Experiencing discomfort around a tooth restored with a filling is a common concern for many people. While the filling is meant to be a permanent solution, the surrounding tooth structure and the restoration’s integrity can change over time, leading to new pain. Understanding the mechanisms behind this pain is the first step toward seeking appropriate professional care.
Why Fillings Start Hurting
Pain originating at a filled tooth often signals a compromise in the tooth’s defense system, allowing irritants to reach sensitive inner structures. The most frequent issue is recurrent decay, also known as secondary caries, which forms beneath the existing restoration. This occurs when the seal between the filling and the tooth enamel weakens, creating microscopic gaps. Bacteria and food particles seep underneath, eroding the tooth structure from the inside, often remaining invisible until the decay is extensive.
The filling material itself can also cause pain if it suffers a structural failure. Fillings are subjected to immense pressure from chewing, which can lead to a crack, chip, or general wear that breaks the protective barrier. A fractured filling exposes the underlying dentin, which contains microscopic tubules leading directly to the tooth’s nerve. This exposure results in sharp, sudden sensitivity to temperature changes or air pressure.
Another significant cause of pain is pulpitis, the inflammation of the dental pulp. If the original cavity was deep, the trauma of drilling or the proximity of the filling to the pulp may trigger this reaction. Pulpitis can be reversible, causing temporary sensitivity that resolves, or irreversible, where the nerve tissue is too damaged or infected to heal. A persistent, throbbing ache, especially without external stimulus, often indicates irreversible nerve damage.
Recognizing Warning Signs and Dental Emergencies
While minor, temporary sensitivity can be part of the healing process, certain symptoms indicate a serious problem requiring immediate professional attention. A clear warning sign is pain that is severe, constant, and throbbing, especially if it is unresponsive to over-the-counter pain relievers. Unrelenting discomfort, particularly if it wakes you from sleep, often suggests a severe infection or irreversible nerve damage.
Any visible swelling in the gum tissue around the filled tooth, face, or jaw requires an immediate call to your dentist. Swelling accompanied by a fever is a systemic sign that the infection has progressed beyond the tooth. The presence of a persistent bad taste or a small, pimple-like bump on the gum, known as an abscess, confirms pus and a serious infection.
Temporary Measures for Pain Relief
While waiting for your dental appointment, several steps can temporarily manage discomfort. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, help reduce pain and inflammation. Always follow dosage instructions precisely and check for potential interactions with other medications.
To soothe irritated tissues, try the following measures:
- Rinse your mouth several times a day with a warm saltwater solution (a teaspoon of salt in warm water).
- If facial swelling occurs, apply a cold compress wrapped in a cloth to the outside of your cheek for ten to fifteen minutes.
- Avoid chewing food on the side of the mouth with the painful filling to prevent further damage.
- Temporarily avoid extremely hot, cold, or sugary foods and drinks to minimize sensitivity triggers.
These measures provide symptomatic relief but are not a substitute for professional diagnosis and treatment.
What to Expect at the Dentist
Your dentist will begin the diagnostic process by taking dental X-rays to look for signs of decay beneath the filling or any evidence of infection at the root tip. They will also use an explorer tool to check the filling margins for any gaps or softness that indicate a failing seal or recurrent decay. Additionally, thermal and percussion tests may be performed to assess the health and responsiveness of the tooth’s nerve.
Filling Replacement and Repair
If the pain is caused by a minor issue like a structural failure or a small area of recurrent decay, the most straightforward solution is a filling replacement or repair. This procedure involves removing the old filling and decay, then placing a new restoration to seal the tooth effectively and restore its function.
Root Canal Therapy (RCT)
If the testing reveals irreversible pulpitis or a deeply infected nerve, a more involved procedure called root canal therapy (RCT) will be necessary. RCT involves accessing the pulp chamber, removing the infected nerve tissue, disinfecting the internal canals, and sealing them to prevent future infection. This procedure is designed to preserve the remaining tooth structure and avoid extraction.
Extraction
If the recurrent decay or structural damage is so extensive that the tooth cannot be saved, either with a filling or a root canal, the final course of action is extraction. Your dentist will discuss which of these options is appropriate based on the severity of the underlying issue and the long-term prognosis for the tooth.