told her about my pain. She noticed a crack in the old filling, and decided I need a crown. I also need one on the opposing top tooth. Its been two weeks now since my crown prep, and my back molar bottom seems worse. I woke up tonight in horrible pain and cannot get back to sleep. I can't wear my retainer at all, since it seems to intensify the pain.

    Now, I am getting my crowns put on on Monday, and this is perhaps the last time I can see my dentist before I turn 26 and lose my insurance. Should I ask for a root canal? Would this put an end to this horrible pain? Will this mess up the crown? I need to fix this, and fear if I don't act now I'm going to be forced to deal with ongoing pain, or a large hit to my wallet. Let me know what you think, any help is appreciated. After reading some of your stuff I think it may be irreversible pulpitis caused by my braces. All I know is I haven't been able to eat on the left side of my mouth for a long time now, and it is no fun waking up at 4 am from a toothache.

    • Hi Kyle - Usually when people wake up from spontaneous tooth pain, it's a good sign of irreversible pulpitis. If I were you, I would have my dentist run some tests on the tooth to determine whether or not it's irreverisble pulpitis. If it was, I would try to get the root canal before I lost my insurance. It could have been a combination of the braces treatment and cutting the tooth for a crown. Cutting a tooth for a crown can be so traumatic for the nerve that many times these teeth end up needing to get root canals.

      I hope that helps. Let me know if you have any other questions. Thanks for your comment, Kyle!

      • Thank you for your response! I ended needing the root canal, and may I say its been fabulous. No more pain, I can eat on my left side again, and the crown is perfect! It Feels like a normal tooth again.

        • Hi Kyle - Thanks for the update! I had to have a root canal a few years ago in one of my back teeth and the tooth has felt great ever since.

  39. Hi Tom. Your blog has given me some insight on my current situation. Let me give you a brief history of my teeth. About 2.5 yrs ago, I started invisalign treatment. Everything appeared to be working accordingly until the last 4 weeks. I normally experienced pain whenever I changed my retainer however this pain was different. Whenever I put on my braces, my front tooth (on the right side) began to ache. I experienced a lot of discomfort so I decided to take off the braces to relieve the pain. That was working out for me. I barely ever experienced pain thereafter, but take in consideration, I was not wearing my invisalign trays as frequently because of the discomfort. Two weeks ago, I noticed the same tooth is darker than all the others. The gum line looks semi-gray and the tooth itself is darker. Its not very noticeable, but if you stare at my teeth, the color difference is visible. I visited my dentist within a few days. He took x-rays and discovered that the blood vessels were inflamed. He prescribed sensitive flouride to put into my invisalign trays at night and to take motrin to reduce the inflammation. Yesterday, I saw another dentist who simply said that my tooth is dying and I need a root canal. My dentist which is his colleague said to hold off on doing further tests (such as electric pulpitis test..something like that to check the sensitivity of the tooth) since the discoloration has not worsened and the pain is rare, but present when I tap on the tooth or eat something rough like steak. I never had a cavity on that tooth. Also, I do not recall any trauma to my teeth besides the invisalign treatment. Does it sound like reversible pulpitis to you? Thanks a mil!

    • Hi Lisa - My guess is that the force from the Invisalign pushed the tooth so much that it compressed the blood vessels that enter into the tooth, which caused irritation to the pulp tissue inside of the tooth.

      Fortunately, the discoloration doesn't necessarily mean that the nerve inside is dead. It could be dead, or it could simply have been hemorrhaging as a result of the compressed blood vessels during the Invisalign treatment.

      The textbook Endodontics: Principles and Practice by Torabinejad states, "Generally, intrapulpal hemorrhage is associated with an impact injury to a tooth that results in disrupted coronal blood vessels, hemorrhage, and lysis of erythrocytes (breakdown of red blood cells)...If the pulp becomes necrotic (dies), the discoloration usually remains. If the pulp survives, the discoloration may resolve and the tooth regains its original shade."

      Hopefully your tooth will be fine since it sounds like it is getting better now that you have stopped using the Invisalign trays. From what you've told me, it sounds like there is a chance that it could eventually die or it could get better - only time will tell.

      I hope that helps, Lisa. Let me know if you have any other questions. Thanks for your comment!

      • Hi Tom- Thank you for your knowledge on the topic. My tooth no longer aches unless I eat something very cold which is rare. The top of the tooth, near the gumline is still grayish in color. Is that a sign that it is slowly getting better or getting worse? How long does it take to eventually die? Thank you for all your help!

        • Hi Lisa - I'm glad it helped. If it seems like the gray is going away, it probably is getting better. Your dentist can check the nerve to make sure that it is still alive. I hope that helps! Let me know if you have any other questions.

          • Hi Tom- I really hope that's the case. What is the name of the test to check the nerve?

            • Hi Lisa - It's a pulp vitality test. There are a number of ways that the dentist can do it. One common way is to take some ice and put it on the tooth and see if you feel it. We test multiple "normal" teeth first, and then test the tooth in question to see if it reacts the same way to ice. If it does, more than likely there isn't a problem with the nerve.

  40. Hi, I've just had a deep amalgam filling on one of my back bottom teeth about 8 days ago by a dentist in Glasgow.
    Since having the filling, the side of the gum next to the tooth was inflamed and the side of my face a bit numb.
    The tooth hurt (a lot) when I drive from vibration and also hurts from hot drinks (not cold)
    The tooth has raised up a bit from the other teeth by 2mm
    Another thing that sometimes caused pain was going to bed, but if I got out of bed and sat and watched TV the pain would go after 5 mins, so its like lying down causes the pain.

    I guess i have pulpitis, and after 8 days I think it getting better (but hot drinks are still a problem)
    Do I need to see my dentist again? if the nerve dies and the pain goes can I just leave it?
    I've had root canal on another back tooth years ago, but the tooth sort of raised up about 5 mm above the other teeth and had to be taken out, so i'm not keen to have this done again.

  41. PS just to correct my previous post,looking in the mirror the tooth has not raised by 2mm, but moved to the side by 1 or 2 mm , i.e. it is no longer in line with the other teeth

    • Hi Tim - If the tooth is moving around that much, chances are that there is something wrong. Usually we only see infected teeth move around that much. Also, the numbness and pain from vibration doesn't sound normal. It may be a good idea to check back with your dentist to find out what's going on.

      I hope that helps, Tim. Let me know if you have any other questions. Thanks for your comment!

  42. my name is sairum i am having pulpitis from 2 yrz now.and every time i go for the root canal treatment the dentist gives me anesthesia first but unfortunetly every time i feel throbbing pain when the dentist proceeds with grinding.plz tell mr what should i do to get rid of this problem.ill be thankful to you

    • Hi Sairum - There are a variety of different anesthetic administration techniques to try to get your tooth numb. If you are having problems with this dentist, you may want to try another one. You also could see if they are willing to give you a pill before coming in that would make you drowsy and less aware of what's going on.

      I hope that helps, Sairum. Let me know if you have any other questions. Thanks for your comment!

  43. Hi Tom,
    you are really doing a great job...i have to ask you few questions,as i have my presentation on this topic next week..
    my questions are...

    1.histologically,how can we differentiate between reversible and irreversible pulpitus,if in both cases pulp remains vital?

    2.what can be the complications of both? in case of reversible...if untreated,it will lead to irreversible pulpitis(that's what i understand)and in case of irreversible?(in one of your replies i have read about pericronitis..i will be obliged if you mention some other too in sequence, before RCT.

    3.what are the roles of pulp caping(direct and indirect) in reversible and irreversible pulpitis seperately?

    4.please elaborate the term apexification in context of reversible and irreversible pulpitis?

    5.indications for RCT and when will we go for extraction?

    i will be very thakfull to you if you tell me the answers.

    Ushna

    • Hi Ushna -

      Thanks for the kind words. That sounds like an interesting presentation. Your questions go beyond the purpose of this site in providing dental information to the general public.

      Your best source for the answers to your questions would be any endodontics textbook. The one we use at my school is the endodontics text by Torabinejad, which I found very helpful during our endodontic courses.

      Good luck with your presentation!

  44. Hi Tom,

    Wonder if you can help me. I've been diagnosed with irreverible pupitis caused from a deep filling which I've had for a while and then a bit broke off. Originally tried stick on filing rather than doing the full filling, but this failed a number of times. So the dentist said re-do the filling. In waiting a week my tooth inflamed with great pain and was then told that the only way forward was specialist root canal (nerve is thin and curved) and crown, or extraction (and imlplant later is wanted). The filling is very deep and like a quarter of the tooth missing. Was prescribed antibiotics which seemed get rid of the pain, but not totally. I can function on the current sensations without painkillers at the moment, but it feels far from right, a bit achy, stuill swollen and I'm not eating on that size. I cannot get the canal treatment done at the moment due to my wife expecting a baby which can come in the next five weeks 37-42, plus paternity at least one week as I can't just leave my wife to it all (3rd kid). The first root canal availability is is not for 2 weeks and even if I get it done now there may be problems. I can't get into the chair and then receive a call to get home. If I can put up with the discomfort in the mean time do you think I will be ok if I wait another 7-8 weeks. I still do not know if the root canal and crown root is the best anyway as its it very expensive and apparently tooth is below gumline, so maybe the extraction and implant root is better which is the same price anyway here. Look forward to you comments on my complicated life! Nick..

    • Hi Nick - Sounds like you've got your hands full! If the filling is below the gum-line, it sounds like you're missing a lot of tooth. After a root canal and crown, you'll be left with even less natural tooth structure. That may last only a few years or it could last a couple of decades, depending on the current health of the tooth and how well it's taken care of. An implant would probably end up lasting longer than a compromised tooth.

      Usually it's best to get the root canal done ASAP so that you can get the infection out of your body. I can't comment on whether or not you can wait since I don't know what's going on with the tooth. If you want to keep it, the sooner the root canal is done, the better.

      If it's the same price, I know a lot of people recommend simply getting the implant, since even if you go with the root canal/crown, you could end up having problems a few years down the road and need to get the implant anyway.

      I hope that helps. Let me know if you have any other questions. Thanks for your comment, Nick!

      • Hi Tom,

        Thanks for the reply. I've managed to find an endodondist that will look at the tooth tommorow, so thought it was best to cross fingers and go for this. Apparently they will recommend the best approach and perform the root canal there and then if we go ahead, so I guess if there isn't enough tooth like you say then an implant would be better. I'll wait and see.

        Nick..

        • Thanks for the update, Nick. Good luck!

          • Hi Tom,

            Just to let you know. Saw the guy and at least he was honest and said that the decay was too fair below the gumline, as even after root canal a crown would not work on the tooth, so he removed it for me. At least I can now forget about this all for now and have an implant a little later this year.

            Nick..

  45. About a year ago, I had to replace my invisaligner trays that I've worn for years as retainers. The new trays were really tight even though they were made to use only as retainers. For several months, the only way I managed to remove the upper trays was to jerk really hard in the area of my two front top teeth. Beginning last winter, I began to notice uncomfortable aching in these 2 top front teeth after coming in from walking in the cold which I would treat with ibuprofen. I had never had this type of sensitivity before. I discussed with my dentist at my last checkup a couple of months ago and he concluded it was simply sensitivity to the abrupt change in temperature. Unfortunately, these same 2 teeth have continued to ache even though it's summertime. It happens about twice a week and sometimes there seems to be no precipitating factor. The aching is very uncomfortable and will last for about 5 minutes. I'm going back to my dentist tomorrow, but I afraid that I may have irreversible pulpitis and I'm wondering if I caused it by not removing my trays more gently. Fortunately, a few months ago my top tray finally became easier to remove so I am no longer jerking it off.

    • Hi Michelle - It sounds like your two front teeth got reversible pulpitis last winter. Since your tray is easier to remove now, my only thought is that the Invisalign trays moved your upper teeth into a position where they are getting hit by your lower teeth every time you bite down. This constant hitting could cause the symptoms that you are experiencing. After you've worn the retainer for a while and then bite down, does it feel like your upper front teeth and lower front teeth are contacting a little harder than the other teeth?

      That's the only thing that comes to mind right off the bat. Hopefully the pulpitis is still reversible. Let us know what happens!

      I hope that helps, Michelle. Let me know if you have any other questions. Thanks for your comment!

  46. Hi Tom,

    I had one of the molars on my lower jaw filled on Tuesday. In the couple of days before the filling, that area had been aching intermittently, but I never had any real sensitivity to hot, cold, or biting. After the filling, my dentist told me that the cavity had been deep, and that the tooth might need a root canal--we just have to wait and see while I monitor it closely. The day after the filling that area ached a lot, and I took a painkiller to stave off the pain, hoping that the work that was done to fill the tooth had simply irritated the nerve/pulp. The next day, there was no pain, and I hoped that I was in the clear. This morning, it's aching again. The ache is not excruciating, just bothersome, and is not exacerbated by hot, cold, biting down, or touching the tooth. It's only been two days since my filling--do I wait for this to get worse/better? I'm going to Colorado for the weekend, from tomorrow until Sunday, and my worst fear is that the pain will suddenly intensify while I'm on vacation. I'm also very scared of the root canal procedure in general. I'd really appreciate your opinion.

    Best,
    Mel

    • New development: had a cold glass of water with lunch, tooth was definitely sensitive to it. Not sure if that's the filling or something else.

      • Hey Mel - Thanks for the update - It sounds more like reversible pulpitis if cold and heat bring on the sensitivity. If you're getting spontaneous, excruciating pain then that's a sign of irreversible pulpitis.

        I hope that helps - Thanks for your comment! Let me know if you have any other questions, Mel.

    • Hi Mel - I had a patient that we did a deep filling on and then we put some medicine over the nerve. He said it stopped hurting after a couple of days. Everyone's different and whether or not you'll need a root canal will depend on a lot of factors. If the ache gets excruciating, it's a good idea to call your dentist.

      Since I was taking finals last week, it took a long time to get back to you, so I'm probably too late! Hopefully everything worked out with your trip and the tooth calmed down.

      I hope that helps! Let me know if you have any other questions, Mel.

  47. hi tom
    . in june this year i had a fair bit of dental work done in thailand. this inclued a bridge between molars for a missing tooth (no root canals done) and removal of 7 large amalgam filiings and replaced with white ones. the bridge was installed about 7 weeks ago. i have had pain at the back molar ever since. i think it is gradually decreasing( gradually ). i have been in email contact with the dentist who says ,( excuse the english)
    "we are sure that the tooth preparation during the procedure of the bridge work was done completely, with NO deep damage to the teeth. Anyway, the type of the cementation to insert this bridge is called the resin cement (Panavia-F), which is the strongest cementaiton, but this is the mild acid, and this may cause the reversible pulpitis. However, as our natural teeth are alive, it takes time for the healing, and the tooth can be turned to normal. We would like to ask you that the pain from then has be constant , more or less. Do you feel the pain during sleeping at night too?"

    what do you think???

    yours painfully
    mark

    • Hi Mark - If the pain is constant, it could be a sign of irreversible pulpitis. If it is only brought about by things you do (like chewing, cold temperatures, etc.) then it could be reversible pulpitis. It is possible that the nerve of the tooth is also slightly aggravated by the cement that was used. Another possibility is that the bridge is slightly high, and it is damaging the ligament around the tooth every time you chew.

      I hope that helps - Thanks for your comment, Mark. Let me know if you have any other questions.

      • hi tom'
        thanks for that, if it is the cement that is slightly irritating the nerve is that likely to resolve itself over time??
        thanks again

        • Hi Mark - My guess is that it would resolve over time if it is just slightly irritated from the cement. Many times teeth that are prepared for crowns and bridges do end up needing root canals.

          I hope that helps - let me know if you have any more questions, Mark.

      • Hello Tom, in your reply you said "If the pain is constant, it could be a sign of irreversible pulpitis. If it is only brought about by things you do (like chewing, cold temperatures, etc.) then it could be irreversible pulpitis.

        It seems like you were going to say if this then its irreversible and "if only" this then reversible?

        Letr me know, thanks.

        • Thanks for pointing that out, Frank! That should have been "reversible" in the second sentence. I updated it above.

          • Dear Tom, I also wanted to comment that this blog is very useful for those of us experiencing dental discomfort, thank you for your help and insight.

            In my case, an old filling caused the rear molar to crack and break off. There was no real pain, except at the moment it happened. A couple of day later the tooth was prepared for a crown. There wasn't any evidence of decay or deeper cracks under microscopic exam. Everything looked pretty good. The temp was fitted and then over the next four day the tooth became very sensitive to compression only (sensitivity to hot or cold - very little to none). I had the height adjusted and was told if it didn’t improve I should see a root canal specialist. It was recommended I start taking antibiotics and anti-inflammatory ibuprofen. There have been improvements in my sensitivity to compression, but it is very slow - as in roughly 20% less in five days.

            I know the science of sensitivity isn’t exact and everyone and every situation varies. What are your thoughts on how long I should give this tooth a reasonable chance to settle down? Also, I see where you commented on the use of antibiotics before, what your thoughts on that in this situation? And lastly, please comment on ibuprofen as helpful or not.

            Respectfully, Frank

            • Hi Frank - Your dentist should be able to perform some tests to see if the nerve is healthy. If not, you may need a root canal. Sensitivity on biting usually indicates a crack or inflammation in the ligament that surrounds the tooth. Since every tooth is different, I can't give you an exact time frame, but some of my professors have recommended a few weeks to wait for the ligament to heal. The fact that it seems to be getting better is encouraging.

              Ibuprofen is anti-inflammation. It can help relieve pain, but the best way to resolve a problem is to find the cause and eliminate it rather than "bandaging" it with a drug.

              I hope that helps - Let me know if you have any other questions. Thanks for your comment, Frank!

  48. Hi Tom,

    I had a filling for a deep cavity about 5 weeks ago. Following this, I experienced a small amount of pain when biting down on the tooth in question, particularly when eating hard foods, but it was only when it hit one small sensitive part of the tooth. I went back to see the dentist 4 weeks later, as this didn't go away and was worried there was an underlying problem. He did an adjustment to the tooth, right on the sensitive spot which hurt a lot. Ever since then I have not been able to bite down on the tooth at all, or even brush it properly. There's no real hot and cold sensitivity, or lasting pain, but quite severe pain when I bite on it. Today I also noticed a bit of tingling in the tooth/gum.

    Do you think this could be reversible (or irreversible) pulpitis, or is it more likely to be a result of a tooth fracture or something else? Should I try and wait it out for a few weeks or go back to the dentist?

    It might also be worth mentioning that I am half way though a course of antibiotics to treat a bad cold.

    Thanks,
    Sarina

    • Hi Sarina - Is it in pain all of the time, or just when you bite on it? Constant pain usually indicates irreversible pulpitis. If it only hurts when you bite on it, there is a chance that it may heal.

      I hope that helps - Thanks for your comment, Sarina. Let me know if you have any other questions.

      • Thanks for your reply Tom.
        It only hurts when I bite down on it, but some tingling/throbbing has also started, which is not painful as such, but I am worried it is getting worse. How long does it usually take for irreversible pulpitis to take hold? Its been 5 days since my visit to the dentist.

        • Hi Sarina - The length of time it would take depends on many factors. If you don't feel like it's getting better, then it probably isn't and you might want to check with your dentist on what your options are at this point.

          I hope that helps - Thanks for your comment, Sarina. Let me know if you have any other questions.

          • Hi Tom,

            Just to let you know, I went back to the dentist, had the tooth x-rayed and checked for fractures, and the dentist thinks the sensitivity will heal itself with time. Thanks for answering my questions though, this has been really helpful!

  49. Dear Tom,

    I am in my mid fifties with a mouth full of large fillings and crowns.
    In the past 3 months I have had irreversible pulpitis in two molars, in teeth with existing crowns. I am coming to the end of a root canal treatment in the second tooth (first one done about a month ago). I now appear to be developing irreversible pulpitis in yet another tooth.
    Is this unusual? Anything to be worried about (besides the cost in money, pain and time)?

    Thanks for taking the time to answer my question.

