Dental Fillings
 

What about Aftercare, Recovery and Possible Side Effects?

How long will the anaesthetic take to wear off?

Most anaesthetics last between 2 and 4 hours but certain types can last up to 7 hours. So expect if you have had anaesthetic to be numb for another couple of hours after your appointment.

How numb you become depends on a number of things, including how much anaesthetic was given and which type of anaesthetic was used. Whilst you are numb it is important to be careful with anything hot, as you are not able to tell temperature in that area and could easily burn yourself. Be careful not to bite or chew your lip or cheek during this time, as you may be left with a nasty ulcer when the numbness wears off.

This is particularly a problem with children who find it amazing that they can’t feel anything. The area of numbness will feel large and swollen but most of the time, it looks completely normal- check in the mirror if you need re-assurance- though sometimes when you smile your lips don’t move in quite the same way.

The wearing off of anaesthetic will feel like a reversal of the numbing process- it will feel like pins and needles and then return to normal feeling again.

Drinking and eating in public whilst you are numb is not a wise idea, as it is difficult to tell where exactly your mouth is and to control liquid and food in the normal way. Things could get a little embarrassing so just be aware. A good indication of your lack of control can be seen when you attempt to rinse and spit after the filling- often missing the spitoon or dribbling a bit onto the protective sheet or apron covering your clothes.

Is There Anything I Should or Shouldn’t Do? Can I Eat?

When you have had a composite or glass ionomer filling set by the blue dental light, you are good to go.

The filling is set hard and you can eat and chew as normal. That said, if you have had a large build up on one of your front teeth, it is important to keep in mind that this will never be as strong as your natural tooth and you must be aware of this and be careful with harder foods such as chocolate bars and apples. I suggest that you either cut up harder food or use your stronger teeth on the side.

Try also to avoid biting fingernails, chewing pens, opening bottles (bonded teeth or not!!!) etc. with your bonded teeth as this will put them under increased stress and they will be more likely to fracture.

Coffee, tea, red wine and all the foods that cause staining on your natural teeth, will also cause staining on and around the bonded material, so reduce the consumption of these wherever possible. Fortunately, it can most of the time be polished off, but the cleaner the filling remains, the better.

Smoking can cause a yellowing of the white composite material- which you will be able to see (unlike the damage you are doing to your lungs). Just another reason, in addition to gum disease and heart problems to kick the habit.

Any material that sets chemically generally takes about 24 hours to set fully. This is true for amalgam and glass ionomer cements. Since an amalgam filling is more likely to be on a chewing surface and thus taking a lot of pressure, it is best to take it easy for a full day, to ensure the filling gets to maximum hardness before you eat and chew as normal. A softer diet is a good idea for that day.

When the dentist has finished a filling they will check to see if it is too high in your bite and adjust it. Sometimes because you are numb, it is not always that easy to get you to bite in your normal position and so the filling may not be adjusted fully. If after the anaesthetic has worn off, the tooth feels high, give it a few days to settle down, but if the feeling persists, return to your dentist who will make the necessary minor adjustments.

It is important to consider why you needed the filling in the first place, and take steps to try and stop it from happening again in the future. As I have said many times, this comes down to better brushing, flossing, good diet and getting the right amount of fluoride
.

Will I get Pain After my Filling?

With composite, depending on the system used, the tooth can often experience some sensitivity following the filling. This is by far the most common complaint from patients after a filling.

Sensitivity can come from hot, cold, air, pressure or sweet foods.

Most of the time this will settle over a few weeks and I tend to advise using toothpaste for sensitive teeth. Try during this time, to get the tooth to settle by not having things that are too hot or too cold. If pain persists or gets worse (or if you are in any doubt) return to the dentist and have it checked out.

Sometimes the sensitivity is a result of the filling being very deep and sometimes it can be a result of the bonding technique.

If it doesn’t settle, the dentist may redo the filling or if it was very deep, place a sedative dressing to see if this settles things down before filling it back up. If the decay was very deep it is possible that maybe something more serious is going on, especially if the tooth is more painful than sensitive. (see below)

If the top and side of the tooth were filled, it is likely a matrix band will have been used to shape the filling. When this is tightened you will feel some pushing on your gum and the depth of decay will determine how far it is necessary to try and push the band down. When the anaesthetic wears off this may mean that your gum may be sore for a day or so.

You can sometimes get pain on biting following a filling because the filling is too high- after the anaesthetic wears off, the tooth may feel high and hurt to bite on. The extra pressure from the high filling can cause you to bruise the ligament that surrounds your tooth. Teeth do have the ability to move slightly because of this ligament, which acts like suspension on a car or bike so it is best to give this a couple of days (unless the pain is significant) to see if it settles down.

If the pain on biting gets worse or the teeth on the other side aren’t meeting as they normally do, then you must go back to the dentist for him to re-shape the filling and adjust the bite. White fillings are less forgiving than amalgam and cause this problem to occur more often.

If you have an amalgam filling, sometimes you can experience a sharp little electrical shock when you bite together. This ‘galvanic’ shock as it is known, can occur between two different metals such as an amalgam filling biting onto a gold crown. A small electric current is generated in your mouth and felt as a little, but often surprising and painful, jolt. Chewing foil or biting a fork with your amalgam fillings can also cause this to happen.

You may also discover that once the anaesthetic has worn off, the tooth feels a little rough. Often this will smooth down after a couple of days of normal eating and chewing. If it doesn’t or is particularly sharp or annoying, just visit the dentist to have the area smoothed and the tooth polished.

My Dentist said, “The Filling is Very Deep”- What Does This Mean?

If your filling is very deep it means that the decay or previous filling has gone very close to the nerve.
When this situation occurs, one of two things can happen- the tooth can live or the tooth can die. Because your tooth is a living tissue, it can respond to insults such as decay by laying down further dentine (what we call secondary dentine) to try and protect itself and in doing so maintain the vitality or life of the pulp (nerve).

When you get dental caries (decay in a tooth), it causes Pulpitis; inflammation (‘itis) in the nerve or pulp of the tooth.

We can broadly categorize pulpitis into reversible pulpitis and irreversible pulpitis.

In reversible pulpitis, the amount of swelling isn’t as severe and once the filling has been placed, it is likely that the tooth will return to normal and continue living.

In irreversible pulpitis, the swelling is such that even if you place a filling, the chances of the nerve living is very unlikely- the tooth is irreversibly damaged and will die off, needing either a root canal
to keep the tooth in the mouth or unfortunately, it may require an extraction. This happens because the blood vessels supplying the tooth enter through a very small gap at the end of the root, and if the nerve inside swells sufficiently, it blocks off this supply, essentially strangling itself.

When your dentist says a filling is deep- he is warning you that the filling is close to the nerve and there is a chance that the tooth may not respond to efforts to save it, thus dying off and needing root canal treatment. A special lining will often be used to try and maintain the tooth’s vitality.

A tooth may be painful right after having the filling, or 6 months down the line, or even a year or two later. If it becomes very sore to touch- it is likely that the tooth had died sometime ago and that you now have an apical abscess. If a tooth dies off, it can remain silent for a while but there is no saying when it might start becoming painful. Think of it like a mini time-bomb- it could go off at any minute- we just don’t know.

Symptoms suggesting reversible pulpitis include- pain coming on with hot and cold or sweet only and lasting a short period of time- up to a 2 minutes. Irreversible pulpitis comes on spontaneously- pain can last for much longer periods of time and the tell-tale sign is often being woken up at night by pain in the tooth.