Monica,
I’m guessing from what you’re telling me that this is a porcelain onlay that you’re talking about and not a gold onlay, since you mentioned that it now looks gray.

Sometimes, if the tooth wasn’t reduced enough in the preparation appointment and if something wasn’t done right with your bite, or if there’s a problem in seating the restoration accurately, you can end up with a lot of adjustment being required to get the tooth to fit the bite. Usually this won’t affect the integrity of the restoration, but it could. I can’t really tell from what you’ve told me if it has or hasn’t. But repairing it with a composite filling wouldn’t help. If you wear through the onlay later, then a repair could be an option to replacing the onlay. My guess would be that the onlay is fine, but maybe not.

But I’m concerned about the pain you’re feeling when you’re chewing. You’re talking about a deep sensitivity in this tooth. I’m wondering if your tooth is infected.

I’d suggest getting a second opinion. Get a recommendation of a dentist you feel you can trust and ask him or her to x-ray this tooth and examine it to see if it’s okay. That will answer the question about possible infection, and if there is enough onlay left on the tooth to protect the tooth.

Dr. Hall

Problems with your bite can lead to TMJ disorder. Read about Boca Raton TMJ Dentist Dr. Kagan.

Sarah,
Your problems with the teeth hurting wouldn’t be from the number of fillings you had but from how big the cavities were. When you don’t go for a long period of time, the cavities keep growing. And what happens is that the dentist gets the decay out and fills the tooth. But if the decay was deep enough so that it is close to the pulp of your tooth, there will always be some bacteria that get into your pulp. The dentin on the inside of the tooth is porous and this is what happens. So you have these bacteria in the pulp, and the tooth is a little irritated from having been worked on, and it starts an infection in your tooth that results in this toothache pain that you’re having. Unfortunately, once the inside of the tooth gets infected, the only way to treat that is with a root canal treatment.

Nothing you have said gives me any indication that your dentist did anything wrong.

I hope this is helpful to you.

Here’s her response:
Thank you very much for your response. I had it done today with less fear and more confidence in my dentist. It still hurts but I guess I’ll be ok in a couple of days.
- Emily from Texas

Links: see the original posting: My tooth doesn’t hurt – why did it need a pulpotomy?
Read more about root canal treatments.

I went home and the tooth start hurting. He could see me only two days later and at that time he “cleaned up” some more. This time he gave me some antibiotics – for 7 days. 7 days later still hurts. More antibiotics for another 7. I am now 5 days later and still have pain – I don’t know if the infecton cleared up yet. Tomorrow I am scheduled to get a root canal. Should I get it while my tooth still hurts? Did I needed the “pulpotomy” in the first place? Thank you.
- Emily from Texas

Emily,
With dental work, it’s especially important to be able to trust your dentist. The reason is that often you cannot tell when anything is wrong, and then problems that are put off are always more expensive to fix later, and can result in irreversible damage to your teeth. So far, from what you’ve told me, your dentist is treating you right. So hopefully you feel you can trust him. If not, find a dentist you feel you can trust.

Let me explain what is happening in your mouth. If a tooth is abscessed, antibiotics alone will not clear up the problem, they only help put off the symptoms. You see, infections are caused by dead or infected tissue inside the tooth. Antibiotics don’t get to the inside of your tooth when it is filled with dead tissue, because there is no blood circulation there. The abscess is caused by the tooth spewing bacteria out the end of the root. So the antibiotics will fight those bacteria but can’t ever eliminate the source because it’s protected inside the tooth.

And to answer your questions, yes, you did need the pulpotomy and yes you need the root canal treatment. Your tooth may continue to hurt until you get this done. The root canal treatment is to solve the pain, the abscess, by getting rid of the source of the infection. The tooth is carefully and thoroughly cleaned out and then is sealed.

I would have actually strongly recommended that you have the root canal treatment when you first discovered the abscess. While you want to avoid dental work during the first and third trimesters of a pregnancy, it’s worse for the baby if you have an infection in your body when you are pregnant. Now, after having waited this long, you are more likely to have complications from the deeply entrenched infection as your dentist tries to remove its source by doing a root canal. That’s probably why the infection seems now to be so resistant to the antibiotics. But get it done – the sooner, the better.

Follow-up: Read Emily’s response a week later.

Penny,
Part of your question is simple, and part is a little complicated.

A gold onlay is like a crown that covers the entire tooth, except that it covers just the chewing surface and goes down the sides partway. They can last a long time if they’re done well, and it looks like yours was done well.

Yes, I would much prefer in my own tooth or in a patient’s tooth, to have the hole repaired with white composite rather than amalgam.

Another issue with plugging the hole with amalgam is that you would then have two dissimilar metals in the same tooth. This creates a slight electric current, which would accelerate the corrosion of the amalgam. Plus, a little of the mercury gets absorbed in the surface of the gold.

The complication is that, if your dentist prefers using amalgam here, he is not one I would ask to do the composite repair. Dentists who know how to do the composite repair well almost universally prefer that technique. It is very risky to try to nudge a dentist out of his or her comfort zone. They will not want to reveal their discomfort with a procedure, and it’s a recipe for disaster. These composite fillings are very technique sensitive, and many dentists don’t know how to do them well.

Bottom line – if you want to have your dentist do this, let him do it the way he wants. If you have a problem with that, seek out a dentist who does composites on back teeth routinely. A good way to find such a dentist is to call the office and ask if the dentist does very many silver fillings (as if that is what you wanted). If they tell you the dentist doesn’t do many silver fillings or doesn’t recommend silver fillings, then you can be fairly sure he or she is very comfortable doing composites on back teeth.

