Likely cause of problems after recent dental treatment:
Dental injections of anesthetic most commonly contain Xylocaine with epinephrine. The needle and solution cause tears in the muscle, bleeding, and nerve stimulation resulting in pain, limited opening, swelling, bruising, and on rare occasion numbness which usually resolves. Ice, anti-inflammatory, muscle relaxant, and time will help. See neurologist if severe nerve pain persists.
Removing caries causes small fractures, as well as heat, and inflammation of the nerve and vessels inside the tooth. A tooth that already has a large filling or crown may end up needing root canal therapy, especially if it has undergone a lot of past treatment. Always choose the longest lasting restoration. Repeated treatment is not good for the tooth.
Silver or white restorations cause fractures from expansion or contraction, condensing or bonding. Often fractures are already present, especially in wide restored teeth. Those cracks can grow and become symptomatic after treatment. Choosing a crown instead of a larger wide filling will hold the tooth together. Taste from the material may be present for a few days, depending on polymerization. Make sure the bite is adjusted so all teeth meet evenly. If you can feel the filling when biting down or to the side, it is too high leading to the number one cause of post op pain. If excessive air is blown on the tooth before bonding, the tooth will be very sensitive for about 6 weeks. If a liner is used that pulls away from base of the prep after bonding, the tooth will be very sensitive to biting down. A healthy tooth should not be unbearably sensitive after a filling, or it should be replaced with a sedative filling. Deep restorations may need root canal therapy if symptoms occur as the tooth may have been already partially necrotic but asymptomatic before treatment. Sometimes during a silver filling, the material will permanently tattoo the gum black. Foil or metal, especially metal crowns contacting the silver filling may hurt due to a galvanic reaction. Silver nitrate should be placed over a new silver filling if a severe shocking sensation is present.
The Root Canal
During root canal therapy, removing the nerve properly is very difficult. Sometimes an extra nerve exists, especially in upper molars. The procedure is done by "feel." It is common to go long or short while cleaning out the root. The irritation from filing, and irrigation into the ligament surrounding the root causes pain. Swelling after could be from an infection or a Sodium Hypochlorite accident which should resolve possibly with bruising after a week. Take Advil, or Vicodin. Make sure the tooth is adjusted lower. If you feel hot or cold, that could mean there is a fracture present, or pain is from a neighboring tooth. Without a nerve the tooth should not feel hot or cold. If a large abscess is present, antibiotics may be required. Post op pain is normal and can be felt near the end of roots on the gum, or behind the nose in anterior teeth. Unresolved pain or swelling needs antibiotics, and possibly re-treatment, unless a fracture is present. Avoid posts and pins when possible.
The Crown or Bridge
After tooth preparation, make sure no cement is irritating the gum (see #6), and that the bite is fine. Temporary crowns which are made of acrylic or aluminum are not always attractive or comfortable, but they should be sealed as much as possible, occlusion adjusted, and cement removed thoroughly. If the tooth is very sensitive at this stage, have the temporary checked for openings and height lowered. If the tooth remains slightly painful, the permanent crown may be placed with temporary cement until comfortable, or removed for root canal therapy. The tooth should feel like one of your own after a short while, unless the crown is too bulky. When the crown is finally cemented, the tooth may be irritated for a couple weeks, especially if the tooth was badly damaged before preparation (i.e. Decayed, fractured). Make sure food is not being trapped between the crown and adjacent teeth. Have the gum area cleaned and bite adjusted if pain persists. Root canal therapy is sometimes needed. When the gum recedes around the crown, sometimes a black line is noticed. This is usually, either a thin stained junction between the tooth and the crown, or a thicker area of the silver metal below the porcelain. It can also be caries, so get it checked out.
After a cleaning, plaque and calculus are removed, thus roots may be more sensitive to cold. In addition, dormant infections or deep caries may become symptomatic; the teeth are vibrated and stripped of debris, making the body more aware of hidden problems. We recommend x-rays so that the dentist can evaluate undiagnosed conditions. To prevent infections after a deep cleaning, irrigate with hydrogen peroxide 2 x day for 3 days. Some patients need antibiotics, depending on severity of their condition. For cold sensitivity, apply a high fluoride toothpaste or gel, or a desensitizing medication. For other pain, seek treatment.
After an extraction, you will have some pain, swelling, and possible bruising. Don't rinse for the first 24 hours. Don't apply heat for 72 hours. Keep tongue off it. After 24 hours gently rinse with salt water. Do not use hydrogen peroxide for at least 2 weeks. After one week, you can return to normal foods. Don't eat popcorn until the area is well covered by granulation tissue. The site will look weird and have different colors as it heals. If the tooth was surgically extracted with bone being removed and tissue cut, more swelling and pain would be expected. Severe pain worsening after 2.5 days, and/or a bad taste and yellow discharge must be treated immediately.
A dry socket or infection could be starting. Small bone fragments may extrude through the gum, and usually fall out on their own. Sometimes a second surgery is necessary to smooth rough edges and remove larger pieces. The suture may need to be removed, especially if it is non-resorbing material. The tissue will heal over the socket in a couple weeks; the bone takes much longer to fill in leaving the jaw vulnerable to fracture. Numbness from the injection or extraction may remain for a few days or months. Sometimes permanently. This must be monitored by an oral surgeon. In the case of partial or complete nerve separation, immediate referral to a neurosurgeon is appropriate.
Most people can get use to anything after a while. Dentures feel very strange. They are a prosthesis, like any other on the body, and practice is necessary to be proficient at chewing. Early on the mouth waters more, and food tastes different. Speech needs to accommodate. Muscles need to adapt to hold the dentures by suction, and balance the set. Sore spots need to be adjusted. Relines are necessary as the bone recedes and loosening occurs. Take them out at night brush and soak in a cleanser, not Listerine. If broken, they can be fixed. Implants help secure the denture for people without much bone, or with a strong gag reflex and can't tolerate the tradition size. Lisping, sores on the corners of the mouth, or clicking usually mean that the denture is either separating the jaws to much or too little, and need to be remade.
Post Op Tips-
Dental treatment will cause inflammation. If your health allows, taking ibuprofen before and after restorative treatment for at least 2 weeks will lessen the irritation and the chances of needing root canal therapy. Some pain is normal. The pain should diminish each day and be virtually gone in 3-6 weeks. If it worsens after 3 days, have the bite adjusted. If your tooth throbs constantly after 3 days and does not respond to ibuprofen, see your dentist.