    • Hi Paul - It does seem rather unusual to have this happen all of the sudden. Do you know if you've changed anything in your diet or oral hygiene routine? Also, grinding your teeth can cause pulpitis due to the inflammation it can cause in the ligament that surrounds the tooth.

      Did the dentist say whether or not there was decay under the crown? Did the dentist simply go through the crown to do the root canal or take it off?

      If anything comes to mind, let me know.

    • I sympathize with you. I had this happen to all my teeth after taking care if them for 56 years. Hygenist did rough cleaning. Teeth are cracked and I noticed fillings darkened and one tooth looks broken. I have been suffering for 2 years. Dentists only want to clean. They are blaming my body but it is the teeth. Had a bite made for bottom teeth which are sharp and shifting. The mercury fillings are now black when they were silver before the cleaning. I have the chills sore throat redness in face that I can't even wear my glasses or contacts. Pain is constant and all my teeth are shifting and mouth swollen. Despite not being able to enjoy food, protein shakes gritty. Sensitive to all temperatures, air breathing and my tongue and lil's cause pain. Teeth are translucent some are gray or blue green. Was with my dentist from 1972 to 2011. I told him I did not want to lose my teeth. He abandoned me after he fired Hygenist that did this to me. Endontist did not want to see me. Please advise what I can do difficult to speak with structural changes. If anyone would like to discuss this drop me a line. Looking for. Info on tests to check for oshmelitis of jaw, infection lock jaw, Ludwigs angina as neck is swollen. No pain relief with OTC and unable to take stronger due to reaction of vomiting. Pain is unbearable and my face jousts hangs like a crown and when I smile lips all crack due to swelling. Pain giving me headaches, neck and joint pain. On east coast will travel to find the best team of doctors, surgeons etc.

  50. Hi Tom,
    Thank you for this wonderful site. I usually do not have sensitive teeth. However, I guess for a while, I don't really know how long, there has been some bite sensitivity (not even pain) on a section of my crowned molar 19. For the first time, I felt heat and cold sensitivity when eating. I felt more heat than cold sensitivity. I went to the dentist to check it out. I didn't take advil or anything to see if the temperature sensitivity would go away by using advil. I forgot to tell the dentist that I had some bite sensitivity (only sometimes and only in a certain section of the tooth) and was more focused on the heat sensitivity. He took an xray and said that there was a slightly darkened section of the root on that tooth that looked suspicious. However, I'm pretty sure he said that he didn't see signs of an infection. He said that when there's heat sensitivity, that's a sign that the nerve is dying. He wanted to get me to an endodontist which I did. I have no pain in this tooth. The endodontist did some sort of cold test which did not make me uncomfortable at all. He also took xrays and said that the dark section of the xray indicated that the tooth nerve was dying. He said the heat I felt was from methane gas releasing from the dying nerve. He recommends a root canal. Could the dark part of the xray simply be reversible pulpitis or can he tell from the xray that it is irreversible? I thought he didn't see infection either. He would recommend antibiotics if he did, right? I thought he said the root looked a little narrower to him at the bottom. The other root is healthy in the tooth. The plastic bite test where the sensitivity is shows the area near the nerve he's talking about. Root canals are permanent so I don't know if I should wait to see if I can get better. The heat sensitivity has gone away. I think it happened after a night of clenching my teeth. I've been eating on the other side to try to rest that tooth. Is there an advantage to having the root canal right now? It just seems strange to have a root canal when I'm not in pain.

    • Hi Lena - You're welcome! It sounds like you do have some pain since you aren't eating on that side. It is possible that there is a problem at the end of one root, and if that's what the endodontist and your dentist are suspecting, then it is probably a good idea to get the root canal. Sometimes antibiotics are recommended, and sometimes they are not - it is usually determined on a case-by-case basis. I would imagine that the dark section of the x-ray is an inflamed periodontal ligament, which could indicate a problem with the nerve, or could indicate that it is under stress due to a high crown (which may be very unlikely if you've had the crown for a long time and haven't had nay problems.)

      I hope that helps, let me know if you have any other questions.

      • Thanks so much Tom. Do you know what it means when they also see calcification in the xray?

        • Hi Lena - In your case, they probably mean that part of the root canal in your tooth is calcified. This means that the pulp inside of your tooth has built up so much dentin around it that the canal is almost closed.

          Take a look at this post on the anatomy of a tooth, then imagine the root canal portion to be very skinny and nearly closed off by dentin. This is what I would imagine they were talking about with respect to your teeth.

          I hope that helps, let me know if you have any other questions.

          • Thanks Tom. I had the root canal which I am told went well. What made this whole thing so confusing is that I never had pain. When I had a previous root canal, I had that twinging pain. This was just some sensitivity occasionally and sometimes a funny feeling when I bit a certain way on the tooth (but not often). I was told that the heat sensitivity indicated the tooth was dying. Because I never took advil before seeing the dentist to see if the inflammation went down, I didn't feel I gave advil and resting a proper chance to work. I noticed the heat sensitivity after a night of clenching my teeth. It lasted for a few days but I didn't realize to stay off that side and avoid hot drinks. I've learned a lot. I know there were no signs of infection, so I was confused why it was considered irreversible. I was told the nerve was slowly dying. I figured it was probably better to do it sooner rather than later, but I didn't know if I was jumping in too soon. I also was told that flying can make these things worse and I didn't want to have an issue abroad. I've traveled a lot since this thing started about a year or two ago and never had a problem. Because it never really hurt, I was very confused. Your site is wonderful and I have learned so much. You are pretty amazing to be answering all these questions and going through your program. I'm sure you are going to be a really great dentist someday. Your caring for people comes through.

  51. Just adding, I believe the part of the xray shows inflammation, correct? Wouldn't a nerve on an xray appear inflamed whether it's reversible or irreversible pulpitis?

    • Hi Lena - The only way we can see inflammation on the x-ray is if the ligament is inflamed around the root of the tooth. If that looks wider on an x-ray, then it is probably inflamed. The nerve always looks the same, since x-rays are best at showing bone and teeth and not so good at showing the softer tissues of your mouth.

      • Hi Tom,

        Thanks for this wonderful sitel I sent a brief email the other day, but wanted to send it from the direct thread and with more info. I had the root canal almost 8 weeks ago and had to go back the next day to have the temporary filling adjusted because the bite was too high. The tooth didn't feel normal in the way that my upper molar root canal (years ago and that had a sharp pain) felt normal quickly. The next week my dentist filled in the crown with the permanent filling (it was drilled down the middle). I would think by now my tooth should feel like the other teeth, but it doesn't. I feel something when I floss that I don't with other teeth. I also feel that strange discomfort when I run my finger on the crown on the side by the cheek. I don't feel pain when I bite down. When I suck my teeth (pull the cheeks in and suck up), I feel a strange sensation in the center of the tooth - almost like the feeling when a cavity is loose. In addition, I think the bite on that side is off now. I feel like he reduced the bite on the crown so that the teeth immediately in front (particularly the top) have too much pressure on them. I clench my teeth at night and wonder if this can affect a root canal tooth. However, this tooth has never felt "normal" since the root canal. It feels normal while resting and while brushing. I am not in pain, but I just don't want to risk something being wrong and getting worse. I could have lived with the tooth before the root canal but chose to do it because the endodontist said the root would ultimately die. What are the possibilities of what could be going on? If there is a fracture of the tooth that they missed, what happens now? This is the first time this dentist has done work on me so I don't have a long term relationship (I moved). Can he add more filling to the crown to build it back up? If there is a minor fracture, is there any danger with living with it? I know my bite is off because I am resting my mouth lately without the teeth resting against each other. I am only noticing the bite issue within the last few weeks. I can't remember if this dentist took an xray after he filled in the crown. I don't think he did. Is it possible that some infection took place within the week I had the temporary filling? I didn't take anti-biotics. Is it possible that this is just the gum somehow still healing? By the way, someone said that dentists affiliated with Pankey are really good. Any thoughts there? Also, an aside, seeing some dentists advertise same day crowns with an E4D machine. That seemed strange to me because I thought there was a benefit to living with a temporary crown before the permanent is glued in. Also, any over the counter night bite plates you recommend for clenching. I ultimately want a dentist to make one for me. I really appreciate any info you can provide.

        • Hi Lena - The tooth may need some time to calm down after the root canal. It can cause problems if the crown does not fit with your normal bite. If it is too low, it can put extra stress on your other teeth. I can't recommend any OTC night guards, since I don't have any experience in that area. Personally, I would want something that fits exactly over my teeth while I'm sleeping - it would make me feel safer.

          The Pankey Institute aims to provide dentists with more knowledge to treat more complex dental problems, but I don't have experience dealing with a "Pankey Dentist" I hope that helps - Let me know if you have any other questions. Thanks for your comment, Lena!

          • Hi Tom,

            Hope you are having a wonderful holiday season. I have a very old amalgam filling in a different molar that may have some decay. A tiny piece of the tooth fell off and I know I need to have either an inlay or a crown or something like that because the original filling was so big. The upper molar next to it also has an old filling in it, although that tooth seems to be fine to me. One dentist not convenient to me geographically suggested I have crowns put on both of them because I think he saw cracks as I am a clencher. (However, I find the night guard he made for me pretty uncomfortable). I am trying to decide between two dentists in my area to do work. I am concerned about pulpitis as I read this often happens after dental work so I want to choose the best dentist for me as I know doing nothing is not an option. One dentist does same day crowns which are developed in his office through an E4D dental system that involves digital scanner, virtual design center, and a milling unit capable of fabricating porcelain restorations. The other dentist uses a traditional system of temporary and then the lab providing the permanent crown. The promotional literature for the E4D system says that you minimize potential problems while wearing a temporary. However, I wonder if gluing down a permanent crown right away is problematic (although I think his office said that if they see a problem with the tooth they can use temporary cement). I don't know how to make the decision. Is a potential pulpitis problem with the tooth more how the dentist does the cutting of the tooth? Is the tooth cut the same way whether you use a same day system or use an outside lab? Any thoughts on this?

  52. Hi, Tom -

    Thanks for this site ... I've been learning more just reading through it!

    Lately I've been experiencing some pain that I can't quite figure out what the origin is. Are you ready for the saga? =)

    In the spring I had a root canal performed on my #2 molar, and a crown placed over it as well my #3 and #4 molars. The cavity in my #3 molar was only 1mm away from the pulp, so I was aware that a root canal might be required, but we were hoping to avoid it. Earlier in the spring I also had three somewhat large fillings placed in my #29-31 molars. (Yes ... it's payback time for not having visited the dentist while I was a poor college student!)

    Everything was healing nicely. My #3 nerve/ligament was sensitive while chewing (hard/tough foods especially) but it was getting a little better daily. Encouraged, after a couple months I began to wear my bottom retainer again at night, just to keep my teeth in place.

    After a couple weeks of wearing the retainer at night, my bottom teeth (specifically the two teeth that the bracket clips onto) began hurting. When the normal dull ache of moving teeth escalated into pain on the whole right side of my lower/upper jaw, I stopped wearing the retainer. The pain in the lower jaw mostly subsided, but the pain in the upper jaw did not.

    Currently, I can go several days with nothing hurting and it never hurts to chew (I'm still a bit sensitive on the right side, compared to the left, though). However, inexplicably, the pain will come in my upper jaw (and sometimes my lower jaw) in the form of a throbbing, aching, intense pain. Sometimes it lasts only 5 min. and sometimes it lasts hours. This has happened several times at night, thought not every night; several times after eating, though not every time; once while driving from elevation into the valley; and once after eating ice cream. Ibuprofen takes care of the pain. When I wake up in the morning, my bite often feels a little off on the right side, then adjusts throughout the day to feel normal again.

    Unfortunately, I can't decipher which tooth is causing the problem. Of course, I'm very suspicious of #3 but it doesn't hurt at all when I tap/wiggle it (none of my teeth do). My gums aren't red/swollen and I definitely don't have any externally visible abscesses.

    Any thoughts? I appreciate your input - I live in a rural, isolated area, so there's no such thing as a "quick trip to the dentist"! I already have an appt. on October 26, so I'm trying to figure out if I can wait until then or if there's something serious going on that I need to see him about before then.

    THANK YOU!

    • Hi Vanessa - When you had the crowns placed, the laboratory put the grooves and cusps in line with how your bite was. I am guessing that wearing your retainer may have thrown off the bite that the crowns were fitted to. Also, the brackets on the retainer were probably putting a lot of force on those teeth, causing painful inflammation in the ligament.

      If I had to guess, it sounds like it may be a problem with your occlusion (how your teeth come together.) Do you know if you grind your teeth at night? This can cause pain similar to what you describe. You can ask your dentist about it and have an appliance made that you wear at night (similar to a retainer) that may help solve the pain that you're feeling.

      I hope that helps, Vanessa - Thanks for your comment! Let me know if you have any other questions.

  53. Hi, Tom

    I think I have irrevesable pulpitus now. I am travelling for work and am in Japan. I saw a dentist here and they want to give me two days of antibiotics and I think grind down a tooth. The antibiotics are strong enough that I will need a stomach calmer (prevent vomiting i think)...

    I would do the antibiotics, but Im not keen on getting a root canal here. Do you have to do a root canal right away, or will the antibiotics help kill the infection, and I can wait a week till im back in Canada (home).

    The pain is severe, and the flight here 3 days ago was insane for pain. Constant cold water flushing helped. THe dentist here found a cavity on the tooth with the problem. The cavity was from at least 3 years ago if not more... I am currently using a oral gel pain killer that numbs the area, and it is working really great... a phamacist in Tokyo gave it to me, and it is for tooth pain specifically.

    My hope is to not have surgery here, With all my options and the up coming plane ride in two weeks back, what should I do?

    Thanks
    Rob

    • Hi Rob - The antibiotics may help fight the infection so that you can have it done when you get back home. I can't say anything definitive - you would have to ask the dentist who examined you in Japan to make sure that you'll be fine for a couple of weeks.

      Hopefully the antibiotics have helped already since I'm a few days late replying to this - let us know how things go.

      I hope that helps - Let me know if you have any other questions. Thanks for your comment, Rob.

  54. Hello

    Just over a month ago part of my filling in my upper second premolar fell out. I had it replaced by an emergency dentist. However, three weeks later I was still experiencing pain when biting, sensitivity to cold as well as occasional mild ache at night.

    Last Tuesday I saw my regular dentist who after a thorough examination and an x-ray couldn't find anything wrong with it. He replaced the filling, putting in a lot more insulation. He concluded that liquid might have got into the tooth when the emergency dentist placed the filling.

    The tooth is no longer sensitive to cold and it doesn't hurt at night. However, I still cannot bite on it. Even if I apply pressure with my finger to one particular spot on the tooth, I feel pain.

    Is it something that will go away on its own? The dentist mentioned that if the pain persists I might need a root canal treatment. What are your thought as to the cause of this pain? Is it pulpitis (reversible?)? Or could it be a crack (I'm told the walls of the tooth are very thin)?

    Thank you very much in anticipation of your assistance.

    Kind Regards

    Joanne

    • Hi Joanne - It could be a crack in the tooth that is causing your pain. There's also a chance that the original filling was high and that caused the ligament around the tooth to become inflamed and sensitive. That will usually resolve as long as the filling isn't high anymore. Hopefully it's feeling better by now - If not, your dentist may have some other ideas since he has seen the tooth.

      I hope everything works out well. Let me know if you have any other questions. Thanks for your comment, Joanne!

  55. For years now I have had a lot of pain around tooth #3/#2. Just spontaneously happened one day sitting at my desk at work. A year before I had some dental work done on #2 so I thought that there might have been repercussions from that(amalgam removal). Also a week before the pain started I just got over a bad head cold. Have had many bad head colds through my life but never any dental pain resulting. I could not precisely localize the pain, but it was certainly #3/#2 region. Throbbing and cold sensitivity....but constant pain. No heat sensitivity…never has been, even at the endo office with heat test. Tooth #2 had a history of multiple fillings and #3 has no history of dental work. So about 8 months after the pain started I had a root canal on #2 which did not resolve my problem. The cold sensitivity went away for one week but came back. I got some second opinions. One dentist that I saw did a nerve block(to block throbbing sensation) in the upper right and it actually exacerbated the throbbing immensely. I had a cone beam ct scan which showed no issues with the teeth, but some sinus thickening and small air fluid level. Had ENT visit and sinus CT showed thickening and small fluid level as well, but ENT doc said it would be unusual for the intense pain I have to be caused by somewhat milder thickening and fluid level. Another ENT doctor agreed. I went for a second opinion with another endodontist probably eight months after the root canal. He said I did have irreversible pulpitis at #3 because of the exacerbation of the pain after cold was applied. Negative on percussion. Negative on x-ray. He said the root canal on #2 was well done and no retreatment was needed. No crown was ever put on #2 however. I ended up having tooth #2 extracted because many months after the root canal it started to hurt when I bit on it as well as pushed on it. Some of the dentists noted pocketing as well on that tooth. The extraction did not help, but the oral surgeon said there was some infection above the tooth that he cleaned to the bone. I have neither biting pain on #3 nor pain when I push on it. I have had extreme sensitivity to cold at that tooth. The pain can be spontaneous as well. Food hitting the gingiva at the extraction site can also trigger throbbing. Throughout this ordeal the quality or type of pain has been the same.

    It is very worrisome and a bit depressing because I think I had the wrong tooth(#2) root canalled and extracted. I have had some dentists tell me that even cold sensitivity is not definitive for a root canal issue(on #3). I am scared that if I root canal #3 and the root canal "goes south" so to speak, I would have to extract that one and that leaves me with no upper molars on the upper right side, so my chewing and smile would go out the window. I really don’t know what to do. The dentists seem to be stumped but it seems the cold sensitivity is enough to be definitive in my layperson opinion. I even have seen an oral pain dentist (and still consult with him) and he said that unless it is radiographically evident of a problem at #3, I should not proceed with anymore work. He also said the cold sensitivity would not be definitive as well, even though it is a trigger. I certainly want to have this taken care of but chasing pain also has me cautious. I think my issue has become much clouded. I feel that if I had not extracted #2, I would feel much more comfortable root canalling #3. Recently I had #2 exposed root surface covered with composite and cold sensitivity is almost gone, but pain remains. This has been over 3 years now. It is looking like it is neuropathic but I am still skeptical.

    • Hi Al - It looks like you've tried just about everything. You've been to people with much more experience than me, so I don't think I can be of too much help. When you say you went to an oral pain dentist, are you referring to an oral pathologist? Have you tried getting the exposed root surface of #3 covered with a composite filling to relieve the sensitivity? I wouldn't go beyond that because it doesn't sound likely that you need a root canal on #3.

      I'm stumped as well - if you end up figuring it out, please come back and leave an update. Thanks for your comment, Al. I wish I could be of more help - hopefully you get everything figured out and the pain eliminated. Tooth pain can be awful.

      • Thanks Tom. I did have a composite cover put on #3, not on #2 as I said in the previous post. Tooth #2 is gone! The composite cover helped with cold sensitivity to a good degree, but I still have pain of course, but at least a major trigger has been removed. The tooth NEVER had any heat sensitivity and my endodontist said heat would determine if the nerve is truly dying. she says heat is her prefered way of pulp testing. One concern I had is that now a composite cover is over the exposed root of the tooth, I will be masking any pulpal issue I may have. If I go to the endodontist again and my x-rays are negative, it seems like the endodontist will not have much to work with since the composite material protects from thermal sensitivity and thermal tests are something they diagnose with. Does that make sense? Also if tooth #3 had a crack for this long....almost 4 years of pain, wouldn't it show by now in the many x-rays I have had in 4 years or at least it would hurt when I directly bite on the tooth....which it does not. Also, I see an orofacial pain specialist and not an oral pathologist.

        • Hi Al - The thermal tests are designed to go through the solid tooth structure and heat up/cool down the nerve to get a response. The composite over your root surface shouldn't affect that test. The root sensitivity you were experiencing was more likely due to open dentinal tubules, which are direct connections to the nerve - now that those are covered up, your sensitivity is gone.

