Sep
Dear Reader,
Sorry you are hurting. Severe pain requires immediate attention.
Semi (or temporary) permanent fillings are often used by dentists to describe the restoration of a tooth that is compromised or when a permanent filling must or should be postponed. I am not in possession of all your facts…the most important being, why was the filling placed with a temporary? Perhaps the cavity you mention was deep and encroaching on the pulp. Or maybe it was an emergency appointment and the dentist felt unable to do her best work with the time constraint?
Go see your dentist now. If tooth decay was removed well at the temporary filling appointment, and the temporary filling is intact, a new temporary filling will be of little use. Oral bacteria have already infected the pulp prior to the procedure and the temporary was to to see IF the tooth might recover. If painful, the tooth clearly is declining into irreversible pulpitis.
If you are developing a facial swelling, antibiotics are called for. She may suggest you take a course of antibiotics anyway as inflammation reduces the effectiveness of anesthesia in some instances. Antibiotic may be prescribed in either case to reduce the infection at the tooth site which will secondarily stop the pain.
Ask your dentist if the tooth has enough structure to consider keeping, and if your health status would tolerate root canal therapy. If the tooth has plenty of structure, and your health is good, root canal therapy may be a good choice. If not, removal of the tooth and replacement by some other means may be best.
If you just are unable to decide, a pulpectomy is a stop-gap option. This is the opening of the pulp chamber and cleaning of its contents and is an emergency treatment for acute pain.
A pulptectomy is not a completed root canal, nor should it be considered final treatment. I only use this procedure in a emergency when I and the patient need more time to complete a comprehensive exam to determine what the true final best course of action should be. This step saves much time and a lot of money in the mid and long run.
Make your appointment for removal or root canal therapy to occur the same week you finish antibiotic therapy. This is your window of opportunity to have the best outcome of either treatment.
My best,
Dr. Cynthia Copeland
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Severe pain, especially spontanteous (sitting doing nothing but the tooth hurts like the dickens) pain may be from tooth pulp or periodontal (gum) tissue.
If the original cause is a trauma or large cavity, it is likely pulpal and is an indication of irreversible pulpitis. This means the tooth will absolutely not recover.
Irreversible pulpitis tell us that bacteria from the mouth have entered the vulnerable pulp where the nerve, blood and lymph tissue of the tooth reside. The bacteria cause the tissue inside the pulp to degrade and die.
Degrading tissues release gases which can cause exquisite discomfort as there is no way for the pressure to release. Or, the tooth socket cushion that dentists call the periodontal ligament space may be more affected causing pain to touch, or when pushing on the area or biting.
Whether the pain feels like comes from the pulp or the socket, irreversible pulpitis will not go away until the infected pulp is removed by either extraction of the whole tooth or by leaving the
tooth and removing the pulp only. Both treatments have pro and cons- discuss them with your dentist.
Antibiotics can not bring a tooth back to life, and are useful to treat the acute symptoms of infection. One should have the plan in place to remove the tooth or have root canal therapy at the very end of the antibiotic course- preferably with in a week of completion.
Waiting to see your dentist increases costs and reduces the choices for a best outcome due to tissue inflammation and time constraints inherent to emergency care.