Why are my teeth sensitive after dental work?

Well, apparently I have this weird thing about sensitive teeth and can’t quit talking about them. In my last blog, I discussed some common causes of teeth sensitivity. You can read it here. I want to continue with the discussion on tooth sensitivity and discuss the most common reasons why teeth can be sensitive after dental treatment.

Trust me, we hate it too!

I hate patients having pain after dental work. It’s so frustrating when a patient didn’t have pain with their teeth before we worked on them, but then the teeth hurt afterwards. I wish we dentists could do all of work without causing pain to our patients. Unfortunately, that just isn’t always the case. In this post I want to discuss some of the possible causes of pain after dental work

Pain after Fillings or Crowns

The first and most common cause of pain is an irritated nerve in a tooth after a deep filling or crown. Like I mentioned in my previous blog post, teeth have three layers: enamel, dentin, and pulp. The pulp is an open chamber that contains nerves and blood vessels. Anytime we do work on a tooth, such as crowns, fillings, and veneers, we can irritate the nerves. When these nerves become irritated, they become hypersensitive. The usual result is the tooth hurts when you eat or drink something hot or cold. Generally the deeper the decay, the more likely the tooth is to hurt. However we can’t always 100% predict when your teeth will be sensitive after dental work. I love to use the following analogy to describe pain after dental treatment. Teeth are like cups of water. Every time work is done on a tooth, you pour water into that cup. And you can’t predict when that cup will run over and cause pain to the patient because every patient is different and ever tooth is different. I can do a large, deep filling on one person, and the tooth will never hurt. I can do a smaller filling on another person, and their tooth will hurt. I can even do several deep fillings on the same person, and maybe one tooth will hurt but the others won’t.

The next question the patient usually asks when they have pain after doing a filling or crown is when will the pain stop? If the decay was not into the pulp, then most likely it will calm down in less than a month. Usually it’s even a shorter time than that, probably less than two weeks. However, once again, every tooth is different and every person is different. Sometimes, even if we don’t enter the pulp when we are removing decay, the nerve may still become too irritated and never heal. When this occurs, unfortunately the tooth will require a root canal or have to be extracted.

Another possible cause of pain after fillings or crowns is if the restoration is too “high.” When a dentist place a filling or crown, we always try to adjust it to where your bite is the same as it was before we did the work. In other words, we want the upper and lower teeth to contact each other in the same place with the same amount of pressure as they did before we did the work. By nature most dentist are perfectionists, and we try our best to do perfect work for every patient every time. However we are also human and we don’t get it perfect every time no matter how hard we try. Sometimes the new filling or crown may not be adjusted properly and may hit harder than the other teeth. Most often the result is pain with chewing or biting down. Occasionally the tooth can have hot or cold sensitivity. If this is the problem, it is usually a simple fix of adjusting the filling or crown to lessen the pressure on the tooth when you bite.

Sensitivity After Cleanings

Another time a person may have pain or sensitivity after dental work is having hot or cold sensitivity after having their teeth cleaned. This is usually more common after deep cleanings. How can teeth be sensitive after cleanings? If you read my last blog post, you will remember that the teeth have less insulation over the roots. They also have microscopic open tubules in the dentin that radiate from the pulp. When the ends of these tubules are open on the root, the tooth is more likely to have sensitivity. In the process of cleaning your teeth along the gumline, oftentimes a very, very slight layer of the root is removed. This usually only occurs when a patient has deep cleanings done. And it’s actually a good thing we do this. The reason is because bacteria and their toxic byproducts can infiltrate into the tubules. So when the hygienist cleans the tartar and buildup off the teeth, she also has to remove that thin outer layer that contains the bacteria. Unfortunately this may leave open tubules that lead to sensitive teeth. My most common choice of treatment is sensitivity toothpaste combined with prescription fluoride toothpaste. This combination will most often clog the tubules, decreasing the sensitivity.



This is a microscopic image of the dentinal tubules with bacteria inside them.



We’re Here to Help!

Like I said previously, we dentists really do hate for our patients to have pain after dental work just as much as our patients do. And it’s like I tell my patients, if you don’t tell us you’re having a problem, we don’t know it. So if you are having pain with your teeth or mouth, please inform your dentist. We will do our very best to educate you on the causes of your pain and offer treatment to help.