          Cracks can be tricky to diagnose. They don't show up on x-rays usually. One good test to determine if the tooth is cracked is to have your dentist shine a bright light through it to see if the light travels through the tooth evenly. If it doesn't, there's probably a crack. This is known as transillumination. Another test is a special bite stick designed to put pressure on various points of your tooth to pinpoint the location of the crack. If you can't get any pain response when you bite on your tooth in different spots, then it probably isn't a crack - just an idea.

          In any case, it doesn't sound like the pain is coming from a tooth. Hopefully you'll get this figured out. I wish I could be of more help - Thanks for your comment, Al.

  56. Hi Tom,

    I have a question for you.

    Last week I had an appt with my dentist because a white filling came out, no pain or anything. It was a large filling, well to me, in that from my vantage point it covered the whole left side of my tooth (bottom left, far back molar, the molar before the last one, no wisdom teeth present), so it covered the whole left side and the the side of the tooth that meets the tooth in front of it. He put in an amalgam filling. The appt took literally 15 minutes for him. 5 minutes to numb, 10 minutes to refill the filling. He made it seem no big deal. Although he did say that the filling required an amalgam.

    For that day after the numbness wore off, and the next day, I had a painful gum, sort of like the gum was being pinched. Tyenol immediately helped. The gum pain then went away. Everything was fine.

    So now my head is WAY below my body and when I do that the tooth beings to hurt, within minutes. But when I sit up the pain is gone within several minutes, maybe 15 or so, no medicine needed. I mentioned this to the dentist this morning, at my cleaning and asked if the bite was off and his exact words were "there is no occlusion there". I don't know what that means, but he basically said it is not applicable here and he said my gums look fine and there's no problem with the tooth.

    So to reiterate, I have no pain at all during the day, nor in the evening, nor when I eat or drink anything, nor when I bite or chew, it's only when my head is lower than my body. As my comedic father would say, well, then don't lower your head lower than your body, but that is beside the point, I want to know WHY it hurts. What is it about the blood getting to that tooth that hurts so much? It does NOT hurt if I lay like normal with my head on my pillow, only when the pillow is removed and I am flat on my back with a pillow underneath my lower half. I cannot bring myself to say this to my dentist, even though I adore him, because I am too embarrassed. Can you offer any insight? Well, as much insight as can be gleaned over the internet without seeing someone.

    Thank you so much! Kindest regards, Ann

    • Hi Ann - Once you post the comment, it goes live on the site once you make it through the spam filter - so it posted, but I edited it for you! Let me know if it's alright now :-)

      My only guess is that the tooth is slightly irritated from the filling, so it's already a little bit more sensitive than your other teeth and when the blood rushes to your head, it forces more blood into the nerve of the tooth. Normally, when parts of our body get too much blood, they can expand to compensate for the increased volume, but the nerve of the tooth is encased in a tooth that doesn't expand, so it stimulates the nerves in the tooth which send a pain signal to your brain. That's my theory. Hopefully it made sense!

      When your dentist says, "there's no occlusion there" it means that the teeth aren't touching together when you bite together so there's no points abnormal points of contact that would be causing pain.

      I hope that helps - Let me know if you have any other questions. Thanks for your comment, Ann - it was probably the most entertaining one I answered today!

  57. I am so happy to find this. I'll be as brief as possible. I visited a high end dentist. She replaced all of my fillings (for several reasons). All teeth are virgin otherwise. After replacing them, some large, she said I could wear my Essix retainer. My teeth felt like someone had a pair of pliers and squeezing them. Additionally, the Essix retainer I received was so painful to put in my mouth it felt like my teeth were going to burst PRIOR to the fillings. The ortho didn't seem concerned. My dentist said that ALL OF MY TEETH have some form of cracking (craze lines - some legitimate cracks). I never had them prior to the ill-fitting retainer. That's when I sought the cause of my pain. The essix is a C-plus btw. Back to the DDS who replaced the fillings. She said my pain was because of tooth movement not that the teeth expanded with the new fillings which was what I thought. In any case. The retainer "eventually fit" meaning, the tightness went away. Now, the retainer is very hard and has not cracked. However, when the retainer is out of my mouth - now I have pain - all day and hurts to breathe, eat or drink anything. I require percocet. My incisal edges as can be seen on the models I have, are splitting on the incisors. I DON'T clench and I wear nightguard and take flexeril. I'm very scared because I'm noticing more cracks in my teeth - lingual sides of laterals and incisors and canines and bicuspids. Is it possible to have irreversible pulpitis? Is the ill-fitting retainer what caused the cracks. It's been 2 years since the fillings. My DDS dismissed me because she thinks it's in my head. It's not. I would like your feedback. Thank you. PS. I have clinical photos to share if interested.

    • Hi Jeff - The Essix retainer should have been made on a cast of your teeth, so I'm not sure why it wouldn't fit well unless it hadn't been worn for a while and your teeth had time to start shifting back to their old position. I do question why you had all of your fillings replaced - each time a drill touches a tooth, it can traumatize the nerve and can cause pulpitis (usually reversible if any.)

      Another possibility is that the forced movement of your teeth caused the ligaments to become inflamed, which interrupted the blood supply to the nerve of your tooth, which could cause pulpitis. I have not heard of a retainer causing craze lines - my understanding is that these occur from short "bursts" of force like when chewing on ice or grinding your teeth. As people age, they also tend to get more craze lines due to the age of the enamel.

      I hope that helps, Jeff. Let me know if you have any other questions. Thanks for your comment!

      • I just saw your reply. Glad I found it. Let me answer some of your questions. Yes, the retainer was made on my teeth. I know from my research (directly from essix) that if the retainer is removed from the cast before cooled completely, it can shrink. This essix was made and given "immediately" after debonding (impression take when brackets off, teeth cleaned - and not done well). I had all of my fillings replaced because they were old and I was told composite last 7 years and since one was leaking, I thought all would leak since it had been 16 years old. My question would be - why wouldn't a dentist advise against it with the same feedback you gave upon me asking?

        I don't think it was inflammed ligaments because there was no tooth movement since it had been just minutes from debonding to placement.

        According to David Clark, prothodontist who specializes in cracked teeth (lecture circuit) he said that teeth, when compressed, will "tend" to crack at the incisal or cusp edges to relieve the force. So my theory is the retainer was removed prior to complete cooling due to the fact it doesn't fit my model or my teeth and due to the high degree of compression, the pressure had to relieved - according to David Clark - the incisal egdes. My theory is wearing the retainer at night and (perhaps) clenching (though a sleep study revealed not a single evidence of grinding/clenching - but I'll work with the "go to" that DDS seem to suggest as a cause - that "if" I did clench that the 'extra' compressive forces multiplied the compression forces greatly causing the cracks, splits, and perhaps craze lines. Considering I value my teeth and don't use my front teeth for anything - even chewing (no wings, chips, etc - I break my food) AND since my top teeth don't touch AT ALL my bottom teeth since I have an overbite (ortho was interrupted by my DDS and a dental university due to poor treatment and incorrect treatment plan (which is an oxymoron because there was no "treatment plan" to begin with which was part of the problem) - but, my teeth don't touch at all in the front. But, other than the ability to read, reason and use all of my degrees - I am not a dentist - so I'm trying to rule out causes and thus my email.

  58. Hi!

    I am so glad i found this website as I have been suffering from tooth pain for 2.5 weeks now and i finally feel like i have a bit of understanding as to what is going on. I had what the dentist called a small filling done on my bottom right side (fourth tooth from the front) A couple of days after the filling i noticed that it was uncomfortable at times when i would chew food on that side, it would make me jump but it wasn't all that painful. As the days went on it started to become sensitive to hot and cold, and usually after supper my tooth would ache for 10 minutes or so. the pain from drinking something hot would linger for 10-20 minutes but pain from drinking something cold would only last 1 or 2 seconds. During the night the pain was awful and i had to take Advil to stop the pain which worked well. I saw my dentist 10 days after the filling and he shaved down my filling and told me that it will probably still be sensitve for awhile. So i am now at 8 days after he corrected the high filling. The pain is slowly getting better as yesterday was the first day i didn't have to take Advil in the evening or during the night. The tooth remains sensitive to hot and cold and usually hurts during the night however there are starting to be long periods where the tooth is quiet and i feel no pain at all. it is still uncomfortable at times when i chew but everything seems to be slowing improving. I'm not sure if I should see my dentist about the lingering pain or if i should give it more time to improve. I read on one of the earlier posts that with pulpitis the pain can actually improve because the pulp dies. I'm not sure if i have reversible pulpitis that is finally improving or if it's irreversible and because my tooth to going to need further treatment. I have an appointment in a week for another filling so i'm not sure if i should wait until then or address this issue sooner. Please help!!!! Thanking you in advance!

  59. Hi Tom,

    Thank you for you help. I got a filling done a few days ago. The tooth that had the filling done experienced sensitivity to sugar, hot, and cold, resulting in a 5-10 second sharp pain. I went back to the dentist today and she "polished" the tooth. However, I am still experiencing a sharp pain when exposed to hot or cold temperatures and sweets. Additionally, I've been experiencing a dull pain on the tooth that had the filling done. Could this be a sign of irreversible pulpitus?

    Thank you,
    Wade

  60. Hi Tom,

    I had a right, back lower 2nd molar removed 6 months ago, which after healing, has resulted in a wisdom tooth trying to come through in that area.

    The wisdom tooth is slightly impacted, and this led to a v.painful bout of pericoronitis, which has fortunately subsided after 4 days on penicillin 500mg (3 x day).

    It doesn't appear to be so close to the adjacent 2nd molar, as I have seen in pictures, and there doesn't appear to be any obvious caries, but I have pulpitis in the 2nd molar which is painful, especially at night and is causing problems sleeping.

    The 2nd molar hurts when I tap it with the percussion test, and feels slightly loose and painful when I try to rock it side to side.

    I have a dental appointment in 2 days time, to check on the pericoronitis infection, but I'm in the UK and the dentisit won't do another X-ray, as I had one recently.

    I'm hoping (!) the pain in the 2nd adjacent molar is a result of pressure from the emerging wisdom tooth, but am thinking I could have an abscess under the 2nd molar, needing a root canal, however surely the antibiotics over the last 4-5 days would have controlled an abscess?

    I would be very grateful to any advice you can offer,

    Many thanks and best regards,

    Chris

  61. PS. Thanks for such a great & informative blog, and by the way, I'm taking painkillers in the form of Ibuprofen (aka. Advil) and paracetamol - mainly Ibuprofen every 4 hours as that's the most effective out of the two, but once or twice a day taking paracetamol instead of an Ibuprofen dose.

    Thanks again

  62. As an update today: the pulpitis kept on getting more and more painful until last night, when I took some Co-codamol, which enabled me to sleep, and now this morning the pulpitis is apparently subsiding, but the jaw around it is swollen (a symptom I've not had before in this area).

    I think it may be an abscess which has spread from the pericoronitis, though I have felt around the jaw and tooth, but can't feel any bumps (at this stage) ??

    Thanks

  63. Hi Tom,

    Firstly, thanks for providing such useful info. I hope you might be able to offer me a few words of advice too.

    I have just got back from a visit to a dentist after experiencing some discomfort for the last three days or so when I bite. I'm a Brit currently in Indonesia so would welcome a 2nd opinion from you because I'm a long way from home.

    It's not a constant pain but I feel it momentarily when the top set of teeth come down on the lower set and I've been chewing food carefully on the other side of my mouth. The dentist said that the problem tooth (bottom right, one from the back) only had a temporary filling and yet I'm not aware of being told this filling was only temporary when I last had treatment. I did experience some tooth sensitivity in the area a couple of years ago, but switching to a brand of toothpaste for sensitive teeth resolved the problem.

    An X-ray was taken today and the dentist said that my filling was deep and right down to the pulp. She diagnosed my problem as pulpitis, She drilled in and said she was inserting a type of medicine that would kill the nerve, then gave me a quick filling. She told me to return in a week when she would remove the nerve. This was all discussed in the local language, but I guess that means a root canal.

    I should add that the gum under the innerside of the affected tooth and surrounding teeth feels 'fatter' than on the other side of the mouth but is not at all sensitive to the touch.

    So, my first question is does this sound like pulpitis to you? From reading this Web site it seems that if the pain is only momentary then reversible pulpitis is suspected. If this is the case, would it really be necessary to conduct a root canal? Thanks in advance.

  64. Hello Tom!

    It is very comforting to see other people with similar problems and read your thoughtful replies. I have what I hope isn't a major problem, but internet research has turned on the neurotic worry switch.

    Eleven days ago I got 4 fillings on the top of my mouth, two on each side. The first few days after were fine, with only mild sensitivity, but after 3 days I started having pain when chewing food (not when simply closing my teeth together). Exactly a week after the procedure, I went back to the dentist to make doubly sure the fillings weren't high, and she did some slight adjustments, but claimed it didn't really seem to be much off. The chewing pain continued, and I resolved to eat only very soft foods. Now, I wake up in the morning with very little pain, though I am aware of some sensation in my teeth. As the night progresses, however, my top right fillings begin to ache, and the pain seems to refer to my bottom right teeth as well. I do feel minor sensitivity to cold, but not hot. The top left fillings seem to be doing fine.

    The pain at night varies, and is never sharp and jolting, but simply persistent. I would say it varies between a 1 and a 3. The teeth do not feel any particular pain from direct contact or pressure other than that created by chewing.

    During the adjustment, the dentist also filed between two of my top right teeth that had a little extra composite between them because it was interfering with my flossing. I can now floss, but still detect a noticeable little ridge of extra composite in the between space. I don't know if this could possibly be a contributor to the pain.

    My big fear is that I might have irreversible pulpitis, as a root canal would pretty much bankrupt me. Angst!

    Do you have any insight into this pain?

    • Just as a follow-up, a few days later the pain has gone down noticeably, though I still feel slight periodic aching later in the evening. Instead of fluctuating between a 1 and a 3, I'd say the pain goes between a 0 and a 1. The sensitivity when chewing is still present, though slightly less.

    • Hi Jeffery - It sounds like it may have been some temporary inflammation (reversible pulpitis) after the trauma from having the fillings done. If you still hav ea ridge of composite between the teeth, make sure you're able to clean it all when you floss or you may want to have your dentist take a sanding strip between the teeth to smooth it out some more.

      I hope that helps - Let me know if you have any other questions. Thanks for your comment, Jeffery.

      • I went in yesterday to have the dentist check everything again, as the pain continues. She could not find anything visually, by banging on my teeth, or with xrays. She did another bit of filing down to adjust my bite. This morning I woke up with little pain, but it returned surprisingly early in the day, whereas before it was only happening at night.

        The pain does not feel terribly localized to a tooth, and both the top and bottom of the right side of my mouth aches, especially along the jawline (I had no work done on the bottom). Is this level of persistent soreness common in bite adjustments? My dentist wasn't really sure what could be causing the pain. It's not a mind-shattering pain, but it is strong and persistent enough to really interfere with my daily life.

  65. Hi Tom, I am hoping you can help with this issue. It concerns my 19 year old daughter. Three years ago she had orthodontic bands applied and orthodontist said 18 months should be sufficient as her problems were not complicated. They remained on for 2 1/2 years. No definite explanation for this duration was given. Towards the last few months of treatment she was experiencing quite a considerable degree of discomfort on the right hand side of her mouth , but being a little toughie she endured it , but did of course mention it to ortho. Bands were removed March this year. In April she was still experiencing pain mainly now focused on the upper right area so she revisited ortho and he and dental hygienist ( who did a lot of the treatment) said it was probably her wisdom teeth erupting. No tests were done. The pain continued so she visited a general dentist in May and explained the pain was causing her great discomfort and time off work and university. He performed no thermal tests, or xrays and suggested the use of a sensodyne tooth paste. Again believing there could be nothing seriously wrong she went away still experiencing bouts of quite severe pain. Late September she made another appointment with the same clinic and saw another dentist who immediately asked her had she had a trauma to the right side of her face or orthodontic treatment, and noted the class 1 filling in the upper left 6 , but said it could not have caused the death of this tooth. He took a digital radiograph and did a thermal test. Tooth of course is dead and abscessed. Open drain performed one week later by first dentist and antibiotics prescribed. At end of appointment he suggests she sees an endontologist as I believe he , by then. realised he had failed to diagnose correctly in May. Just over a week later she sees endo and he cannot begin RCT as tooth still very infected ( sinus tract fistula etc), so he performs another open drain. Unfortunately even though we live in Australia and have private health cover there is only one endontologist in the island state we live in. He is booked solid until Decmeber. She is however on cancellation list but I am so worried that this could become more serious. The ortho and the first dentist have contacted each other and then called me and have 'blamed' the class 1 composite filling as the cause of this problem. As a qualified dental assistant I find this very hard to believe and think 2 and 1/2 years of orthodontic work is more likely to be the cause. However regardless of the cause my concern is her health and the chronic abscess which has probably been festering away for over 8 months, and the risk of any of her other teeth which may present one day with resorption. I have read that resorption usually occurs within the first 6 to 9 months of ortho work but have also read that 'trauma' to a tooth can take up to 10 years for the pulp to react and die. No one here is giving my daughter or myself any answers , so I am hoping you can advise me. I love you blog by the way and commend you on the friendly helpful advice you're giving to so many.!

    • Hi Tamara - If there was significant force on the teeth during the orthodontic treatment (and it sounds like there was), it is possible to have traumatized the ligament and in turn choked off the blood supply to the nerve, ultimately killing it. If she never had any pain after the class I composite filling, then it seems more likely that it was the orthodontics. I hope that helps - Thanks for your comment!

  66. Hi Tom-

    I had a rear upper molar prepped for a crown on Wednesday 10/19. Since then, I have been taking Advil and with that usage I don't really have any problems. My issue is that when I wake up the past two days I have pain in the tooth that requires more Advil. I know they did some sort of work on my gums and told me to get the peroxide rinse to help with discomfort.

    Is still having pain five days later typcial. Do you think this could be reversable pulpitis or do you think it's more likely irreversable?

    Thanks.

    Kevin

  67. HELP!! I have had a root canal x 2 and a crown on a molar for 2 years. The tooth has remained sensitive throughout-- no serious pain. Is it possible to get irreversible pulpitis after a root canal at the top of the roots since the nerve canal has already been filled?? Is extraction the only answer?

    • please answer this question-- i am trying to make a decision on what to do with this tooth and i need another opinion

    • Hi Stephanie - Was the root canal performed by an endodontist? Sometimes there are extra canals in molar teeth that are hard to find, and an endodontist may be the best one to do the root canal.

      If the tooth is still sensitive, there is a chance that one of the canals was never found and filled with root canal material.

      When a root canal is done, the whole canal is filled and sealed up so that bacteria cannot get back into the root canal system. While it you wouldn't get irreversible pulpitis after a root canal if all of the canals are properly filled, it is possible to get pain coming from the ligament area around the tooth. That may happen if the crown is too high and it causes you to put excess pressure on the tooth when you bite.

      I hope that helps - Let me know if you have any other questions, Stephanie!

      • this root canal was done by an endodontist x 2. the x-ray now shows a dark space inside the tooth at the top of the roots. ?????? what do you think??

        • Hi Stephanie - You would have to compare the x-ray to previous x-rays and look at the angle at which they were taken. The area around the roots can take up to a year to heal after a root canal is performed.

  68. Hi Tom,

    Thanks for the information. I had a accident two days back and I have visible horizontal crack on my front teeth. I have no regular pain but i have a sense of broken teeth. I can also feel a pain when I put some pressure on the that teeth. Yesterday when I put pushed my that teeth I saw little bit of blood came out but now I am not seeing any sign of blood. I drunk hot tea and had a hot juice also but did not feel any pain. Due to weekend I can not visit the doctor and will visit the doctor as soon as possible on Monday. By reading your article i am feeling positive that I might save my teeth but I am not sure. I am right now taking antibiotics three times a day. What do you think by my explanation? Is it a reversible pulpitis or irreversible?

