Not very happy with dentist

sabrina99

Hi

A little while ago I had a root canal done, I had a lot of pain during this procedure ( had one done a few years ago and was painless) When I left the dentist I had Milton running down my nose for about 3 hours which was very unpleasant.
Last week I returned for a filling on a different tooth, I had no pain with this tooth before hand but there was a cavity in it, the dentist put a white filling in it. since then I have had a lot of pain in it, have to eat on other side on mouth and if i do bite on that side, its very painful.
Im quite annoyed to be honest but am I overreacting?

Big_G

Milton running down your nose? You should mention this to your dentist. It is possible that you've had a perforation of the floor of your maxillary sinus. I don't wish to alarm you, it is not usually a serious problem.

Perhaps one of the endo experts would like to elaborate? Res?

TiwstaSista

Maybe the cavity is deep? I had a filling too and the pain was there even after a week and i called her to ask why the pain didn't go away fast. She told me it was deep and yeah after two weeks the pain did go away.

res ipsa

What tooth was the root treatment on?
Root canal treatment should be a PAINLESS procedure with the anaesthetics available nowadays.

BryanL

Res,
I'm surprised you've never experienced difficulty in providing painless root canal?
Bryan

Big_G

Me too. Even with six point articaine intralig injections, sometimes those hot pulps are just too damn tricky. I either use the trusty pulp killer ledermix or I give an intrapulpal. My patients don't love me for that one. I would estimate I have this problem in about 1% of cases.

res ipsa

Of course there are hot pulps, and cases of allodynia, but there's always a way to deliver endodontic tx in a pain free manner, sometimes with a combination of patience, analgesia, anesthesia & conscious sedation.This article from the American association of endodontists is recent & easy to read.

http://www.aae.org/NR/rdonlyres/3C1D7FE5-C61A-41FA-8206-E2FA7F09451E/0/winter09ecfe.pdf
Testing the tooth after anesthesia with a cold refrigerant such as Endofrost(-50degrees) will reinforce to the patient that you are a caring dentist & reduce their pain/anxiety.

BryanL

Great article thanks, but still it says in 5-10% you have to go in, which is going to hurt and give an intrapulpal, thats rarely going to be pleasant. Big G your beating the curve with only 1% needing more.
Amazing to see how ineffectice a lower black can be:eek:


"In approximately 5-10% of mandibular posterior teeth with irreversible pulpitis, supplemental injections, even when repeated,
do not produce profound anesthesia; pain persists when the pulp is entered. This is an indication for an intrapulpal injection. The
advantage of the intrapulpal injection is that it works well if given under back-pressure (51,52). Onset will be immediate and
no special syringes or needles are required. The disadvantage is that the injection is painful."

res ipsa

Hi Bryan,
Attached is another short article a little closer to home,which talks about this subject.


I had a patient in 4 weeks ago who had seen(according to herself) 4 dentists & one practitioner ltd to endo, who werent able to get into the pulp as it was hot.
She was at her wits end literally & was after starting a new business so she needed to get back to her work.
I gave her tlc, temazepam, ibuprofen, paracetemol, codeine first off, articaine, mepivicaine & lidocaine as Gates Glidden Block, ID block and buccal infiltration,waited an hour, but despite not feeling Endofrost on the tooth she still felt pain as I entered the profusely bleeding pulp, so I placed benzocaine 30% topical for 10 minutes & then intrapulpal which she didn't feel, even though I warned her she might.I then put the Endofrost into the pulp space to reassure her everything was going to be ok.It was.
She came in at 2pm but I only put my first file in at 3.30pm.

georgieporgy

Hi Res

I presume the rest of the endo treatment went ok then. Can you share with us if you adjusted your fee upwards for this case, or do you simply have one average fee and put up with the extra effort some unusual cases require. I'm just curious what other dentists do in such situations. It's hard to have an 'average' fee.

georgieporgy

sabrina99 wrote: »

Hi

A little while ago I had a root canal done, I had a lot of pain during this procedure ( had one done a few years ago and was painless) When I left the dentist I had Milton running down my nose for about 3 hours which was very unpleasant.
Last week I returned for a filling on a different tooth, I had no pain with this tooth before hand but there was a cavity in it, the dentist put a white filling in it. since then I have had a lot of pain in it, have to eat on other side on mouth and if i do bite on that side, its very painful.
Im quite annoyed to be honest but am I overreacting?

Was it a big or small filling? it may be hard for you to know, but did he indicate it was quite deep or anything? does the bite feel high or uneven on the newly filled tooth? a small high spot can make the tooth feel very painful after a few days. Usually fillings don't hurt so you should go back and report it to your dentist. if he can't solve it with a minor adjustment then we can think again.

sabrina99

Hi thanks for the replies, the root canal was done on the upper right- 3 from the back (i dont have a wisdom tooth)
It was very painful when I got the root canal done as I mentioned before, like a hot poker to the skin is the best way I can describe it. I had 5 x-rays during the procedure also which I thought was a bit strange?
Thanks Georgie for reply, the filling is on the bottom left, the last one ( not a wisdom tooth either), she did tell me it was a deep cavity alright, and she did do it high at first as she asked me to grind on this red tin foily thing and she
amended the filling, I also had to repeat this procedure 4 or 5 times, maybe this is the norm for it to be painful?
Even if I drink cold water now it is really sore if it gets near the filled tooth, its 2 weeks since that filling

res ipsa

georgieporgy wrote: »

Hi Res

I presume the rest of the endo treatment went ok then. Can you share with us if you adjusted your fee upwards for this case, or do you simply have one average fee and put up with the extra effort some unusual cases require. I'm just curious what other dentists do in such situations. It's hard to have an 'average' fee.

The fee for that case was 795 which is the standard fee for a molar in that practice. The patient was out of the chair at 5.10pm, and I didnt have anyone else booked in that afternoon.
The job satisfaction in that case was very high, as the patient was effusive in her thanks.

BryanL

Thanks for the links Res. There's nothing like getting the job done well.
Bryan

res ipsa

sabrina99 wrote: »

Hi thanks for the replies, the root canal was done on the upper right- 3 from the back (i dont have a wisdom tooth)
It was very painful when I got the root canal done as I mentioned before, like a hot poker to the skin is the best way I can describe it. I had 5 x-rays during the procedure also which I thought was a bit strange?
Thanks Georgie for reply, the filling is on the bottom left, the last one ( not a wisdom tooth either), she did tell me it was a deep cavity alright, and she did do it high at first as she asked me to grind on this red tin foily thing and she
amended the filling, I also had to repeat this procedure 4 or 5 times, maybe this is the norm for it to be painful?
Even if I drink cold water now it is really sore if it gets near the filled tooth, its 2 weeks since that filling

I had a deep filling done at the end of july, and it caused me a lot of bother in august, so much so that I had to take painkillers once or twice. Thankfully it settled down by the end of the month and I can now drink hot tea and cold drinks without wincing. It doesnt mean that the dentist did a shoddy job if the nerve "kicks off" after the filling, just that there is an upset nerve underneath the filling.

ballsymchugh

Big_G wrote: »

Me too. Even with six point articaine intralig injections, sometimes those hot pulps are just too damn tricky. I either use the trusty pulp killer ledermix or I give an intrapulpal. My patients don't love me for that one. I would estimate I have this problem in about 1% of cases.

they love you when they get some sleep that night though. when i was in the uk i used to use the 800 years excuse as to why intrapulpals hurt. on the right patients though!!