Why do the fillings just put in hurt me when I eat?

This question was asked yesterday by one of my patients who happens to be an attorney. Luckily for me I do a large number of fillings and most don't hurt afterwards, but when they do it can be upsetting.  How do I handle this situation? I start by asking my patient a series of questions. I ask "When does it hurt?" Patients often have different responses. Yesterday my patient explained that it only hurt when she ate food and it didn't hurt the day I placed the fillings.  Now this was good news to me because the most common and easily correctable problem is a "high bite". If a filling hits prematurely when a patient bites it can cause trauma to the tooth ligament and result in pain when pressure is exerted on the tooth.

I checked her bite in "excursions" since her normal bite had been adjusted correctly but probably I hadn't checked her bite during lateral movements. This was probably why her teeth hurt when she was chewing since when chewing people don't just bite in one position but often move their jaws around. I asked that she call me back in 48 hours with feedback.

Of course there are other possibilities for a patients pain after a filling , including a crack in the tooth, a loose filling, a tooth that was overly desiccated when filled, a leaky filling due to a poorly filling material, a pulpitis or even a pulp that has become infected. All of these can cause pain after a filling.  A good dental diagnostician has to put on his Sherlock Holmes hat and can often diagnose each by examining the teeth, asking questions and performing tests when needed.  Is the tooth sensitive to hot and or cold? Does an x-ray show widening of the periodontal ligament around the apex? Did the tooth start hurting the day the filling was placed or at a later time.  Is food getting stuck adjacent to the filling?

If afterwards , I still  can't ascertain the cause for my patients complaint and a obvious way to correct the problem I often take a wait and see approach because its not predictable to try and make a symptom go away when the dentist is not certain what is causing the patients discomfort. fortunately sometimes  the symptom goes away without me doing anything .

Of course if my patient has still has symptoms months after a filling has been placed, usually something should be done. I could remove the filling, check for any hidden internal problems ( a crack or a small pulpal exposure) and place a sedative temporary filling. If afterwards my patient still has symptoms a root canal or a crown maybe the ultimate solution.

Ironically, sometimes patients come in complaining about a filling I did in the past, the symptoms are coming from an entirely different tooth,  sometimes in a completely different quadrant. I guess its natural for patients to assume their pain is coming from the last filling placed . I make sure to demonstrate which tooth is symptomatic and read to them from my last chart entry that mentions which tooth had their most recent filling.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/12/why-do-fillings-just-put-in-hurt-me.html - http://lspindelnycdds.blogspot.com/