    Thanks once again for helpful information!!!

    -Sid

  69. Hi Tom,

    Thanks for the information. I had a accident two days back and I have visible horizontal crack on my front teeth. I have no regular pain but i have a sense of broken teeth. I can also feel a pain when I put some pressure on the teeth. Yesterday when I pushed my that teeth I saw little bit of blood came out but now I am not seeing any sign of blood. I drunk hot tea and had a hot juice also but did not feel any pain. Due to weekend I can not visit the doctor and will visit the doctor as soon as possible on Monday. By reading your article i am feeling positive that I might save my teeth but I am not sure. I am right now taking antibiotics three times a day. What do you think by my explanation? Is it a reversible pulpitis or irreversible?

    Thanks once again for helpful information!!!

    -Sid

  70. Hi Tom,

    I have horrible teeth! Three abscesses in my back molars - 2 root canal treatments and 1 extraction. Needless to say, I get a bit nervous when my I start to feel tooth pain/irritation. I take care of my teeth very well and yet still seem to have teeth problems, which I find extremely embarrassing. The past few days my front tooth has been very sensitive to hot/cold and air from outside. I finally went to the dentist today and she preformed a pulp test and took x-rays. Based on all the results - which were fairly inconclusive - but with my dental history and the fact that my front tooth ligament (or artery) is a bit swollen, she thinks a possible explanation could be irreversible pulpitis. She gave me anti-inflammatories and antibiotics, but I'm wondering if we are simply delaying the inevitable? Should I be expecting another trip to the dentist for yet another root canal in the near futur?

    Thanks for your help!

  71. Dear Tom,
    I am quite concerned by the incorrect information you have provided people with on this page:

    "Some common causes of reversible pulpitis are:
    Cavities that are just starting in the outer tooth structure - this is a white spot lesion - it would not cause pain and definitely not reversible pulpitits
    Drilling done by a dentist when doing a filling or crown preparation on the tooth - the caries would have initiated dental pain beforehand, unless the operator was extremely and un-necessarily invasive
    A fracture of the enamel layer of the tooth which can expose the dentin - this is dentine hypersensitivity, NOT reversible pulpitits
    Getting your teeth cleaned (scraped!) by a dental hygienist, especially when they clean the roots if you have periodontal disease. - are you serious? cementum should not be removed nowadays, so even dentine hypersensitivity should not occur in root surface debridement, LET ALONE pulpitis!!!

    I think you need to work on your pain diagnosing skills. Absolutely shocking!

    Jenny.

    • Hi Jenny - There's no need to be concerned. When I discussed cavities that were starting, I didn't get my point across very well. I had meant a cavity that had literally turned into a hole (cavity), not simply a white spot lesion. I changed the text of the article to be more clear. As for the other three points you brought up, the following paragraph from one of the leading textbooks in the field of periodontics should help:

      "Minor injury such as periodontal root planing or the conservative preparation of a tooth for a restoration may lead to pulpal symptoms. A transient hypersenitivity to thermal stimuli is the most common symptom noted. The application of a thermal stimulus results in a brief, painful response that varies in intensity from mild to severe. The response rapidly disappears after removal of the stimulus. Although permanent pulpal damage may not occur, a transient inflammatory response can lead to the deposition of reparative dentin if odontoblasts are destroyed. The reversibility of inflammation and symptoms, without permanent pulpal damage, has led to a classification of this condition as reversible pulpitis."

      Thanks for bring that to my attention, Jenny. Let me know if there is anything else I need to clear up.

      As an aside, I do strive to provide accurate, current dental health information. If you find anything incorrect in any of my previous articles, please leave a comment and let me know so I can make it right. Thanks!

  72. Hi Tom-- I had a temporary crown put my second back molar last Thursday. Hours after the Novocaine wore off- I tried eating something. There was a very sharp pain when I chewed. Now many days later, I am still in pain when I chew on that tooth. My jaw has been periodically throbbing as well I went back to the dentist and they don't see anything wrong. They tried readjusting the bite and took xrays. The nerve and crown both look normal. Do you think this pain will go away? Or do you think I will need a root canal? Would love to hear your thoughts. Thank you!

    • Hi Joe - If the tooth does have irreversible pulpitis as a result of the trauma from the crown preparation, it most likely wouldn't show up on the x-ray until an abscess developed around the root of the tooth after the nerve died.

      If your tooth is throbbing without you doing anything (like eating, chewing, breathing in cold air, etc.) then that is a good sign that it is irreversible pulpitis and you will need a root canal. I hope that helps. Thanks for your comment!

  73. Hi,

    I had 2 fillings that hurt when I bite. A week ago I had them grinded down a bit. One side was fine, but the tooth on the other side needed a lot more drilling at it. The bite was fine after this but the tooth that was drilled for a while has hurt ever since. It started the next day with throbbing and over the past 7 days it has got slightly better each day and it's now just a small, more niggling sort of pain.

    Is this normal and how long will it take to go away completely? Could my tooth be bruised? As the dentist didn't drill through my tooth, I am wondering if that rules out the possibility of needing a root canal.

    What I am worried about is that I've already had 3 root canals in my life. The first two were fine, but the third one was the rearmost upper tooth which was difficult for the dentist & they said they only found 2 roots in it & may have to take my tooth out which made me panic. I caught an infection in it and I was very stressed and upset that my tooth wouldn't be saved. Eventually, it all settled but I am dreading if I would have to go through all that stress and upset again. The sore tooth is a premolar.

    Please help. With this and the recent problematic root canal I had, I've had a month of problems and I can't get on with my life.

    Maureen.

    • Hi

      I should also add that the aching tooth is not sensitive to hot/cold anything. It has just felt sore since that drilling but nothing in particular brings on sharp or sensitive type pains.

  74. I had a couple of crowns done on two adjacent molars. The teeth were basically being held together by old fillings and required a fair bit of drilling.

    I immediately started experiencing pain with the temps which I attributed to the bite being too high and too much pressure. Got the permanent ones in and same pain so I went back to have them buffed down but then left the city.

    I work out of town (geologist on oil rigs) and haven't been back for 45 days. I'm taking 1200 mg of Motrin/day just to get by. As soon as it wears off my jaw aches to the point that the back of my head hurts! I need this addressed before my liver fails from Motrin overdose.

    I have deduced that the bite is probably OK now but the pain when eating is brutal if I put any pressure on the new crown(s). I chew on the other side of my mouth but even then I have to be careful not to close too tightly.

    I think the pulp was damaged during the process of preparing the crown which is apparently an inherent risk with getting crowns. The dentist did mention a small chance of needing a root canal but I don't recall the reasoning.

    Presuming the pulp was damaged and is now encased in a shiny new crown, am I looking at having to get a root canal and yet another crown?

    • Never mind..., I have since been to the dentist and got a root canal. For the rest of you who are wondering... If you get a crown or something major and suddenly get all sorts of pain on chewing etc., probably the pulp got damaged during the procedure and you'll need a root canal.

      Don't panic though..., the root canal is painless pretty much and the brutal pain is gone right away.

  75. Hi Tom,

    Thank you very much for the information.

    I'd like to have your opinion on my problem:

    About one month ago I went to a dentist because I had a black shadow between two incisors. He drilled deeply into one to remove caries on its inner face. He filled the cavity with a glass ionomer. One week later the tooth started to be sensitive and its 'architecture' was very uncomfortable. He then put a composite on the glass ionomer.

    One week later... I came to undergo a complete examination of my teeth. The dentist asked me if the tooth was OK. I told him it was fine but the filling was blocking the dental floss. He insisted on filing it down and, in this process, removed the filling by accident (and it was painful!). He replaced it with either a composite or a hybrid glass ionomer (I'm not sure—it doesn’t seem to be a normal composite because it has a distinct, quite unpleasant, metallic taste). Then, because the filling wasn't even, he polished it, and he polished also a part of the previously untouched crown of the tooth...

    This happened two weeks ago. Now, the tooth is sensible to heat and cold, and I also feel pain when I chew into something hard. A feeling of slight pain remains for minutes, and, sometimes, even hours, but without being excruciating. I’m taking ibuprofen hoping it will relieve the possible inflammation.

    I'm afraid this could be pulpitis, caused either by the repeated trauma or by the filling itself... Do you think this could be reversible? And in such case, what can/should I do? I’m nervous about losing the vitality of an incisor…

    Kind regards.

    (Please excuse my English: I am not a native speaker.)

  76. Hi Tom:

    I hope you are doing fine.
    I had a crown preparation last Monday and the temporary crown was left high but I did not experience any pain until the third noght that Inwoke up in pai. I took a couple of tylenol and the pain subsided. I am a grinder so I think taht being the provisional mdid not hav

  77. I am sorry! I hit the wring button on the message above.
    I was telling you that being the provisional molar high I thught that was irritatin the nerve more so the molar was adjusted yesterday morning but last night I had pain again. Not as much but still had pain. My questions are:
    How do I know if I have irreversible pulpitis?

    Can it be a good sign that there is no pain at all while standing up and it only appears after 40 minutes approx after lying down?

    How ling does it take for the inflamation or the pulpitis to calm down?

    Thank you very much for your help

  78. hi, i just had a crown put in a week ago. Yesterday, i started to experience a throbbing pain that has persisted. if i tap on it with my finger i feel a sharp pain. would you advise me to wait a few more days and see if it goes away or call my dentist right away?

    thanks,
    ash

  79. I wonder if you can advise please; I had a deep filling in one of my molars about 7 days ago. Initially my dentist didn't think the filling would be a problem - however, as he began to drill he discovered that a previous dentist had 'patched' the tooth, leaving decay below the patch. He began to look a bit worried and explained that as the filling was now so deep, it may not work and a root canal may be required. As I had the filling on 21st Dec, I was happy to leave things as they were over the festive period, hoping that it wouldn't be too sore and would settle down. How wrong I was!! I have been in unbearable pain since the anaesthetic wore off, and sledged through Christmas (and now more than likely new year) on a cocktail of ibuprofen, paracetamol and voltarol. Not very nice. I am still hoping that things will settle down - am I being unrealistic? I am on annual leave for the next week, but the prospect of returning to work if this pain continues is bringing me out in a cold sweat. I have been reading about reversible and irreversible pulpitis, and also about fillings taking between 8 and 12 weeks to settle down. Should I sit and wait (the pain isn't getting any worse) or go back to the dentist?

  80. dear tom how r u? i am very thankful about your job, i would like to have your opinion in my problem

    i have bachelor degree in dental science(BDSc) it is three years program but my title is Mr not Doctor but i work as a dentist is it possible to called by my patients as Mr?and is my degree is internationally accepted? i am worried i practice dentistry for five years in some governmental hospital some were Africa. i want your answer badly,thank you for your help

  81. Hi Tom,

    I had crown preparation a week ago. The temporary crown is cold but not hot sensitive. The sensitivity goes away in a few seconds. I have been getting intermittent mild toothaches here and there, but they aren't bad. The permanent crown isn't scheduled to be placed for another 2 weeks.

    The cold sensitivity I expected. Just wondering if the occasional mild ache is normal a week after the crown prep.

    Thanks.

    Ed

  82. Hi Tom,

    In Oct. 2011 my adult braces were removed, I had braces as a teen so this was my second time. My teeth got loose and moved due to Graves Disease and my front space came back. I have my teeth beside my upper front teeth grew in as tiny pegs so after my teen braces crowns were placed and I never felt I had an issue with them. I went to a new dentist in November and she prepped my four top front teeth to replace the two crowns and put veneers on the upper two front teeth. It has not been a pleasant experience. I had three sets of plastic type, temps that she removed and I felt like she was ripping my mouth apart each time, her assistants did a poor job of helping and chunks went flying all over my mouth and down my throat. The next step was temp porcelain that was supposed to be final but the lab she sent them to did a horrible job. She glued them in with temp glue and vaseline. My next appt was rescheduled twice because the lab messed up again. When I finally went in she said we have to start all over doing molds again and everything since the lab broke all the molds too. I begged them to shape the porcelains that were glued with the temp glue vaseline mix. They did shape them for me I'm still not thrilled with how they look but I can't sit in the chair and go through more, I've always had a fear of dentists and now I'm petrified. My problem is pain, when I floss one of the crowns on one side I feel horrible pain when the floss hits the top of the gums. Do I have pulpitis? What should I do?

  83. Hi Tom,

    I forgot to mention one more thing, since the cosmetic work began I now have a terrible crackling sound on inhaling while breathing that I've never had in my life. My family doctor has ran several tests on me including sending me to an ENT doc. The results of all the tests have been normal. I told him this all started with the awful cosmetic prep and numerous temps being ripped out of my mouth. We wonder if all those flying particles affected my lungs? Also I had a mirror and looked at my poor teeth after each removal and the gums surrounding the crowned tooth that hurts on flossing was horribly red and inflammed.

  84. Hi Tom,

    Hope all is well. I had two adjacent molars crowned recently and had to wear temps for 3 weeks on one and 4 on the other. I had bite sensitivity which finally went away with the temps, but the temperature sensitivity was there the whole time. I still have temperature sensitivity which is diminishing, but still there. I even have a strange sensation (not pain), but something different and not comfortable with room temp water sometimes. I can eat most nuts, but almonds sometimes make the tooth feel tender. I am trying to see if the teeth will calm down. I've had the permanent crown on one for almost a month and the other for two and a half weeks. I had thought the dentist took an xray before crowning, but it turns out the xray he took was for the contacts and I'm not sure if he saw the root of the teethin a bitewing. I know I might ultimately need a root canal(s) but I'm waiting it out to see if it calms down. This dentist does not believe in going through the crowns for root canals. Other dentists say it is fine. This dentist said something like the filling material is a different composition so it can settle in a way over time that can leave a slight gap or something. In any event, what is the opinion in dental school about the best result for root canals on crowned teeth. Is it just as good to go through the crown or is a new crown a better procedure? I would think there might also be risks with a new crown so I'm not sure what is better.

  85. Hi Tom,

    Thank you for all you are doing here!!

    About three weeks ago I got four temorary crowns on my front teeth. After maybe four or five days I felt something, I would't call it pain, just an awareness that something was going on on one of my front teeth. After 8 days into my temp. crowns I felt a sharp pain everytime I ate something "cold" or breathing cold air from outside. I was unbearable but it went away after a couple of seconds ... each time. I did not wanted to talk anymore. So I contacted my dentist and she told me that I most likely had an inflammation going on and that I should take some Advil or inflammatory, use toothpaste for sensitive teeth but without whitening and see how it goes. She did tell me that my tooth could have a trauma and I might need a root canal done. So over the course of two days, which was the weekend, I took Ibuprofen three times a day and the pain was still there but maybe a little less. On Monday I called them to be seen. My dentist took a look at the cement, nothing was lose though, and decided to put a little bit more cement on, because she thought something might have gotten lose. Right after she was done, no anesthesia used, it felt much much better, I would even say the pain was gone. Because I did bleach my teeth before I got my temp. crowns she gave me a relief gel and special tooth paste to use. Oh and I use this special rinse so my gums would not get infected (Peridex), twice a day. When I was in pain I could not take it because of the cold factor even it was not really cold. Later on the next day the pain came back but not as bad and intense as the time before. On Thursday of that same week I went in to get my permanent crowns placed. She cemented two teeth in with permanent cement because those were the teeth without pain and had a root canal done years before that. One the other two teeth she used again, but a different kind, temporary cement. Just in case if the pain would not go away and I needed a root canal done. After she placed my four permanent crowns everything felt perfect! She also told me that is was my right big front tooth who was inflammed because she saw the inflammation and descibed it to me. After everthing was done I was totally pain free .... but only for 3 1/2 days. On Sunday morning afterI woke up I felt a sensitivity to cold again, nothing super big but it was there again. Only if I drink cold stuff and cold air again. I did feel some stuff peeling of my temp. Cement but I guess that is only the stuff what they put over the cement, right?
    Remember, when I went to my dentist after I had so much pain and she put mor cement on. I did call her when the pain came a bit back and told her that a string or something like that peels or comes off. She said that is ok and I forgot how she called it. Anyway the same thing happened on my permanent crowns. I am hoping that there is only a tiny gap or losening going on that will make this cold sensitivity?
    Any ideas why it comes and goes that way? Why did I have no pain at all for over three days and now it is back. It is not that bad but it came back. I did use the Peridex after I got my permanent crowns maybe three times a day so everything would stay healthy in my mouth because my gms were sore. On the night before my sensitivity came back I put my lower orthodontic retainers in because the upper once don't fit anymore. Do you think that could have caused something! I also grind at night.
    I really hope I don't have to have a root canal done!!!

    Thank you Tom in advance!

  86. Is Tom still reponding?

  87. Thank you so much for this site. Here is my issue:

    About 10 years ago an amalgam filling that I had since childhood finally fell out of my 2nd lower right molar. I was in EXCRUCIATING PAIN!!! To the point where my entire right side of my face and body was in pain and feeling very weak. I finally went to see a dentist for an emergency visit. He quickly wanted to do a root canal and even though I was desparate, I refused and suffered. I then found a holistic dentist that said I didn't need a root canal. He cleaned out the molar and put a temporary filing and told me to return. The agony stopped IMMEDIATELY. I never returned to him and the temp filing lasted for 10 years.

    On Thanksgiving Day 2012, the filing finally called it quits and came out. It didn't hurt at at, but food would get caught in it and I would clean it out. Well, at the end of March, the molar started hurting. And as the days went on the pain increased. In April it got really bad, but for some reason not as bad as it did 10 years ago. But it was enough to keep me awake a night crying. So I went for an emergency visit to a different dentist. He then said "root canal or pull the tooth". I still hesitated. I asked him if he could just clean out the cavity and put a temporary filing. He didn't clean it, but he put gauze (which I found out he did later) and covered it with temporary filing. I went home and that evening the pain was unbearable and just increased in intensity over the next few days. I ran back to him and told him to take the tooth out. He said "Are you sure, because we can do a root canal to save the tooth." It was the gauze that was touching something in my tooth that caused it to throb really bad. The holistic dentist never put gauze and that's why it didn't hurt for 10 years. As he gave me novicane and started working on me, I felt pain. He had to inject me 3x with novicane. The third time, I was in such EXCRUCIATING PAIN he had to stop. All of the dental assistants ran into the room and watched me as I cried and writhed from the pain. I sure they thought something bad was going to happen. The dentist handed me a Motrin on top of the anesthesia, but I didn't take it. I was in so much pain, I didn't dare even open my mouth for anything at that point. I was afraid of having too much medicine in my body already. So as I waited a half hour or what seemed like it, for the pain to subside, the dentist said "I'm not going to touch it anymore. I'm sending you to the oral surgeon so he can do the root canal instead." He gave me a referral, prescription for Ibeuprofin 800 mg, and Amoxicilin 500 mg. With an empty hold in my tooth, the pain over the course of a week has gone down to a mere pinch without the medication. I clean it out with salt water, baking soda, several drops of clove and eucalypus oils, dry it with gauze and cover the hole with dental wax. Sometimes I just use warm salty water to clean the hole. There is slight pain or discomfort if I bite down to hard on my right side, but generally it seems to be getting better. I can tell the pulp is still alive because it would throb a bit if I bite down too hard on the wax. As the days go by, I have less and less pain. I'm thinking I should find that holistic dentist since he seemed to have given me the best results. Like I said, I had not been to the dentist in 10 years and I have no cavities in any of my other teeth. The 2nd lower right molar is the only problem. At the time of this writing, I feel nothing but a pin prick of pain in the tooth and I can bite down with about 1lb of pressure without pain. Any more than that I feel a little pain. That's my story. Oh by the way, when I looked at my chart, it did say: 'Pulpitis', but not sure if it's reversible or irriversible. Maybe you can answer that for me. Thanks.

    Lisa

  88. I forgot to mention the pain got worse when the dentist drilled down into the tooth after the anethesia. That's when I told him to "STOP IT HURTS!!!" lol

    Thank you,

    Lisa

  89. Hello Tom, your website is a real service. I found it helpful to read other people’s experiences and your insightful remarks.

