Dr Ian Kerr has completed advanced training in the management of dental pain. He prides himself on providing detailed diagnosis and treatment for patients when they are most in need…
Dental Pain – Why we get it and how we make it go away
There is not getting away from the fact that for many people the word “dentist” conjures only one thing in their mind: Dental Pain. And this is really a terrible shame because almost all dental disease is preventable and all dental procedures can be either totally painless or, at worst, a cause of short-lived mild discomfort or awareness.
When we talk about dental pain we should consider three distinct types
- Acute pain arising from a specific tooth: Toothache
- Pain caused by the actions of clenching or grinding teeth: Tempero-mandibular Dysfunction or TMD
- Pain felt in the teeth or tissues of the mouth but not caused by them: referred and neuropathic pain
For more information on each type of pain please click on the links above.
Clearly the cause of the pain an individual is feeling will impact greatly on how we will treat them so it is essential that we take the time to find out the cause and provide a correct diagnosis before we begin any work.
Relief of dental pain; how we do it at StoneRock
Seeing a person in acute, severe pain as an unscheduled appointment is often one of the most demanding things that we as dentists are faced with. It is also the best service that we can ever give to our patients and the one that we at StoneRock pride ourselves on.
Treating emergency dental pain all starts with a phone call. When someone phones in pain our reception team will ask a series of questions that will help establish what appointment is required and how urgent it is. If appropriate, a dentist will phone the patient back and give advice on what pain relief can be taken prior to the appointment to assist with the treatment.
At the time of the appointment, the dentist will take a full history of the current pain and any recent similar episodes and will carry out all necessary tests and radiographs to assist in diagnosis. They will then give the patient their provisional diagnosis and will, if appropriate, offer treatment choices along with an estimate of cost.
For almost all patients presenting with acute pain of dental origin, it is necessary and appropriate to treat the tooth at this emergency visit. It is very rare that a prescription of antibiotics on its own will be effective or even appropriate. Antibiotics are reserved for patients with worsening oral or facial swelling, raised temperature, clear signs of systemic effects and are used in conjunction with appropriate dental treatment of the cause of infection.
At StoneRock, we know how much people dislike getting injections and we take every effort to provide local anaesthetic in as gentle a fashion as possible using anaesthetic gels, devices such as The Wand and a calm slow infusion technique that provides the least possible discomfort.
Once the patient is happy that the tooth is numb enough for us to proceed we will do the minimum amount of work required to relieve the pain and will then dress the tooth in such a way that it will no longer pose a threat of further pain to the patient.
At the end of the appointment, we will explain clearly what we have done and what further work is required to complete the treatment. We will then provide a written estimate along with an explanation of all appropriate alternative treatment options that the patient will receive before their next appointment. We phone the patient the next day to check how they are feeling and to see if any further work is required to settle any remaining symptoms.
One option following initial pain relief appointment is a root canal filling. At StoneRock Dr Ian Kerr carries out this procedure for all patients of the practice and those referred from further afield.
What is a Root Canal Filling?
A root canal filling is a way of keeping a tooth, once the live part (the pulp) has become irreversibly damaged.
The pulp is a mixture of nerve fibres and tiny blood vessels that can become very inflamed (giving tooth ache) or die off (causing an abscess). This can happen either in the presence of tooth decay or after a heavy blow to the tooth.
The aim of the procedure is to painlessly remove the damaged pulp, under local anaesthetic, and remove any infection that may be present. Once the canals have been cleaned and shaped they are filled with a special filling material. This work is usually carried out over two visits of up to 90 minutes a time. Once the root canal filling is in place, the crown of the tooth is restored with a large filling or cast restoration.
An Example of Root Canal Filled Teeth
Are root fillings always successful?
Root canal fillings are a very successful treatment, with success rates well over 90% for many teeth. Obviously some cases do fail, most commonly when teeth are either very broken down or have an unusually complex root structure. Failure can also occur when the root canals are infected with bacteria that are resistant to the anti-bacterial pastes that are used.
Why does a root filling cost so much more than a normal filling?
A root canal filling takes much longer than a routine filling, usually over two visits and the fees reflect this. As well as the extra time, root canal fillings also require a great deal of specialist equipment and extra training, which adds to the overall cost.
Do root fillings hurt?
With careful use of local anaesthetic a root canal filling can be completely painless from start to finish. When a root canal filling is being done to a tooth that has been causing toothache, it will take the pain away and leave the patient feeling much better.
My dentist says I need a root filling but the tooth doesn’t hurt me, so why should I bother?
When a tooth has died off there is often no pain from it, usually because the pulp has been destroyed. Although there is no pain, there will be infection present that will lead to an abscess. Early treatment of the tooth will remove this infection before it worsens and will prevent the abscess from becoming a problem.
If I don’t want a root filling what other choices have I got?
Once the pulp of the tooth has become irreversibly damaged then a root canal filling is the only way of keeping the tooth. The only alternative treatment is to extract the tooth. Before making a decision on whether to save a tooth or not, any patient should consider how much it would cost to replace the tooth, and how this work will affect the teeth round about. Keeping the tooth with a root canal filling is usually the cheapest, least destructive option.