Link: See our page explaining that Dr. Kagan is a mercury-free Boca Raton dentist.

After the new crowns were installed, I began to notice sensitivity to cold and bite pressure. I asked my dentist and he said that this was normal after this type of procedure. I asked if I may need a root canal and he said that the X-rays did not show anything and that he didn’t think it was warranted. After a short while, the pain associated with the bite pressure went away. I never felt any discomfort with hot foods. After 1.5 years, I still feel pain when eating cold things and recently started to experience pain with bite pressure. I have contacted my dentist on two separate occasions over the 1.5 years and each time, he stated that this will either eventually go away or will be permanent. Can you provide me with your thoughts on what might be causing this pain and recommend my next course of action to get rid of this pain? Any input would be greatly appreciated. Thanks.
Gene from California

Gene,
I can’t really tell what is wrong with your tooth without an x-ray and testing it, but it sounds as if it may need root canal treatment.

Pain to cold indicates that the pulp of the tooth is irritated. When the pain to cold lingers, it indicates that the irritation will not get better on its own, and the tooth needs root canal treatment.

Pain to biting could mean that the bite is off, or that the tooth has a traumatic injury, or that the tissue around the end of the tooth is infected from the beginnings of a tooth abscess. When the pain to biting just appeared seemingly out of nowhere with a tooth that has had long-term cold sensitivity, my first suspicion is that there has been a long-standing slight infection in that tooth, and that infection has spread to the end of the root. An infected tooth will not get better on its own – it will need a root canal treatment.

Have your dentist look this tooth over very carefully and test it. If  he is unsure, ask for a referral to a specialist.

David,
Yes, once you have Lumineers, or any brand of porcelain veneers, it is possible to get cavities in those teeth. You won’t get a cavity under the veneer, but you could get it on the edge or another place on your tooth. This cavity can be filled with white filling materials, and it’s not too different from any other cavity on a front tooth, except that special bonding techniques are needed to bond the filling material to the porcelain. So it’s good to have your artistic, specially trained cosmetic dentist do the filling – just as you would have this special dentist do the original smile makeover.

Having said that, as a cosmetic dentist, I discourage people who tend to not take care of their teeth from getting porcelain veneers. After investing so much money in a beautiful smile, if you then get a lot of cavities on those teeth, it can really affect the longevity of the veneers, and they could end up needing to be replaced with crowns. My advice is that, if you get a smile makeover, take good care of it by brushing and flossing every day, getting regular checkups, and don’t be a constant snacker. The snacking habit leads to lots of cavities.

Other links:
Dr. Robert Thein does Lumineers in Los Angeles. He is very careful.

Steve,
Your fever and general malaise could well be because of your teeth. Yes, teeth infections do poison your system, and the symptoms would be exactly what you are experiencing. You need to see a dentist.

The thing I worry about is that when you go to the dentist, you’ll probably just have these teeth extracted. But that will compound your problems down the road, because you won’t be able to chew well, and will then gradually have all your teeth extracted, experience facial collapse, and end up with shrunken jaws that can’t even hold a set of dentures. All big holes in teeth start out as small holes that need simple fillings.

Click here to read more about Dr. Kagan’s conservative dentistry philosophy. We also provide sedation dentistry for fearful patients.

Susan,
No, this shouldn’t be expected, that a porcelain crown keeps falling out. If they’re done right they won’t ever fall out. But I can understand why your dentist wants to charge for this, because now he has to make it from scratch, and it’s kind of expensive for him to do this.

What holds crowns in is the near parallelism of the way the tooth is prepared. The more parallel the tooth is prepared, the stronger is the retention. But if the tooth walls are made TOO parallel, there is a risk of what are called undercuts, and the crown won’t fit at all. Different dentists have different levels of comfort with how parallel they will make their preparations. The less parallel they are made, the easier it is to fit the crown.

But then with all-porcelain crowns, they are also bonded to the teeth. And if they are properly bonded, they don’t need a lot of retention in the design.

I’m suspecting that your dentist doesn’t know how to bond porcelain crowns. They’re supposed to be bonded to your tooth, and they get most of their strength from the bonding procedure. It sounds like your dentist has simply cemented it in instead of bonding, as that’s the only reason I could think that an all-porcelain crown would just fall out like that.

Yes, I would say that your dentist should just replace this for no charge. But I don’t believe he’s legally required to do this, and if he has lots of these crowns falling out, I imagine he’s getting tired of doing this for free, and it’s hurting his bottom line.

Olivia
Yes, when you wear traditional braces, they catch food. You have to clean them off everytime you eat anything at all, or they can eat into your teeth and you end up with these white spots on your teeth when your braces come off. These are decalcification spots.

Bleaching could make them worse. I know of cases where dentists without much experience with teeth bleaching try using that to get rid of the spots, and the problem is that they whiten the tooth uniformly, and it seems that the white spots become even more prominent.

If they aren’t too extensive, I would recommend dental bonding. The dentist will remove the damaged enamel and replace it with a composite that is shade matched to your tooth and polished to a high luster. If done right, the repair is invisible.

And since your enamel is damaged, if you have dental insurance, your benefits should help pay for this – at least a portion of this.

Invisalign invisible braces don’t have this problem. There are no brackets to catch food. When you eat, you just snap out the aligners, and then you put them back in when you’re done. At night, you take them out to clean your teeth and put them back in.