    I visited my dentist a week ago The previous two weeks I had been experiencing persistent, intense tooth sensitivity to hot and cold in the area of my back, right upper molars, one of which had had a filling 15 years earlier. I was also experiencing discomfort on biting down in the same region. It was difficult at the time to identify exactly which tooth/teeth was/were involved. There was no pain around the gums. I avoided eating on that side. I began to wake up at night with a light throbbing pain that would last about ½ hour and disappear allowing me to return to sleep. There was no discomfort when I woke up. My dentist took x-rays, which were inconclusive, and determined that there was sensitivity. He treated the back molars conservatively (but did not explain the treatment to me). If the pain persisted after 10 days I was to contact him. Here is the situation 8 days later: I can identify the tooth responsible for my discomfort now. While the conservative treatment provided has reduced the sensitivity somewhat during the day, it is still there and I continue to wake up in the middle of the night with moderate throbbing pain when I lie on the same side as the tooth. It goes away when I lie on my other side. My dilemma is whether or not I should throw in the towel? On the basis of the evidence, I am inclined to think that I have irreversible pulpitis. I will, of course, discuss this further with my dentist, but wondered if I should give myself more time since the pain has subsided somewhat during the day, although I am still unable to chew comfortably on that side. Your thoughts on this matter would be greatly appreciated.

  90. Hello, Thanks for providing this site. I had a tooth crowned about 5 years ago. Four days ago I began to have pain radiating through in my right ear and right jaw. I thought it was allergy related, perhaps even an ear or sinus infection. The next day that pain continued, and I also noticed sensitivity (when biting on food) in the crowned tooth.

    Unsure whether the problem was dental or sinus related, I decided to go to the dentist. He took x-rays of top and bottom teeth on the right, and found no indication of any problems. He tapped on my teeth and I did have sensitivity in the tooth that has been bothering me. He said that he thought the problem might be sinuses since I have so much radiating pain in the ear and jaw. I then saw my regular family doctor, who found no infection in the ear, nose, throat, etc. He recommended motrin, sudafed, and flonase for my allergies in case the problem was sinus related. He seemed to think it was my tooth after all since I could pinpoint one tooth that was sensitive rather than just experiencing generalized tooth sensitivity.

    Since following the motrin/ sudafed/ flonase routine for a day, I do notice significant relief in pain. When I accidentally bite a piece of food, however, the pain will flair to the jaw and ear. I also have a flair-up of pain if I swish with cold water. I talked to the dentist today. He didn't offer any explanation about why my tooth would hurt if there was no abscess. He said if I was still in pain in a week, or if it got worse, he'd refer me for an endodontic evaluation of whether or not to have a root canal. What I don't get is why he wouldn't educate me about pulpitis.

    My questions:

    1. What can the endodontic specialist do that the regular dentist can't to determine whether or not a root canal is needed?
    2. If the x-ray shows no abscess or anything else abnormal, what is the justification for performing that procedure? I'm reluctant to have a root canal solely because my tooth hurts.
    3. Based on my description, what are your thoughts on my tooth? Could it be sinuses?

    Thanks again!!

    • Hi Leah -

      1 - The specialist is more familiar with doing root canals than your regular dentist. I'm not sure they would do any additional diagnostic tests that your dentist woudl not do.
      2 - Each tooth has a nerve in the middle of it. When the nerve is in the process of dying, it can be extremely painful. After the nerve is dead, bacteria can collect around the roots of the tooth. This is called an abscess. Five years ago, I had a root canal done on one of my upper molars. I was in extreme pain. Although I did not have an abscess, I am confident that my pulp was in the process of dying (irreversible pulpitis) and opted to take care of the problem before an abscess formed.
      3 - From what you've described, I would lean more towards it being a problem with that specific tooth. Many teeth that are crowned do eventually end up needing to get root canals somewhere down the road.

      I hope that helps - let me know if you have any other questions, Leah.

  91. I had a crown done about 9 months ago. I've never had any pain or problems with the tooth. All of a sudden, the other night, it started to throb when I breathed in cold air. Drinking cold water didn't bother it. I took some ibuprofen before I went to bed, and the tooth felt better in the morning, and I have not had any pain in it since. Is this weird? Should I be worried about it?

  92. HELLO
    WHAT IS THE DIFFERENCE BETWEEN THE PULPITIS CAUSED BY DENTAL CARIES AND TRAUMA?

  93. I have been experiencing throbbing pain that I now know was due to a high filling. I returned to the dentist this past Monday (a week after I had three cavities filled on the left side of my mount) to inquire about the cause of the pain. After an x-ray and an inspection, the dentist determined that everything looked fine. I was told to wait 2-3 days and to call if the pain continued. I contacted my dentist two days later as the pain did not abate. I was not able to get a hold of the dentist as he neglected to tell me that his office does not operate on a regular schedule on Wednesdays. I then visited another dentist that day since, after much researching, I had determined that the source of the problem was due to a high filling causing inflammation of my periodontal ligament. I had this dentist adjust the height of the filling after he determined that it was, in fact, too high and putting considerable amounts of stress causing pain.

    I have another appointment with my original dentist for an assessment and to determine the course of action since my pain has not abated (I am not sure if I need to wait longer for the ligament to heal).

    My fear is that I have irreversible pulpitis.

    What is the likelihood that my pain is a result of irreversible pulpitis, and that I will need a root canal?

    My symptoms & details:
    - constant throbbing pain in my jaw
    - awaking in middle of the night with this pain
    - pain and unease felt in Masseter, jaw near ear, and temple
    - It was confirmed by my original dentist (during follow-up visti) that the cavities were not deep enough to have cause nerve damage and/or infection
    - (I am ) highly certain that original source of pain was due to high filling (cannot rely on dentist's diagnosis since he did not provide one during the follow-up visit)

  94. In January of this year,I had a cavity filled. The dentist said it was a very deep cavity close the nerve. It was the third cavity I had to have filled in this tooth. Since it has been filled it has been very sensitive. Two weeks ago I started having radiating pain in my mouth which I couldn't tell which tooth is was coming from. I have also been having a lot of pain in ear. I also have been having extreme pressure on face that hasI went to the dentist last week and he did an Xray and he said it showed no abcess or infection. He did prescribe an antibotic just in case I was having sinus issues. He said if it continued to bother me to call back and he would refer me to an endo dentist but didn't want to rush into it yet because the tooth looked fine. Since I was still have pain in my ear I went to my medical doctor today to see if I had an ear infection and she said no it had to be a dental issues. My question is if my tooth/nerve is dying how long will it take? Wouldn't the xray show if the tooth was dying or had an infection. Should I see and endodontist?

  95. Hello Tom,

    Very informative article. It helped me understand a tooth lot better.
    I have few doubts, which, I will be glad, if you can answer :). I recently met with an accident and two of my incisors on the upper jaw were chipped off at the edge ( Specifically, the front one and the smaller one next to it ).
    I had some sensitivity on the day of accident and after that, the sensitivity is no longer present and I have not felt any pain till date.

    I happened to consult two dentists, one of whom suggested only crowning and the other one suggested a root canal and then a crowning, after taking an x-ray (the dentist said the pulp has been damaged to some extent). However, the dentist mentioned that the pulp is still vital.

    After reading your explanation, I now cannot determine if it is a reversible pulpitis or is my pulp dead due to which I do not feel any pain/sensitivity ? What happens after the pulp is dead?

    Can you please suggest if it is good to go for a root canal in any case?

    Thanks again for your suggestions !!

  96. Hi Tom,
    what a fabulous and informative site! Many thanks for taking the time to attend to so many questions. I have recently decided to restore 12 amalgam fillings and replace them with composite as the health risks related to amalgam worry me. The first two fillings were replaced yesterday. The dentist discovered some decay on the bottom of the old filling, and alerted me that the new filling was very deep and may have irritated the nerve. He put medicine underneath the new filling to calm the nerve down. I understand that in the case of irreversible pulpitis the pain could start in a week, in three months or in six months. The risk of pulpitis hadn't occured to me earlier and I am now beginning to question my earlier decision of having all amalgam fillings replaced, as most of my old fillings are large and as such I may put myself at risk of root canals even though my teeth are healthy. Do you know what are the chances of contracting irreversible pulpitis after deep fillings? Would you consider a complete restoration of amalgam fillings reasonable given the risks of subjecting otherwise healthy teeth to potential nerve damage? I travel on business and have several long haul flights scheduled over the next few months (12 hr flights). What if i develop serious toothache while on board a plane? The thought of it terrifies me. Is there an effective painkiller that I can bring along, just in case I will be without access to any medical facilities or pharmacies? Really appreciate your thoughts! Many thanks in advance!

  97. Hi Tom!

    You seem a knowledgeable person, maybe you can give me a hand.

    I have a molar that's been acting up for about a week now, and acting up really is the right word. The tooth feels elevated whenever I try to close my mouth and during the day it feels fine, I have no pain. However, as soon as it gets around 10pm, the pain comes and it's really bad. It spreads to my whole right cheek and it's unbearable. I've been getting by with paracetamol before going to bed, but I wanted to know whether I really have to pay the dentist a visit or if it will just go away on its own.

    What do you think?

    P.S. I am not eating anything extremely hot or cold before bed. I have dinner early and I've been keeping off sweet/cold stuff lately.

    Tiago

  98. i had a filling last week and was told afterwards that it was a mm away from the nerve. So i could require a root canal if nerve is traumatised and damaged. My xrays showed a medium sized filling but dentist after the filling said xrays are 2-3 months behind. The following 4 days i experienced discomfort around surrounding teeth but the tooth filled was fine, no pain, no sensation. However, the following 2 days i experienced throbbing pain which lasted for about 4 mins over period of 2 days. Cold water gurgling set it off and due to pain i clenched my teeth whilst sleeping and biting my inner cheek. I took ibuprofen once in the morning and pain calmed. Throbbing came back in evening and took ibuprofen and had a nice sleep. The pain has gone since and its been 2 days and i dont need ibuprofen. But filled tooth still seems sensitive and slightly discomfort on bite. Dentist said he will review the situation in a week. Is my tooth getting better or has the nerve died???. Also warmth and heat feels soothing to teeth and after brushing with sensodyne, the filled tooth is not sensitive and feels normal. Please advise. Thank you.

  99. Great article, very informative! I had a crown put on 2 months ago, a broken tooth that already had a silver filing. Dentist removed the silver filling and replaced it and prepped the tooth for a crown. I noticed when he put the crown on it was very sensitive to cold (he had to numb me to get it on), the sensitivity never went away, he took another xray and said there wasn't any reason for my pain. This was an upper tooth. Then I went in for a cleaning and the hygienist cleaned some stray cement that was left around the tooth, two days later the pain was excruciating. It radiated from my jaw to the entire side of my head, at first I thought it was my TMD acting up and they called in predisone for me, after being on that a few days it helped tremendously, but the pain wasn't gone. I then went to an oral surgeon thinking it may have been an impacted wisdom tooth. the surgeon did an xray and didn't see any swelling in or around my wisdom tooth but that it was indeed impacted, so much that it was growing into the roots of the tooth in question. He suggested I wait it out and let the steroid do it's job. I did but it was still very sensitive not to cold but to pressure now. My dentist said I needed a root canal, however I couldn't get a root canal done because the wisdom tooth was essentially "in the way". I've had the wisdom tooth removed, and not I don't have any pain in the tooth (so far) no sensitivity to cold or pressure. could this have all been a result of my wisdom tooth compromising my other tooth? Esp after all that work was done on it?

  100. Hello Tom, I have a question for you.

    A couple of weeks ago, I started getting extreme sensitivity in one of my lower molars. It would feel icy cold even from sucking normal air over it. My dentist found a small notch in the dentine near the root of that tooth, but otherwise the X-ray showed the tooth to be totally healthy. She applied a small layer of filling material over the hole to cover it up.

    Now the sensitivity issue is pretty much gone, but I am getting spontaneous pain coming and going from that tooth that does not seem to be getting better. Could that tiny notch in the dentine have caused an irreversible pulpitis?

    (My dentist is currently recommending we simply monitor that tooth. But a year ago, I had pretty much the same issue with the same tooth on the other side of my mouth. That tooth eventually had to have a root canal.)

  101. Dear Tom,

    I have an obvious very large cavity in one of my teeth, insofar as about 1/6th of the tooth has fractured off and there is some darkening of the tooth inside. I have had no symptoms apart from sometimes the root of the tooth feels sensitive when brushing or if I press it from the outside. I intend to see a dentist asap but have moved and need to re-register (in the UK). I think there is a chance I have developed irreversible pulpitis but am very much hoping I have not got an abscess yet- is it possible that I have one?

    Thanks,

    Sagar

  102. I wrote you one year ago regarding mild pulpitis after crown for cracked upper rear molar.. When I started having pain, I saw two endodontists, who both said there was a chance it would resolve and that , in fact, the pulp of a tooth has the ability to wall itself off from the offending insult.. Welll, they were correct, and my pain resolved, and I had the permanent crown cemented in... nice ending huh... Wellll fast forward to now. a year later... I am now having mild aching in the same area of the crowned molar.. There really is no major sensitivity to heat or cold. no major problem biting down on foods.. just a slight achy feeling which starts after eating.. no throbbing.etc.
    I have had this for about 2 weeks, saw the dentist who "crowned me". She took xrays, examined and said there was no evidence of any crack, cavity or anything visible.. Since she has to have something to do LOL.. she said the crowns bite may have to be adjusted.. so they did just that and told me to eat on the other side of my mouth for a week or two. The discomfort so far is very minimal..
    My question for you is..... is it still possible the pulp to wall this off as it did before? The endodontists last year told me something that stuck.with me.... Toothaches due to pulpitis , infection, whatever...will either resolve OR get worse. requiring you eventually to get a root canal. They do NOT linger forever.. Do you agree? and what do you think is the most likely cause for my recurrent mild ache? Good news would be appreciated. Thanks..

    • Hi Jeff - The pulp can create new dentin and lay that down around the outside of the nerve and slowly move away from whatever is causing it to be irritated. Based on your symptoms, I would have also leaned towards adjusting the bite on the crown. A slightly high crown can cause inflammation in the ligament around the root of the tooth, causing a mild aching feeling after chewing. If it doesn't resolve after the bite adjustment, there is a chance that the pulp has been bothered so much with everything that it's been through that it is slowly giving up the ghost and may need a root canal.

      I would agree that toothaches wont' linger forever. They usually do get better or worse. The pulp is a very delicate part of the tooth and can be very temperamental. I hope that helps, and that you didn't feel abandoned when I "left the building". I hope your pain resolved and that you had a happy ending!

  103. Hello Tom
    My name is Deepesh.
    First of all will like to thank you for your such an help to the commom people.
    I wanted to ask you that how can symptomatically reverssible & irreversible pulpitis can be detected. And another thing which i wanted to ask you is that,what are these restorative mouthwashes

  104. Hello Tom
    My name is Ricky.
    First of all will like to thank you for being so informative for all of us.
    I would like to ask you somethings. Tom how could one detect symptomically wheather he/she is suffering from reversible/irreversible pulpitis? And another thing which i would like to ask you is,what are these restorative mouthwashes & how-when to use them?

  105. hi, over 2 weeks ago i had a filling done and was fine for the first week then the pain started, its comes and goes but when it comes its agonising. i went back to my dentist who said it was a very deep filling gave me antibiotics and said to come back for root canal or an extraction if the pain persists which it did for 2 days and seems to have subsided slightly. a friend recommended pro relief toothpaste which i rub on the tooth to get instant relief, weather it remains that way i will wait until i've finished the meds

  106. A part of my last bottom molar cracked off. Must have been an expansion-contraction issue becuase I was eating fat free frozen yogurt at the time this happened. The tooth had a filling in it. The fracture left a sharp edge. The dentist smoothed edge and told me I needed a crown. He had done one successful crown before, so I decided to go ahead. (I think now I should have gone to a dentist with Cerac technology available.) Anyway, the temporary crown gave me round the clock pain which I treated very successfully with 400 mg of Advil every 10-12 hours. When I came for my permanant cown visit, I told the dentist I had terrible pain. He took a Panarex (spelling) xray to check for abscess and did not find one. He said he believed my pain was from pulpitis and that with installation of the permanant, better fitting crown it would let up. Just to be sure, he put the crown on with semi-permanant glue. It's been more than 24 hours, and my pain is back. I have resisted taking Advil because I want to be able to trace what makes the pain worse. Chewing on that side definitely brings on pain. I am considering seeing a second dentist for a second opinion; the scheduler said that I would need to have a PA xray to determine if RCT was needed. Questions: 1) how long is it reasonable to wait to see if this is irreversible or reversible pulpitus? 2) should I avoid eating on the "bad side" to let the area clear up? (Nothing is wrong with the gum area.) 3) can a Cerac crown be created after my natural tooth has already been ground down for a porcelain crown? I have a call into my dentist, but probably won't hear from him until the end of the day.

    • Hi Barb - A good general rule is that when you have spontaneous pain from a tooth, then you have irreversible pulpitis. Since this is simply an inflammation of the pulp, it will not show up on an x-ray until the pulp has died and bacteria form around the roots causing an abscess.

      If that side hurts you, it would be good to avoid eating on it until you get this issue resolved.

      Yes, a Cerec crown should be able to still be done for your tooth. I know I'm late, but I hope this helps!

      • Good news, good news. I spent the entire month of June taking Advil on a 24 hr. dosage. ALWAYS TAKE WITH FOOD IN YOUR STOMACH, EVERYBODY!! I needed it for the anti-inflammatory help as well as the pulpitis pain. The last week, I slowly lowered the dosage. On July 1, I went cold turkey. I have no pain anymore and it's July 13, so I think I am out of the woods. Diagnosis: I had reversible pulpitis. I avoided eating on the "bad side" for one entire month, too. I allowed my body time to heal. I avoided a root canal. The dentist wants me to come in and take off the semi-perm glue and put on permanant, if he canghet the crown off. He admitted that on one pt. recently seen, he was unable to remove the crown which had been seated for several months with semi-perm glue. Congratulations of your graduation. Good luck finding the right position. Are you looking in beautiful Western North Carolina or Upstate South Carolina by any chance?

  107. I've been through a case of pulpitis and still have some lingering sensitivity, not in the tooth, but in the gum over the tooth. I'm wondering if this is just a side effect that will eventually go away or if it is a sign of persistent infection of some sort.

    I had a pretty hairy filling done, and my dentist prescribed me antibiotics (Penicillin VK) and some hydrocodone pain pills. Since I didn't have much pain, I skipped the pain pills and took an aspirin that night and woke up feeling pretty good in the morning. Since there was so little pain, I figured I didn't need the antibiotics, so I stopped taking them after the first day.

    The tooth was sensitive to heat so I bought a tube of Sensodyne and felt it was gradually getting better. But after about four months it started getting worse: there was pain when I bit down on the tooth. I saw my dentist and he said I needed a root canal. I immediately regretted not finishing that antibiotic prescription.

    We scheduled the root canal and he put me back on antibiotics. I immediately felt better and asked to delay the root canal while I finished my original 10-day course of antibiotics. When that ran out, I felt much better but asked for a refill and took a second 10-day course (500 mg x 3x/day).

    I finished my antibiotics over a month ago and the tooth feels fine. No pain or sensitivity. The only thing I notice is some sensitivity in the outer gum above the tooth; feels kind of ticklish when I run my finger over it.

    Any idea what this is? I be back at the dentist for a checkup in just a month or two, but am curious whether I should be worried in the meantime. Thanks.

    • I thought it might be helpful to file a follow-up report:

      That ticklish feeling on the gum above the tooth eventually developed into a gumboil, apparently a typical symptom of pulpitis. Since there was still no pain, I hemmed and hawed with my dentist about a root canal but finally relented and agreed to it.

