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Amalgam Replacement: Pulpalgia Issues

Video: Amalgam Mercury Removal and Replacement
Video: Composite Resin Bonding Shrinkage Problems

Post Treatment Pain and Sensitivity Dynamics

Patients undergoing removal and replacement of amalgam, silver mercury tooth filling replacements sometimes have symptoms of pain or sensitivity that preoperatively, didn't exist.

Retreatments may be sometimes indicated, whenever feasible or possible. In other cases, a Root Canal (RCT) may be recommended to eliminate the perception of pain.

What follows is a brief discussion of the procedures and events that can take place during this popular amalgam replacement service.

Tooth Anatomy Basics

Inside every tooth there is pulp tissue which contains blood vessels and a sensory nerve. Every time a tooth is worked on it is traumatized.

Before mercury removal
Dr.Ara Nazarian, Troy Michigan
As dentists we do what we can to minimize that trauma. By using water in our handpieces, for example, the problem of a tooth overheating is prevented. In many treatments however, there may be traumatization factors that are difficult to control or modify

In cases where the pulp tissue is irritated and is causing a pulpalgia (pain in the dental pulp), the primary question becomes: Is it reversible or non-reversible?

A. If it is reversible it will eventually resolve itself. What determines the ideal or usual time frame will vary from patient to patient.

B. If it is not reversbile, the tooth will probably need root canal therapy. In these situations an endodontic procedure may need to be performed (via your dentist or endodontist) to save the tooth.

No Pretreatment Pain

Patients who report that prior to amalgam replacement they were pain-free but post operatively have significant pain issues may be experiencing symptoms related to the following events:
    After mercury removal
    Dr.Ara Nazarian, Troy Michigan
  1. Etching acids used to condition the tooth in preparation for the new restoration (filling, onlay, overlay, inlay or crown) may have irritated the tooth if it was exposed too long.

  2. A microgap exists between the new composite and tooth. When there is a small gap, every time one bits, a sharp pain can occur in these instances.

  3. Leakage occurs with the new amalgam replacement (crown, overlay, inlay, etc) due to a poor seal. Bacteria accumulates under the restoration and cause sensitvity.

  4. Irritation due to chemical properties of dental cement, causing pulpalgia.

Post Amalgam Replacement Treatment Options

Pain issues that remain unresolved for a considerable amount of time after treatment, regardless of what cause and effect factors may be operating should be evaluated for Root Canal Therapy (RCT).

There may be some instances however where a restoration can be removed, re-prepared and cemented again (e.g., crown).

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