Dental Office - Springhill Dental

A Different Kind of Dental Relationship 

When you visit, our first goal is to establish a feeling of trust. Our job is to listen to you, respect your feelings and concerns, and educate you, rather than judge your decisions. We understand that you may be anxious about the process of receiving dental care; therefore, we make it a point to carefully explain your proposed treatment plan and we take the time to answer all of your questions. Only then will we take you through your treatment with the utmost of care. Modern dentistry has many techniques, local anesthetics, and relaxation methods to increase your comfort. The more involved you are in making your dental health decisions, the less room there is for fear and uncertainty.

Dentist North Little Rock AR

Springhill Dental, PLLC

3401 Springhill Drive, Suite 285

North Little Rock, AR 72117

Telephone: (501) 955-0155

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.

You've got to be less sensitive about things!

One of the most common issues I see every day at Springhill Dental are people with sensitive teeth. These are people complaining of teeth hurting due to hot, cold, or sweet foods or drinks. I’m sure you have seen the commercials on tv for Sensodyne, Crest Sensitive, and all the other toothpaste brands trying to get you to buy their products. In this post I want to explain some of the most common causes of sensitive teeth and some ways you can reduce the sensitivity.

Let's talk tooth anatomy!

First off, what causes teeth to be sensitive. Well, let’s explain how teeth “feel” hot or cold. Let’s have a tooth anatomy lesson. A tooth has three layers:

1.       Enamel—The hard outer layer that acts to protect the dentin and pulp.

2.       Dentin—The middle layer which acts to support the enamel and as insulation over the pulp.

3.       Pulp—The inner layer which contains the nerves and blood vessels.



Cross section of a tooth showing the three layers.



When a person drinks hot or cold, this causes a change in pressure inside of the tooth. You can see this occur when a sealed plastic bottle is heated and it expands or if it is cooled and it contracts. This change in pressure inside of the tooth causes irritation to the nerve, which is transmitted as pain to the brain.

Now that we know how a change in temperature in the mouth can cause pain with a tooth, let’s talk about the possible reasons why a tooth would become more sensitive to these changes. Sometimes the reason people’s teeth or mouth is hurting is obvious. Sometimes though it takes some thought, and I have to go through a number of tests, x-rays, and lengthy exams in order to find the cause of people’s pain. I really enjoy this part of my job. I love that “Aha!” moment when I discover the culprit and find the cause of a person’s dental pain. Tooth sensitivity to temperature changes is often one of those problems that I have to play detective on to find the cause. (For the record I hate it for the patient! I don’t want anybody having dental pain and would be glad to spend every day looking at perfect mouths that don’t need any dental work.)

What's causing those teeth to hurt?

The first and most common is tooth decay. When a tooth develops a cavity, the enamel and dentin become weakened. This loss if insulation over the nerve can cause more sensitivity. How dentists treat decay is to remove all the weakened tooth structure and place a filling or cover it with a crown. If the decay goes untreated and enters into the pulp, this causes inflammation, which causes the nerve to become hypersensitive. Eventually this causes the nerve to die, causing the tooth to require a root canal or to have the tooth removed.

Another common cause of sensitivity is root sensitivity. This occurs when a person has gum recession. Recession occurs when a person loses bone and attachment around a tooth. The root of the tooth has less insulation over the pulp. It also has exposed dentin tubules. Ok, another dental anatomy lesson here. When the dentin develops, it’s actually not a solid block, but instead develops as tubes radiating out from the pulp. It’s a lot like Swiss cheese except the holes radiate from the center. The ends of the tubules are normally sealed by enamel.

This image shows the exposed tubules on the root of the tooth.
Sometimes nerve endings will radiate into the tubules.

However, there isn’t any enamel on the root, so these open tubules are exposed to heat, cold, and irritation from sugar, food, brushing, etc. There are a variety of treatments for root sensitivity. I personally like to start very conservative. This usually consists of using a combination of over-the-counter sensitivity toothpaste and prescription strength fluoride toothpaste. I have found this combination to be very successful. These two types of toothpastes will build a layer of insulation over the root, thus clogging the open tubules. If this treatment doesn’t work, my next treatment is to bond a filling over the root which seals the tubules and adds more insulation over the root. If this treatment doesn’t work, which is very rare, the tooth may need a root canal to remove the nerve from the tooth.

One other possible cause of sensitive teeth that should be mentioned is people grinding their teeth. Grinding your teeth can mildly irritate the nerve, causing them to become sensitive. Over time teeth are worn down from the grinding, thus reducing the insulation over the nerve. This also can cause sensitivity. I have even seen teeth that were worn down so bad from bruxism, the teeth abscessed and needed root canals or had to be removed. Usually teeth that are severely worn down require crowns to cover and protect the tooth. If most or all of the teeth are worn down, the patient may require full mouth reconstruction of their teeth and bite.



This poor person has a severe problem with grinding.
The only long term option is likely full mouth reconstruction or an upper denture.



There are other possible reasons that teeth can be sensitive. These include such things as cracked teeth or deep fillings and crowns. I plan on addressing both of these problems in future posts. If you have sensitive teeth, then I strongly encourage you to talk to your dentist about your problem. We dentists are here to help you with your oral health problems and want your teeth and mouth to look and feel the best it can.