      He opened the tooth up (commenting that it was all dead inside), started probing and poking and drilling, but after a time put his tools down and announced that this was a job for a specialist.

      So a couple of days later I saw a dental surgeon who poked and probed and drilled for several hours. This was a molar, so there were four roots that had to be cleaned out. At the end of three or four hours he announced that he was only able to complete the job on three of the four roots. The fourth was apparently so crooked that he couldn't get all the way to the end. So there was still a little infection left, but he said it would probably clear up on its own. If not, he said there was another operation in which they drill in sideways through the gum to get to the bottom of the tooth.

      After the root canal procedure, the gumboil went away within a day or two and the ticklish feeling went away after a few weeks. I have a slight sensation when I press sideways on the tooth so I suspect there could be a small infection left, but nothing major. Or perhaps the irritation caused by the initial infection is just taking a while to clear up.

  108. I had a root canal about a week ago and the dentist said he wanted to see how the tooth settled before he finished it off. I can only say that my tooth has killed me since then and the pain was as bad as before I went to the dentist. I go to the dentist very often and get my teeth cleaned every 4 months so it isnt a case of cavities. This particular tooth is crowned. Do you think the pain is normal and will I have to have the tooth out. The dentist did tell me I had pulpitis but I hadnt heard of reversible or irreversible until I read your site!!

    • Hi Peecox - When your dentist has worked on you, it's a good idea to get in touch with him to see what's going on. If you are in that much pain, your dentist should be able to prescribe some pain medication for you until you get the problem resolved.

  109. I have been going through my pain for about four months now. It hurts so bad I have found myself looking for the gun.no joke. But dental care I need is very costly and my children come first.I know what I'm now gonna say you probably will not agree with. But if your hurting like I am I've found that swishing hundred proof or more of pure vodka will take away the pain long enough to get to sleep.during the day I take the ORIGINAL Listerine (SMALL BOTTLE) AND MIX A LARGE BOTTLE OF LIQUID AMBASOL (20%) BENZOCAINE AND SWISH IT THROUGH THE DAY.LIFE ANIT BLISS BUT ITS TOLERABLE. I NEED $1500 TO GET AN ORAL SURGEON TO CUT IT OUT.BUT I DONT SEE ME HAVING THAT KIND OF DOUGH NO TIME SOON.BUT I THINK ROBBING A BANK TO GET IT WOULD BE WORTH THE JAIL TIME. IVE HAD PANCREATITSUS QNR A HIP REPLACMENT. BUT THAT PAIN NOT EVEN CLOSE TOBE AGONIZING LIKE THIS IS.THIS IS 24/7 HALF THE TIME ITS AGGRAVATING BUT THE OTHER IM LOOKING FOR A GUN.UNLESS I CAN AFFORD THE VODKA. BUT THANK YOU FOR YOUR TIME.THANK YOU FOR LISTENING. BECAUSE MOST FOLKS DONT UNDERSTAND WHAT THIS FEELS LIKE.WILLIAM

    • Hi William - I'm sorry about your pain. Is it just one tooth that needs to come out? Often you can get one tooth extracted for around $100, depending on your location and proximity to a dental school/clinic. I hope you feel better soon.

  110. I had a deep white filling on my bottom right molar about 5 weeks ago I have been back 3 times to the dentist, fist time she checked with liquid nitrogen in cotton wool and I nearly jumped out of the chair in agony. She said the tooth was fine. I went away and it still hurt. I can't chew on that side at all and I have a dull ache and pain in my tooth and jaw constantly. No swelling. I went back again and she said the bite was too high, adjusted it and there was temporary relief for about two days. The pain has come back more now. I am going back for 3 rd visit we'd as my bite is still too high. They seem perplexed as the tooth looks fine etc ect. But no x rays have been re- taken. Am I looking at root canal or is a bridge and extraction the better route?
    Thanks for your time, I'm driven nuts with popping pain killers and trying to ignore the pain for so long.

    • Hi Sarah - The main sign of irreversible pulpitis is when you have spontaneous pain from the tooth. Chances are if it was a deep filling, there could be some damage to the pulp, resulting in pulpitis. An x-ray would be able to let the dentist know how deep the filling was in relation to the pulp as well as seeing any inflammation around the roots due to a high filling.
      If a tooth can be saved, it's usually a good idea to get the root canal and crown rather than a bridge. I hope that helps, Sarah!

  111. In case anyone has noticed. the moderator has left the building LOL

    • Hi Jeff - I've been busy lately with graduation and getting a job. I will try to answer some of the questions and keep an eye on the comments section.

  112. Is anyone else helping with answers if the moderator has left the building/blog? Thank you.

  113. I went to the dentist yesterday for routine cleaning/x-rays. He saw on the x-rays 2 of my lower bicuspids (#20 and #29) each have an abscess infection, they are asymptomatic.. He said root canals for each would not yield the results we would hope for. They both have been heavily filled, not much tooth left I guess. He said I have to get them extracted, and then bridge work or implants...

    I wish I had had symptoms to alert me, maybe then I could have saved these teeth from irreversible pulpitis. Who knows how long I had these infections. It's been 2 years since I had a dental xray.

    Questions: Why are thse abscesses asymptomatic? Are bicuspids hard to extract? Do they have a lot of roots? Will there be a lot of blood?

    • Hi Jill - Both of those teeth are "second premolars" and they are both located right above a hole in the jawbone called the "mental foramen" which is a passageway that carries nerves out of the jawbone. Many times these can look just like abscesses on x-rays. With that said, they very well could both be abscessed. Did the dentist do tests such as tapping on the tooth to measure pain or putting cold on the tooth to see if the nerve could feel the cold (which would indicate that it is still alive and wouldn't be abscessed)?

      Some abscesses are asymptomatic, but I've found that people usually experience some degree of pain with their teeth before they become abscesssed. Those bicuspids normally have only one root and therefore aren't difficult to extract. Some people bleed more than others during extractions. If you're taking any blood-thinning medication, that can make you bleed more. I hope that helps - Thanks for your comment, Jill!

      • Thanks Tom. It means a lot that, as busy as you are, that you took the time to answer my (and everyone else's) question.

        Just to reiterate, I have had no pain. I feel great. I still can't believe that I have not 1, but 2 infections. I have an appt with an Oral Surgeon in 2 weeks for the extractions, but would it be insulting to my dentist to ask him for a quick appt to do the tapping/cold water thing to test if the pulps are alive? I'm afraid he will be insulted since he "pointed out" the abscesses to me on the xray. I don't want to ask the Oral Surgeon to do those quick tests at the last minute because he would just say why didnt you have the dentist do that before you came here?

        P.s Thanks for answering my extraction/bleeding question. I'm a big baby. My 7 year old is teething, and just pulls each tooth out (sigh), blood and all, and I get squeamish from even that.

      • Just a quick update.

        My dentist doesn't feel the tapping/cold test is necessary because he can see the infections on the xray. He says the reason I have no infection symptoms is because my immune system is keeping the infection at bay all on its own.

        He is adamant that I have these infections. What I don't get is I have had cavities before, and I have had pain from them, but I'm supposed to believe I have 2 infections and not feel a thing???

        I am still going to ask the oral surgeon for the tapping and cold test. My dentist actually told me I should stay off the internet when I told him a dentist online recommended I ask for those tests. He is close to retirement and he doesn't want to be questioned on anything!

        • Hi Jill - Thanks for the update! It very well could be that you have two infections on those teeth without any symptoms. It sounds like your dentist has a lot of experience and is certain that these are abscesses. This makes me believe that they probably are. I just wanted to make you aware that everyone has that hole in the jawbone where nerves exit that can look like an abscess on the x-ray.

          A popular dental textbook, Pathways of the Pulp by Hargreaves & Cohen states, "Many anatomic structures and osteolytic lesions can be mistaken for periradicular pathoses. Among the more commonly misinterpreted anatomic structures are the mental foramen and the incisive foramen. These radiolucencies can be differentiated from pathologic conditions by exposures at different angulations and by pulp-testing procedures."

          That simply states that a couple of ways to make sure that these are abscesses rather than the mental foramen is by taking an x-ray at a different angle or by doing pulp-testing (tapping/cold test).

          Did your dentist mention why root canals wouldn't work? Are the teeth badly decayed?

          As an aside, oral surgeons are paid to extract teeth. Some may check to ensure that they do need to come out, but I believe most see that a competent dentist has prescribed extractions and therefore extract the teeth, assuming that the dentist has done his or her duty to ensure an accurate diagnosis.

          • Hi Tom! Your responses mean the world to me!

            My dentist said that there's not enough tooth to do root canals; they're mostly fillings with little tooth left.

            My dental insurance company refused to cover anything to do with bridges even though they say they cover them. I was told that they refused to crown my healthy teeth for the sake of a missing tooth...so I'm having mini implants.

            Quick question! Do you think Carbocaine is strong enough for a number 20 extraction that only has 1 root? Whenever I get in the dentist chair my heart races a little bit, and this impending extraction on Wednesday morning is all I can think about. The last thing I want is epinephrine to make the heart race. My dentist only uses Carbocaine. Do you think oral surgeons, generally speaking, also have Carbocaine in their offices? Would you honor this request if a patient came to you and asked for Carbocaine? Thanks Tom!

  114. Hi Tom,
    I had a crown on my back and front tooth to have a bridge, this was fine for 4 years, my teeth are very sensitive to hot and cold anyway because of receding gums. In April I noticed a small ulcer between my gum and cheek right at the back next to this tooth, I ignored it thinking it would go away as apart from a little soreness I was not in pain. This week I mentioned it to my dentist and he said I needed a root canal, today he removed the crown and bridge and the smell from my tooth was very bad. He did a root canal treatment, but said I must come back every ten days to have some more stuff squirted into my tooth, until the infection goes as he says the bacteria is live but can't survive without air.When this is done he can give me a new crowns and bridge, it is aching at the moment although I have temporary crown and bridge, I also grind my teeth at night could this have caused the problem? if so can it occur again or should I be alright now I have had root canal

  115. Today my dentist diagnosed irreversible pulpitis in my upper left canine. The tooth has never had any work done on it, and the X-rays show no cavities or other problems. The tooth is sensitive to heat, cold, and sweet, and I just about jumped out of the chair when the dentist tapped on it. I've had a minor ache come and go without stimulus, but it hasn't been keeping me awake at night.

    The dentist told me that a root canal would definitely fix it, but he also said we could wait several days and see if there's any improvement. I have a night guard I plan to start using again to try to protect it in case I have been grinding my teeth at night.

    My questions are whether there might be infection, what will happen if the pulp is dying, what are the chances of this clearing up by itself, and whether I should get it X-rayed again next week to check for abscess.

    Thanks.

    • FWIW, the pain went away after using the night guard for five or six days. I was concerned because I had heard of the possibility of an infection not having many symptoms, but since the pain seems to have been caused by grinding and there is no evidence of damage to the tooth, I don't see how it could be infected.

      • Thanks for the update, Lisa! I've been really busy lately, so I didn't get a chance to respond to your first comment, but I'm glad that it got taken care of. I've had a few patients lately where I told them we could wait and their tooth might be fine and they ended up not needing to get a root canal done.

  116. I had routine dental work done one June 25th (cleaning, x-rays, and fillings). Most of the work was done on the right side at the top on teeth 2,3, and 4. I have been in pain since then. Most of the pain came fron tooth #2 which had a very deep, big 3 layer filling done. I had the bite adjusted several times and I had to get it extracted since I couldn't afford a root canal. The relief was instant (it was a severe shooting pain that affect the entire right side of my head. face, and neck so the relief was felt even with the numbing injections.). I had it extracted on July 17th. Since then tooth number 3 has been bothering me. It feels big like it doesn't belong, my jaw feels stiff and it hurts badly when I lay down on my sides.
    It's not senistive to cold/hot and when it hurts heat makes it feel instantly better. It does feel like it's "off" when I bite down and it feel tender to pressure. I do have a bad habit of grinding/gritting my teeth when I'm stressed and when I sleep.
    My problem it that I have random pain that comes and goes around that tooth/area that lasts about 5-8 minutes without stimilation. My denist doesn't know what's causing it since everything looks fine and dandy.
    OTC pain medications work to relieve any pain I have but I'm nursing and I am afraid of taking to much medication in case it affects my baby. My question is is this normal after an extraction? If it is how long until it feels normal again? Or would I have to have a root canal to fix it?

  117. Hi Tom,

    I banged my front tooth about a week ago and chipped a little bit of the tooth. Now my tooth is sensitive to hot/cold, when I eat and also I get sudden spurts of pain that come and go for no reason. Pain lasts for a few seconds. Is it too soon to know if I will need a root canal? If it is reversible how long will pain/sensitivity generally last?

    Thanks

  118. Thanks for the helpful information. I have a couple of questions/worries about a similar situation to many of the questioners.

    I had a cavity (in #14) filled 6 weeks ago that was under(?) an old filling. The dentist described the new composite filling as deep. Immediately after, I had sensitivity to cold (extreme), hot, sweet and sometimes to biting pressure. Occasionally it would ache slightly and fleetingly for no apparent reason. The dentist told me to wait a month. After a month the pain was basically the same (a bit less to hot and pressure). At week 5 the dentist checked the height of my bite (fine) and painted something to seal the tooth and told me to see if that helped it. Since it remained sensitive (only a small improvement), the dentist removed the filling today (week 6) and placed a temporary filling that I can taste has eugenol. He said he's trying to see if the problem is with the filling or with my tooth. So if things improve with the temporary filling in 2 weeks, he'll place a new permanent filling in the tooth. If not I suspect that means a root canal.

    - Is he trying to see if the pulpitis is reversible by doing the temporary filling?
    - If drilling deep in the tooth causes the pulpitis, why does this plan of action involve so much more drilling (i.e. take the filling out, put a temporary one in, take that out, put another in)? Won't all that drilling just make it worse? What is the logic behind the temporary filling?
    - Given all the drilling, should we have waited longer to see if the pain would go away before taking out the filling?
    - What kinds of problems with the filling (versus my tooth) could cause this kind of sensitivity?

    Many thanks,
    Allison

    PS: sorry that this was originally posted in the wrong place in this thread.

    • Hi Allison - Your dentist is trying to make see if the pulpitis is reversible. The eugenol fillings can have a healing effect on the pulp of the tooth.

      When white fillings are put in the tooth they are soft. We shine a curing light on them to make them hard. When they harden, they also get slightly smaller. Sometimes this can cause the filling to pull on the sides of the tooth, causing pain. The only way to alleviate this is to remove the filling by drilling it out. Although the extra drilling can be traumatic for the nerve, it is probably better than leaving a filling in that is causing stress to the tooth. Six weeks seems like a reasonable amount of time to wait.

      I hope that helps! Let me know if you have any other questions.

    • Hi Allison, did the temporary filling and eugenol work? I am curious as I am having similar tooth pain following a filling.

  119. I am a 31 year old woman with perfect teeth until my car crash 10 years ago. I had never had a cavity or anything before then(well except for having my wisdom teeth out and celence put in my back molars because the center was too deep). Now I have a mouth full of broken teeth and my jaw pops every time I open my mouth. I am constanly in pain because of it and can hardly eat due to it. I know it can be life threatening with the possibility of getting an infection and having it go to my heart but I don't have a job, my credit is very poor(in the toilet), and I do not have insurance because I can't afford it. I live in Eugene/Springfield Oregon and the only free clinic we have here is White Bird and they cant do the extractions on my teeth because they are so bad. I was wondering if you knew anyone who would be willing to pull all of my teeth(or atleast the bottom ones) and will take payments?

    • Also most of the broken teeth are broken below or at the gum line.

    • Hi Abigail - I'm sorry to hear about your accident. Do you know if you qualify for Medicaid? Care credit is another option that many people qualify for, even when they think that they won't. You can Google "care credit" and then there is a form to fill out to find a dentist near you who accepts it. Good luck getting your mouth healthy again.

      • I don't qualify for medicaid (which in Oregon is called the Oregon Health Plan). They don't have money for new people right now. Also I don't qualify for care credit. My credit is to bad and I don't have a job so they won't give it to me.

  120. Hey Tom. I've started from the top and really enjoy your interaction with the people that need help and gave me a sense of good feeling, while learning all about reversible pulpitis and the irreversible pulpitis.

    So I have a top molar on my left that sparks a jolt of pain when I bite down on my teeth or softly play bite to test it's sensitivity. The pain is just a quick jolt. Not continuous, and just fades away until I bite down again.

    I've done several tests on ice cubes to test it's sensitivity to coldness and warm foods on hot triggers on the tooth. The coldness and warmth doesn't trigger pain at all. Just the biting pressure.

    Also when biting food on it, it doesn't trigger. Only when it lands on my bottom corresponding tooth.

    Also this tooth have had a filling on it before on the back of the tooth. But I can sense the pain is on the tip of the crown.

    I would like to repeat that it doesn't inflict any continuous pain at all. And it ONLY triggers if I bite down on my teeth or something of exact hardness. No warmth trigger or coldness trigger.

    I want to know if this is something that can possibly be fixed without a root canal since I had one already and don't want to go through the process of affording it. I can probably sense a cavity, which involves cleaning it and putting on some filling. I'd much rather have that then facing a root canal and crown situation.

    Thank you Tom!

  121. Hi, you have some great answers on here so I'm hoping you can help! I had a White filling dome 6 moths ago and it hasn't been ok since. It had to be filed down a few times
    because it hurt when I bit anything hard. Filing didn't help.

    It was removed after x-rays showed it was ok but it was too sore to keep in. Replaced with silver filling.

    The silver filling then started to throb around the tooth area. A dull ache from time to time. Again x-ray showed nothing wrong. Was too painful to have in so they removed it and put it a sedative filling to see if it would calm down the ache/low throb. This worked for around 3 weeks so it obviously did something right! Then, even with the sedative filling in the throbbing came back. Never agony again. Doesn't keep me up at night. Just there in my mouth, sometimes every 10 mins, sometimes every few hours. Nothing to do with hot and cold as far as I'm aware, just happens. It's my top left back tooth and so it sometimes hurts when I lie down on that side to sleep now too.

    I was given antibiotics 2 weeks ago which didn't help. Ache still here. Sometimes it's shooting pains now too. But x-ray shows nothing and today the sedative filling was removed and replaced - cleaned tooth and looked around and all seems fine! Apparently filling not even near the nerve according to x-ray.

    I've to wait between 1 - 3 weeks and am booked in for either rot canal or filling in 3 weeks either way.

    They just seem to be guessing it is root canal though and I don't want to get something down that isn't even needed if the tooth looks fine?

    Could it be anything else in that area that they are not picking up on? I have had sinus pain aroundtooth area in past so know it can be other things than toothache!

    Do I just bite the bullet and go for root canal soon as the sedative filling was put in 11 hrs ago ad I'm still feeling a low throb (not sure if it takes days to calm the tooth?).

    I have seen numerous dentists over the last 6
    Months and I just feel I might get root canal and actually it is so eking else that is going on. The dentist says I don't have typical symptoms of root canal?

    Please shed some light and your opinion on this as I am running out of patience with this matter as it has been dragging on too long now!

    Thankyou in advance.

    • Just for future reference for people looking up this problem, I had to go into my dentists for an emergency appointment as it was beginning to hurt my neck, give me a headache (above my eyes) and had the beginning of swollen glands.

      It was never AGONY, but a constant throb, and obviously with the other symptoms appearing it was concerning!

      I was told the best treatment was root canal and so I got it - and although it is only 24 hrs after, I am glad I did! It seems a little bit sore from the work that has been done on the tooth (the root canal really wasn't sore AT ALL after you get injected up!). The throbbing seems to have gone (with the tenderness from the work I don't want to say it's fully gone, will have to wait a few days to assess).

      Although there were no signs of infection on the x-ray - when the dentist looked inside my tooth he said he saw an infection and a lot of blood up there. Not sure what that means, but it apparently proves there was an infection there. So don't always trust x-rays to show everything. I knew there was something wrong with my teeth and wish I'd got the root canal done weeks ago! Trying to let it settle with a sedative filling didn't work for me, but it was worth giving it a shot I guess.

      But in the end, prepare for possible root canal - but fingers crossed it seems to have helped mines, and I promise it didn't hurt!! I've to go back in a few weeks to check it and get a filling or crown.

  122. Hello Tom,
    This refers to a 6 year old filled back upper molar. Pain on chewing for some months, dentist could not see an external problem. A week ago I awoke with bad pain. Relieved on standing up, returning every time I reclined. Then pain continuous for a couple of days. Now completely pain free. The dentist suggested a root canal but due to my age (70) and finances, I booked myself in for an extraction in a few days time.
    I reasoned that the problem would return and that it is preferable to get rid of a presumably dodgy tooth, with the concomitant risk of later more serious infection.
    Do you think that I have made the right decision? Or should I wait for the next episode?
    Many thanks

    David

  123. Hi Tom

    Just found this QA site, reading of which has been very helpful. From what I've read looks like I have irreversible pulpitis. Had a fractured back molar and dentist removed old deep filling in preparation for having a crown fitted. A temporary fitting was put in place and at first there was no pain. After 3 days the pain arrived and has got steadily worse with referred pain in my upper teeth. The ache seems to come on late afternoon and is worse at night. I returned to the dentist last week who prescribed antibiotics which I knew would do nothing for the pain but thought they might be prescribed to prevent an abscess forming - is this right? Have to return to the dentist on 20 Sept and now realise there are only two courses open to me ... root canal or have the tooth taken out. Am not looking forward to either treatment in all honesty!

    Jan

  124. Hi,
    my back tooth cracked about 2 weeks ago, and I went to see a dentist to see if he could save the tooth. He told me I need a crown, and prepped my tooth with a temp crown. Since then I have had pain radiating from the jawline to my ear. After I week, I saw my dentist again, and asked him if the pain that I was feeling was normal? He readjusted my temp crown, but I still have pain, especially at night. I then saw another dentist (my went on vacation) after the readjustment (2 weeks later) and he took an x-ray of my tooth to see if there was anything else going on. The x-ray showed a perfectly healthy tooth, and he could not figure out what is causing me so much pain. Any thoughts on my situation?

  125. Hello Tom!
    Toothache with pins and needle (tingly) feeling on the right side of my face!
    I'm in China and I can not communicate with the dentists here beacuase of the language barrier.
    I had filling a few years ago in the lower molar tooth; Three days ago after eating sweets i started to feel pain in my Wisdom tooth (near the tooth with filling); I used Advil and put some powdered aspirin near the gum, it helped a bit; but now I feel tingly feeling on the same side of my face; I feel like sneezing but I cant; I also got runny nose today; the eye on the same (right) side is watery!
    Is it due to the tooth ache or I got somethingelse?

  126. Why is it that today in 2012, that we can have a problem with a deep-filled cavity?

    It seems to me that perhaps we have problems with the material used for the filling.

    I get pain after a filling, with hot and cold. Hot and cold should not reach the tooth nerves. If hot and cold could not get to the nerves I would have no problem (it seems).

    Do we get pulpitis simply because we had a deep filling, or is it to do with inadeqate filling materials?

  127. Hey Tom, I have a quick question. I have a upper back molar (5 teeth from the front upper tooth) that has a large amalgam filling. Ever since the filling, I have had lingering sensitivity to cold (about 5-7 seconds). About a year after the filling (about a month ago now) I had ridiculous pain in my tooth. It felt like it was going to explode, along with a huge headache, and everything else. I couldnt do anything but try and sleep. Went to the dentist the next day, and got xrays. He said there was no abcess, and said that I was really sensitive to "knocking on the tooth". He said if it doesnt go away fully in a week, come back and do a root canal.

    So everything got better, but now a month later, it started again, but about 60% less painful than the first. I can still eat (mostly on the other side of my mouth). It is only sensitive now to pressure, and when I close my mouth when my teeth rest on each other.

    My questions:

    1. I really dont want to get a root canal, I feel that If I do, since the tooth is basically dead, it will eventually crack and I will have to get it extracted and have a implant put in anyways. What do you think about this?

    2. Do you recommend going to an endodontist for a root canal? My dentist said my roots are mostly straight and not curved much. But If I end up getting a root canal, I want it done right. Should dentists be good at root canals, or are they just able to do them?

    Thanks a lot for your time.

    • Hi Chris - It sounds like the tooth had pulpitis, and then it went downhill to irreversible pulpitis (your headaches, ridiculous pain, etc.). After that, the tooth died and an abscess formed, which causes pain when you bite down on the tooth. The x-ray won't show irreversible pulpitis since the pulp is not dead yet and the bacteria haven't quite yet taken over.

      1 - It depends on how much solid tooth structure you have left. If the filling is extremely large and there is just a shell of tooth on the outside remaining, this shell of solid tooth structure will most likely be cut away when the dentist prepares the tooth for the crown. As long as there is a good amount of tooth structure remaining, I would hang onto the tooth and get the root canal.

      2 - Some dentists are very good at root canals, some even better than some specialists. Some dentists aren't good at all. I'm not sure how you would be able to tell, but in general, a specialist will be able to provide a high quality of care.

      I hope that helps, Thanks for your comment!

  128. Interesting. All my teeth are painful, are see through, have lots of scrape marks from Hygenist. Dentin on back of teeth exposed. Pain excruciating keep going to the dentist every 3 months they clean and use a laser to go around all my gum lines. I have facial disfiguration with these teeth, pain in my face, neck and nose and no one wants to treat. Oral surgeons just want to make bites and give drugs, bite I use but told I don't grind, I can no longer eat well as cannot chew and food sticking as we'll as painful to all surfaces. swallowing difficulties. Severe dryness in mouth and nose, teeth shifting. Lips swollen and bottom hangs; loss of jaw. Though some say I have bone. One dentist said no I could not have dentures too dry and no implants due to bone loss. Inflamation redness in face, opening mouth is harder and it hurts to speak. Pain even with air touching them. Stiff neck. Tongue has been white given nystatin to rinse.
    Every cleaning is making them thinner. Food sticks to all surfaces.

    Under a different side you said Vincent's mouth I think it is osmylietis of jaw. Teeth are sharp palate high, tongue has tooth marks on side and they are just shifting. I live in 08724 area code Food tastes awful. Never had dryness or breathing difficulty till this has been going on.

    How do you test for Vincent's disease? My teeth and jaw, whole face is painful.
    I looked at the photo on Wikipedia and I am worse than that. I would share with you a photo for your professional opinion. When I try to smile I am bite off and I no longer have a chin. Pain keeps me from sleeping. One dentist gave me tramadol but I vomit so narcotics don't sit we'll, no over the counter remedy works. Over the counter don't work also. Thank you.

  129. Hi Tom,
    I had my bridge replaces about two years ago just because the former one was over 10 years old and reciding. I've been sensitive to cold ever since and usually just drink cold through a straw or have found ways around it. About three days ago my dog bumped his gigantic head against my bridge and it hurt for a second but I didn't think anything of it. I'm still not positive this is the reason I am having issues now. The next night a weird pain showed up in my bridge but came and went just a handful of times. Each day since the pain has become increasingly worse to the point where now its there always and I can't bite down on that side. Even if I move my lips over it it hurts or let my tongue touch it. It almost feels sore. I'm also pregnant just fyi.

  130. Hi

    I recently had a sinus infection, and was waking at night with my upper left teeth very sensitive to hot and cold. I went on a course of antibiotics and steriods which cleared the sinus infection. However my teeth are still sore, and sensitve to cold esepcially. I went to a dentist and she thought it was my very back tooth based on the x ray and it had a longering pain when she put that cold stuff on it. However, when I drink cold drinks, it is a tooth further in front which hurts.

    I'm wondering if she's got the right tooth? As I'm considering getting the back one extracted rather than a root canal, I want to be sure! She has suggested waiting and seeing if the tooth settles down, but I have been off the antibiotics for 2 weeks and no real improvement. The pain isn't bad, it comes and goes, but occasionally it has started up with no stimulus.

    Should I wait longer, or is this a false hope? I'd like to have it sorted before Xmas! Appreciate the time you put into responding to these questions - this a great site!

    Thanks

  131. Dear Dr. Tom,

    This is the best thread on the Internet about reversible / irreversible pulpitis.

    I have a fundamental question that I cannot find addressed anywhere on the Internet. Everyone says that a dead nerve cell can lead to infection. I have not read anyone claim that it will definitely lead to infection.

    If the nerve dies and is sealed up so not exposed to daily food debris, what is the chance that nature can handle it? Common sense tells me it can, that it should be given a chance before a root canal. More than 200,000 years of human evolution has had time to come up with a solution. Warm-blooded mammals have been around 1000 times longer for 200 million years. Teeth have changed little.

    My pulpitis history is as follows. I suffered a few weeks of both minor chronic tooth pain and also while chewing. It was not isolated, not even to my lower left jaw where the problem tooth number 20 is located. My guess is that was an infection throughout the jaws.

    Suddenly I noticed that half of tooth number 20 was missing. There had been a filling there for 40 years from since I was about 10. A cavity developed under the filling. I immediately went to the dentist who prescribed penicillin which I have been on for about a week. The dentist wished to do root canal but did no testing of the nerve. the nerve appeared as healthy as any other tooth, but I understand x-rays are not very good at judging the health of the nerve. The x-ray showed extremely little evidence of pus ever having drained from the tooth into the jaw.

    Because half of the tooth is gone rather than being a big hole, it is now much easier to clean the area. I believe most of the pain subsided due to this fact, and not from the penicillin. I have no ongoing pain or unusual sensitivity to cold.

    The tooth however is sensitive to even warm tea. The dull constant pain will be 90% gone after 1 min., and 100% gone after 2 min. There can be a 10 second delay after drinking the tea for the pain to start. I intend to start measuring the tea temperature. I could later post here changes in temperature/pain thresholds. It looks like I'll be the first to ever chart this out. Given it has less insulation, there must be a point where it is normal for it to have greater sensitivity.

    I've heard the sensitivity can last a long time. Does continuing sensitivity indicate that the nerve is still alive? The only explanation I've heard for the pain is gas bubbles expanding. There must be some molecular explanation, but given the low temperature of lukewarm tea, it's hard to see how that's the only explanation.

    In general (medical advice of course is impossible without you seeing me), is it better to somehow protect the tooth or is it impossible to cap it until the nerve decides whether it's going to live or die? One dentist is quoted on the Internet saying there is no reason to take out the nerve until it is truly dead. Do you agree with that?

    Nature is telling me to do absolutely nothing at all for now. I sense the tooth is healing itself rather than every day coming closer and closer to exposing the nerve. Is that reasonable or wishful thinking? I'm not against a cosmetic filling, but just feel I should give the tooth some time to heal on its own. But if I have indefinite heat sensitivity, I may have no choice but to leave it alone, or of course undergo root canal which obviously I'm against.

  132. Hey~ I had two fillings done on November 16th, tooth #2 and #3. The thing is that tooth #3 had a large composite "build up" or bond, whatever you want to call it :) However, it had a cavity under the bonding. Basically I had a cavity in between tooth #2 and #3 so the dentist had to completely remove my old bond on tooth #3 to do his thing. So here I am with what looks like an amalgam mixed w/composite on tooth #2 and then a composite bond on #3, but he only left like 50% of my tooth structure (if that!) on tooth #3. So him removing the old bond and leaving me with a smaller tooth is fine, but right when the numbing went away it hurt like hay to chew on it and was SO sensitive to cold. I called and they said don't eat on it, give it a few days etc. So actually, I waited until December 2nd to go in to have him peep it out..what was happening was it throbbed like hay with cold stuff and it throbbed mildly if I chewed on it, the part that worried me was in between the two teeth feels like I have a cavity when I floss in that space, it hurts when I lightly tug the floss out. I went it and he said said a piece of filling was high (but that he didn't think that was the prob). He put some de-sensitizer of sorts in the space and said give it time. He didn't do an x-ray and my tooth was not hurting at that time to really point out what I was talking about. He didn't mention root canal at all, but did say if it is sensitive later on I should get a crown. My problem is not the sensitivity, it is the cavity sensation in between the teeth when flossing..then my concern shifts to the throbbing from cold. My intuition tells me that he didn't fill it correctly, my tooth tells me something is going on in between #2 and #3, right where he filled and drilled. Pain with cold stimuli is light throbbing inflammation about 2/10 pain, and the pain when flossing in between those teeth is more of a sharp pain with floss tugging 4/10 pain. What's your take on it? It's been roughly 18 days since the drilling and filling.

    • p.s~ the inflamed throbbing feeling after cold or excessive chewing seems to lightly throb for awhile, then goes away. Also, when I bite side ways or really deep on the bonded tooth it hurts at times, really intermittent like it suddenly hit something. The sharp pain in between flossing the teeth goes away asap after the floss passes through the two teeth. It doesn't hurt when the floss is going up into the gums, only when passing through the two teeth to exit. Thank you so much, please reply I am dying to know!!!! :) Thanks.

  133. respected sir, i am, myself, a dental student. i want to ask u what is meant by exudative pulpitis? what is the difference between exudative pulpitis and suppurative pulpitis???
    Regards

  134. When the dentist was drilling my tooth, I had to bite down on something that sprayed water on the tooth and sucked water back out of my mouth. After the dentist had been working for some time, it started to hurt right through the novacain. The dentist said, "more water" and I realized that my bite had relaxed and the thing I was biting on had moved and wasn't spraying right on the tooth anymore.
    Two weeks later, I still have a lot of pain in that tooth. I'm afraid that the pulp overheated while my loosening bite allowed that instrument to shift and not cool the tooth properly.
    Could that have happened? What is that instrument I was biting on called? It seemed to spray water and suck it back out.
    What can I do to reduce the risk of the tooth dieing?

  135. Thanks for this amazing blog!.. I think I have pulpitis. Basically, I don't have any pain throughout the day. I do have some sensitivity to my warm salt water rinses.It is only painful when I lay down and go to sleep at night. It feels like the pain is from pressure maybe from blood flow perhaps?? because when I sit up or stand up the pain goes away. Anyway. Im scheduled to have it extracted by an oral surgeon next friday which is a week away. Ive already been experiencing this for over a week but that was the soonest I could get an appointment with him. Is it safe to wait another week to see him? I called the office the other day to see if there was any way to get me in sooner and He offered to put me on antibiotics but I dont like the damage that antibiotics can do, especially if they're not necessary. i Have no idea if you'll read this but I hope you can respond soon. Thank you

    Josh

    • Also, i wanted to mention the reason I had called the surgeon
      s office to get in sooner because I had developed a sore throat which i believe was cause by the tooth. The sore throat was like difficult to swallow. Ive been raw garlic which is a natural antibiotic, and the sore throat went away...i still dont know if its infection or pulpititis, abscess or what?!

  136. I'm having long periods (longer than 15 seconds) of pain in my left hand side of the mouth, upper and lower. I have had a filling recently on a molar but when I went to the dentist yesterday complaining of sporadic excruciating pain, she took some x rays, said there was no visible sign of infection and that my filling were not 'deep' and gave me some antibiotics 'just incase'. I can't locate an exact tooth where there is pain it seems to run the whole of my left hand side of the mouth, mainly at the back and the bottom. She did a sensitivity test by spraying each tooth, but none of them were particularly sensitive and she also 'pricked' them but I couldn't identify particular pain in any tooth, yet the pain comes and goes and when it comes its excruciating, my eyes water spontaneously and the pain lasts for about 20-30 seconds intense or longer but not as intense.
    My worry is that I need root canal but the dentist cannot locate the effected tooth and is hoping it's something else, but I don't want to continue with this pain.
    Any thoughts would be much appreciated
    Huma

  137. Reversible pulpitis and apical periodontitis caused by high filling or irreversible pulpitis?

    I went to the dentist as my lower rear molar was giving me very sharp pains whenever I ate or drank anything cold. The dentist did an xray and said it looked like one of the roots "might" be dead (he wasn't sure). He wanted to extract the tooth and said there wasn't enough space for a crown. He also said that if I have the tooth extracted, the tooth above it would grow longer and start cutting into my gum and that would then have to be shaved down and also have to be removed in time. Is that right? I really don't want to lose the top tooth as well as it is a good tooth.

    I've never had an extraction before and wanted to know if anything else could be done to save the tooth so asked for a second opinion. In the meantime, the first dentist put a temporary filling over the top of the existing filling on the tooth concerned (I'm not sure why as the pain is coming from the outside edge, not the top) but he didn't adjust the bite and the filling was far too high.

    It was painful to chew on the high filling. Initially, the second dentist asked me "if I could live with it" and said I might just have a sensitive tooth and to avoid anything very cold. She also said the tooth above it would not have to be removed as well as it would stop growing when it reached the gum line.

    I returned to see her a week later, by which time I had been chewing with the high filling for about two weeks (and the highest bit had cracked under the strain the day before my appointment) and the tooth had by then become constantly painful. It was also very sensitive if I touched it with my finger and if my finger was slightly cold.

    At the second appointment, the dentist removed the high filling and also drilled out the old filling beneath that. She said there wasn't any decay but that the nerve was inflamed and she put in a temporary sedative filling. Immediately, this made a diference and the tooth seems ok when I eat or drink anything cold.

    However, I do have a more or less constant dull ache from the tooth and it also aches for quite a long time after the pressure of chewing. I'm hoping I might have reversible pulpitis and also apical periodontitis caused by the high filling but it might also be irreversible pulpitis.

    The dentist has asked me to come back in about a week but I'd like to give it a bit longer to see how it feels. How long should it take for the pain to subside if it is apical periodontitis from the high filling and would I expect to see an improved x-ray result soon if I have reversible pulpitis?

  138. Dear Tom,

    Congrats on your graduation and thanks for starting this blog.
    It's of great benefit to many people around the globe.
    The second to last of my top left molar has been hurting on and off , over the last month.
    Sometimes so severe I couldn't sleep till five in the morning,only clove soothed the pain and allowed me to sleep. It was awful! I've been to the dentist about it and he can't see anything on the x-ray. Sadly,for me because the pain keeps coming back, which tells me there must be something wrong. I've quite a big filling in the tooth, today is one of those days that's it's hurting aw.....I feel let down by the dentist. He told me it's really difficult to do a root canal on this tooth. Why doesn't he refer me to a specialist? I've already lost the molar next to it (going forward). I would hate the idea of having an other molar extracted , there would be a huge gap. It won't leave me any teeth to chew with.Only one at the top! Surely, everything should be done to save the tooth?! Please, give me advice as to what to do. I feel so frustrated and let down by my dentist.

  139. I forgot to mention that my wisdom tooth starts to come through on the top left.My dentist told me that possibly due to pressure the molar is hurting.But it's only pushing the gum a little it's not showing yet. Why would my molar hurt when I bite? If it has to do with pressure? It's hurting me constantly today. I can also feel my "heart beating "in the molar. I've no clue why? The dentist said as long as the pain is bearable to leave it or it might be extracted. What about the option of having root canal treatment? Is he trying to escape to sort me out properly or what? A painful tooth is extremely frustrating. I'm looking forward to any advice. Thanks again.

  140. Hi Tom,
    My partner has been diagnosed with irreversible pulpitis. The dentist recommends extracting the tooth, something about 2 roots being dead. Are there other options?
    Thanks

    • Hi Cecile - Usually a tooth can be treated with a root canal when there is irreversible pulpitis. One exception would be if there is a cavity in the tooth that is so close to the bone that it would make it very difficult to put a good crown on the tooth after the root canal.

  141. Hi, great info here!. My problem is that I had a filling replaced for a white one about a month ago. Its a very deep filling ive been told. For the first weeks my tooth hurt with hot foods and drinks. The pain didnt kick in right away but after 30 seconds or so. Then the pain would become less in about 2 minutes. With cold drinks the pain was felt instantly. Now after a few weeks the pain with hot drinks is getting less and less. i feel some mild pain after a minute after the very hot drink. Its the same proces with cold drinks. I still feel that my tooth is very senstive but its not like the pain before. its more of a dull ache for a few minutes. Also sometimes with eating hard food i feel a but of a discomfort. is it geting better or is the nerve just dying?

    My big dillemma is whether it needs a rootcanal treatment or wait till it stops hurting. Also because i will go on a big holiday in about two weeks. So shall i have it treated before boarding a flight?

  142. Hi, Tom.

    I've been experiencing some "phantom tooth pain" in the two front bottom molars on my right side for a handful of months now. I had mentioned it to the dentist a couple of times, but he said the x-rays don't show anything, that "the structure looks good", and he doesn't see anything otherwise. He mentioned it could be the natural shifting of teeth, but that didn't (and still doesn't) make much sense to me seeing as I only feel the discomfort in these two molars and it's been pretty persistent. He said that if it still bothers me, I should come in so he can "do something about it", but I don't want him to do anything unnecessary. Also, because he didn't seem to know what the problem is, I'm not sure how he can do anything in the first place. It's not completely debilitating, but it is uncomfortable, annoying, and can occasionally border on painful--still, I do sometimes experience periods of relief where I don't feel the discomfort for a few days.

    I had never experienced this sort of discomfort until after I started seeing the dentist (before last June, I hadn't been to a dentist in about 6 years. My teeth had never bothered me before then). He refilled three of my teeth, including the first "big" molar next to one of the molars in question. I also got fitted for an occlusal guard to help w/ my grinding (which has been an on/off issue for me).

    I honestly can't remember if I noticed the pain AFTER I started wearing the guard or AFTER I got the filling, though I think it might've started after the filling. Could the pain be caused by either of these things? I've tried to figure out if any other habits could be contributing to it, but it doesn't seem likely. I'm at my wits' end with this. Any suggestions would be great.

    Thanks for the website. I've used it as a reference a few times now :).

    • To clarify, the molars in question DO NOT have fillings and have not had any work done to them. The filling was done to a neighboring molar.

      Also, if it's an issue with the mouth guard, could it be that it's ill-fitting? Mine is acrylic, I think. It's a hard plastic one--are there other options?

      Thanks again.

      • Just saw this one, Amy! Does the mouthguard hurt when you put it in? When you bite down with the mouthguard in, does it feel like all of your teeth are touching the mouthguard fairly evenly? If not, it may need to be adjusted.

        Even teeth without any fillings can develop cracks in them... There's also a LOT of other things that are hard to diagnose that can mimic tooth pain.

    • Hi Amy - Has your dentist tried any test to test each tooth individually to see which one is causing the pain? I'll usually measure inside the gums around each tooth to check for gum problems, feel around each tooth to check for any signs of infection, tap each tooth to test for inflammation in the root, check the tooth for cracks with a bright light, test the tooth for cracks with a bite test, check the bite to make sure that there isn't excessive biting force on any one tooth, and test each tooth with a little bit of ice to see how the nerve reacts. If we still can't conclude anything from all of that, I'll ask the patient how severe their pain is. If it's very severe, I will refer them to a root canal specialist for a consultation (Many times their testing results come back inconclusive as well), if it's not severe, usually we'll keep an eye on it. It sounds like the pain could be related to one of the recent procedures you've had.

      I wish I could be of more help - it's important to remember that some things like hairline cracks in the tooth and inflammation in the nerve won't show up on x-rays... Let me know if you have any other questions. Thanks for your kind words, Amy - Good luck!

      • Thank you for your time and response, Tom. I know it's difficult to give an answer without looking at and examining a person's teeth, but I appreciate it, and it gives me an idea of what to ask the dentist. I've been thinking, for a while now, that it's related to the filling he replaced (especially because I'm pretty sure it started, and then continued for months, after that procedure). The discomfort has actually been a bit more persistent and apparent lately, so I'm going to call the dentist's office to make an appointment. I'm also going to ask him to take a look at the mouth guard. I think it might need some minor adjustments. I don't know--I just really hope that this problem can be resolved and that I can get some answers. It's been uncomfortable, disheartening, frustrating, and stressful. Even though it hasn't been debilitating, it's ever-present, affects my general mood, and even causes me to worry about/question its possible relation to other symptoms I've been experiencing (i.e. certain sensations in my temples and scalp). I've also debated seeing another dentist for a "second look". Like I said, I'm at my wits' end with this. It's funny--I know people should see a dentist, but I feel like it has caused a domino effect of issues for me. That's another story!

        Anyway, thanks again, Tom. I appreciate the information. Take care :).

  143. Hi there,

    Thanks for all the information you are providing; it's very helpful!

    About three months ago, I had a filling down on a back molar (told it wasn't very deep). Immediately after the anesthetic wore off, I would feel a sharp pain when biting down (when they were curing, it didn't feel like the light was in the right place and in fact at some point in the second curing or so, the dentist notified the hygienist that was so, but I was assured that improper curing was not a possibility with the new composite materials). Waited the week-end, and that got better but I would still experience a dull pain when chewing on it. Went back twice and the filling was grinded down/adjusted. Still felt similar pain, plus slight sensitivity to cold. Went back a fourth time and the filling was adjusted again; I was told to give it another month since removing/replacing the filling might only irritate the nerve more.

    It's now been a month since then and although pain on chewing has pretty much gone away, I am still experiencing sensitivity to cold drinks and foods, which has increased this week (usually lingers a bit but I would say no more than 10 seconds). I'm about to make another appointment but wonder what the best course of action would be. Should I give more time for it to settle down since I am worried we may further irritate the nerve and increase the likelihood of causing irreversible pulpitis or is the filling itself causing inflammation and I should have it replaced (hopefully by a temporary filling at first)...?

    Your opinion would be greatly appreciated (I would very much like to avoid RCT and crown).

    Thanks.

  144. Back in early August, I noticed I had a hole in my tooth (I had previously experienced a feeling as if something had gotten stuck between my teeth that made biting uncomfortable but tolerable, but it went away...) Turns out I had a cavity that almost broke through to the pulp.... Well, the dentist I saw at the walk-in clinic drilled out the cavity, filled it with medication and sent me on my way.

    For a week or so, I would get RANDOM pain surging into my tooth for a few seconds and then, suddenly, it was as if the pain never happened.... I have since stopped having such feelings of pain, but the tooth itself is very sensative--- like the feeling of a high filling, old sensitive, and don't get me started on what it feels like when I bite down on something hard (OW!!!!!!)

    I saw a dentist again a few weeks ago (Now March) and he did a cold test--- He put some freeze spray on a cotton swab, and introduced me to a world of hurt that lingered for nearly a whole minute..... He then dubbed that I had Irreversible Puplpitis.... The issue is--- it doesn't hurt, unless of course I bite down on something hard.

    He gave me a round of Penecillan, to which I took the ENTIRE course of, and now my hope is that I can find a way to allow the nerve to become un-inflamed. Any Suggestions?

    (PS - I want to leave a root canal or extraction until the last resort, I don't have the money, or the insurance to go through with one if I can find a herbal, or less extensive or less intrusive way to heal my tooth.)

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  146. Hello Sir, I had my first bought with pupitis. Antibiotics were prescribed but the pain continued. I went back and a root canal was performed. I hadn't felt better in weeks. It started with a little fleeting pain then eventually it just got worse. I think I had irreversible pupitis. Constant pain with cold/hot and sweets. Took Vicodin and doubled up on aspirins. Nothing helped. I always find more info after all is well. I'm glad I stumbled unto your site. So informatative. You can publish my comment if you wish. : )

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  148. Hi Tom,
    Thank you for trying to help so many people - it is a laudable endeavor!
    Here's my situation:
    I chipped a tooth a few weeks ago, but didn't do anything with it (in between jobs).
    Every few days I would have pain in that area when I would lie down.
    Three days ago I started to have that pain much more frequently. The pain is intense & lasts for a couple of minutes, but is instantly relieved by cold water.
    Wondering if RCT is the only option, or if there is some hope that it is reversible pulpitis?
    Thanks again!

  149. Hello Tom!

    Thanks for such a great article, really helped. But I just have a question.

    A few days ago I went to the dentist for a filling on my last upper molar because I had a huge cavity and the enamel wore off I think because I could feel the hole. Anyway she said it was quite close to the nerve but managed to fill it and it's giving me absolutely no problem yet. But what's bothering me is the tooth next to it. The day after the filling I began to feel it a bit weird. When I bit down it, it gave me a small sharp pain and goes away after a few seconds. So basically every time I chew it hurts to an extent, not unbearable but quite annoying. I took a look at the area within it and it looks a little black, probably needs a cleaning or something. What I'm concerned about it, is the fact that it hadn't hurt before the previous filling that I received. What I'd like to know is, do you think it could be pulpitis? I know I need to get it checked by the dentist again and I'm going in a few days. But I'm just really freaked out if she mentions root canal or anything because she's seen the tooth and didn't say anything about it before, like I need to come in for another filling or anything. Just wanted your opinion.
    Thanks so much!

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  151. Hey there, had a filling replaced two weeks ago and it is very very sore when biting, when I floss it aches to one side of newly filled tooth. I have had extream tmj can this cause sensitivity? really struggling to eat or relax the jaw/ cheeks at all, please help. Alice

  152. Hi Dr. Chris,

    I am looking for some insight. I have a unique situation that I feel like I am running in circles with and want to know what you think. About 3 months ago I got a filling done with the new white fillings. My first ones. When I got it done the dentist told me it was bigger than normal so it would be sensitive. Well it was sensitive but wasn’t too bad. I could handle it. Well, I had to travel for work via airplane and noticed not on the littler planes but the bigger planes a sharp pain occurs about 10 minutes into the flight. Approximately when you reach the 30,000 mile mark or when the stewardess hand out drinks. So, it was sharp pain running through my mouth worse I have ever felt. Lasted about 30 minutes. Not continuous just like seemed like when pressure changed occur. This happen to my destination and back home on both airplanes. So when I got back I made an appt with my dentist telling him what happen. He took more xrays, didn’t see anything wrong so he went and re did the filling thinking there might have been an air pocket in there. Well, went on another airplane for my honeymoon about 3 weeks later. Still the same pain. Went on 4 airplanes, 2 littler planes which weren’t nearly as high then the two bigger planes. Again the same thing happen where about 10 minutes into flight get sharp pain and lasted about 30 minutes. I immediately called the dentist and told him I want a referral to an endodontic. So once I got back from vacation I made the appt. which was about 3 weeks ago. Went in, the endodontic did a bunch of tests, did xrays and nothing hurt or was wrong. He filed down the filling cause he said it was a little high and also put something on it to help with seal the filling in. Not sure what it was, but said it should help. Well about a few days after I noticed slight throbbing every now and then. Nothing bad, just annoyance it seemed like. Over the past couple weeks as well since I was in the endodontic, I felt more sensitivity to my tooth when drinking hot and cold items. And the throbbing from the hot and cold items lasts minutes. Sometimes quite a few minutes then goes away. I think it is getting slightly worse for I never experienced that much sensitivity before and feel a root canal will be in order. My problem is I have been saying it ever since I had the airplane experience that I would but the dentist and endodontic said they cannot see anything. I am at a loss and just don’t know what to do. What is worse, is I am going scuba diving this upcoming weekend, and Throbbed was told that might be worse because of the pressure changes you go through as well as the cold water. What do I do? I have read an article about pulpitis or something like that http://www.dental-health-advice.com/pulpitis.html this is the website and it is almost exactly like my symptoms and experience I went through. Any help would be greatly appreciated. I already made another appt with the endodontic but want to have another opinion if you have heard this. I wish I would of gotten a root canal when I first experience my airplane ride, because now I am afraid to fly as well as scuba dive. Plus not to mention the sudden slight throbbing of that filled tooth. Please Help!

  153. I have been complaining to my dentist for about a year about pain from 2 molars the dentist just said I had sensitive teeth and to use sensodyne toothpaste.I had a bout of more intense pain last week and the dentist took an x ray and said there was a shadow which could be infection and he could take the tooth out .I was shocked and said I would not book for an extraction but would wait and hope it settled .By friday night I was a lot worse and telephoned Nhs direct advised pain killers.They did not help and when I could no longer eat and had not slept for 3 nights I saw another dentist who said I had pulpitis.

    Can you tell me how long it is possible to have pulpitis without the pulp dying and causing intense pain?

    One of the teeth is not so sensive now and I am worried the pulp has died and I will have problems later.

    My dentist (who refused to see me over the weekend) has not mentioned pulpitis and I am wondering why I seem to have been mis diagnosed.

  154. Could taking the xray have cracked the tooth and made it worse? What is the difference between sensitive teeth and pulpitis ? is there a test so a dentist can make a different diagnosis?

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  159. Hi Tom!
    I had two "silver" fillings replaced 8 days ago with composite fillings. Ever since I got the new fillings, my teeth and jaw have been killing me! I have been alternating Tylenol and Advil every three hours and I am still in pain one hour out of three. I went to the dentist 2 days ago and she took x-rays and filed down two high spots on my teeth. She said that the fillings weren't that close to the nerve, but since I clench my teeth, one of the teeth could have cracked a little bit from the drill causing me pain. She told me to wait for a few more days and call her for a root canal if I am still in this much pain. She prescribed me antibiotics and Tylenol 3. What are your thoughts about this? I don't want a root canal but I am so tired of this constant ache. Should this clear up on it's own within a few weeks?
    Thank you!

  160. In May I had Irreversible Pulpitis that caused me the most pain any tooth has ever caused me in my life. I got a root canal that did me wonders to treat it all.

    My endodontist prescribed me 5mg Hydrocodon with 325mg of Tylenol to relieve the pain during treatment. It worked like a charm.

    Now that I am suffering from migraines for the last month my Primary Care specialist is trying to tell me that Hydrocodon won't treat nerve pain. Is this true?

    I aplogize if this off topic. Please at least answer if it relieves nerve pain.

    Thank you!

  161. Hi, I had a cavity filling done on saturday, today is Tuesday and all of a sudden, i am having nerve spasm on that tooth, at least that's how it feels, however, i am not feeling any real pain on that tooth at least today. The spasm come and go, so uncomfortable. I am worried because i might have to get a root canal. Also can one have a root canal without having a crown done?

  162. Hello:

    I was diagnosed with irreversible pulpitis two weeks ago. How I came to get it is the mystery. I went to my general dentist for a chipped molar, #15. It didn't hurt. It was just chipped. I remember the dental assistant asking the doctor about putting in a composite filling. He said no, he wanted an amalgam filling.

    While doing the work--after numbing me--he ground away at whatever and I flexed with severe pain even while numbed. Next, he gave me an anesthetic shot in my upper palate--a secondary numbing that enabled him to do the work without me complaining about it.

    When he finished, he said I'd probably feel pain for a few weeks, which was true. The trouble, however, was that I never got better. It pained me more and more.

    When I returned to ask what might be wrong, he gave me more pain pills and asked me to give it a couple more weeks. Still no relief.

    I returned a third time--this time seeing the original dentist's partner. She tapped on my tooth and quickly declared I needed a root canal.

    So here are my questions:

    1. Was the amalgam filling the right choice and might I have survived better with a composite filling?

    2. When the first injection for numbing didn't spare me pain while drilling, should this have alerted him to something that he ignored?

    3. When I returned because of the unabated pain, should he have removed the filling and done something different, or was it just too late?

    4. Is it possible that my initial pain of pulpitis was reversible had different measures been taken?

    I'd just like to know if I was unlucky, or had a bad dentist since my chipped tooth has turned into a $1200 root canal, 1000 crown and mega pain.

  163. Hi there,
    My dentist told me the pulp is 'dying' in my molar. But, if it's 'dying', it's NOT dead yet, right? I had bad symptoms of pain during sleep, etc, but after taking some antibiotics it has subsided. My origianl problem was a cavity so close to the nerve the dentist said he could actually see my nerve. It just never really stopped hurting. Could this be reversible or will the pain/inflammation eventually return? I'd like to avoid a root canal if at all possible. Have you heard of a tooth coming back to life if not dead yet? Are there any nutritional supplements I could be taking? We are starting raw milk tomorrow (as per advice of the Weston A. Price Foundation) and I plan on introducing cod liver oil shortly.
    Thanks!

  164. Hello!

    I'm not sure if this is the best place to post this question but... here it goes.

    I broke a tooth 7 months ago (bottom molar second from the back [I don't have wisdom teeth]). There was no pain. My dentist did a filling just to patch it until I was able to have a crown put on. The entire time there was no pain or sensitivity.

    A week ago I had my tooth prepped for a crown and had a temporary crow put on. I was a bit sore the next day which I expected with what is involved in the crown prep procedure. 3 days later my jaw began to ache a day after that the ache was also at my tooth. Still no temperature sensitivity. I went to the dentist the next day. An x-ray was done and everything was fine. He tapped on the tooth and there was no pain. He did adjust the bite of the temporary. Since my jaw began to ache I have been taking ibuprofen every 4 hours to stop the aching and hoping the keep any inflammation to a minimum. The bite was adjusted 3 days ago but my jaw still aches.

    I guess want I am wondering is, is this pulpitis? Does root inflammation show up on an x-ray? Is this just trauma from the crown prep? Will putting the permanent crown help? How long should it take to calm down the tooth/jaw after adjusting the bite? Could I have developed TMJ from eating on the other side of my mouth?

    Argh! Sorry for all of the questions. I am just very confused since my main issue is an VERY achy jaw (the "tooth ache" is minor)

    Thank you in advance.

    • Hi Marie - Did the dentist put some ice on the tooth to see if the nerve is still healthy? If the nerve is still fine, it could just be trauma around the tooth from the crown prep. If the bite was high, that could also cause some pain that you are feeling, although you would usually have pain on biting and/or pain when the dentist taps the tooth.

      I hope that helps and hope that everything calms down in your jaw. Have a great evening, Marie.

  165. Hi Tom,

    I've had a throbbing pain in my tooth for the last 2 days- really painful, hard to locate where it was coming from- and looked in my mouth and saw a very small hole at the back of the tooth next to my front tooth, near the gum. The pain is sensitive to stimulants and goes away but then aches and throbs during the day. It isn't any worse at night.

    I've got an emergency dentist appointment for tomorrow- would they just be able to put a filling in it, do you think, or do you think it's a full root canal job? I'm so worried!

  166. I had a filling done and the dentist said it was a deep one. It was fine for the first couple of days but probably mainly because i avoided eating on that tooth. but on the 4th day after the filling I was eating cashew nuts and I felt a sharp pain on that tooth and since then I've been having slight pain on it on and off sometimes the pain is more than other times, like it's sore. it's not unbearable or anything or giving me problems to sleep. I know pain anywhere in the body signifies that something might be wrong and i'm worried. I felt the sharp pain three times while eating hard or dense food on that teeth, I've been avoiding eating on it since then which is like another 4 days. if i do eat on it, it's softer foods and i don't apply much pressure on it. Will it subside?
    I have another appointment scheduled two days from now for another filling and i will tell her about it but i'm afraid she'll suggest it requires a root canal and as it's costly and i don't have dental insurance.

  167. Hi, I went and saw a new dentist on Feb 12. I had 2 fillings done on #3 and #29. Well the dentist said that the cavities were deep and that I might need root canals. Once he drilled into them he said he got it all out and was able to just do fillings. I was so relieved. But now it's been almost 4 weeks and I have heat sensitivity to #3. It's a sharp pain just for a few seconds and once the heat is off it it's fine again. I saw my regular dentist just recently and he said he would be more worried if it was sensitive to the cold rather than the heat. He said if it's heat then the pulp is still alive just inflammed. Is that true? I'm reading the opposite online. He looked an X-rays that were taken 2 days after and said it looks fine just thinks I'm having this sensitivity since it was such a deep cavity. What do you think? I'm worried.

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Tom, Creator of Oral AnswersHi, I'm Tom. I recently graduated from dental school and am now a dentist in Bridgewater, Virginia. I started this blog to help people take better care of their teeth. You can learn more about me or ask me a question.

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