Pain After Dental Treatment

Patients trust their dentists. According to Harris Poll Interactive (Harris Poll Interactive, March 2006) 47% of American adults completely trust their dentists. That ranks dentists right between physicians at 50% and nurses at 46%.

Undoubtedly, dentists may lose the trust of some patients as a result of post operative pain - pain that may occur after the routine restoration of a tooth with a filling, crown or root canal treatment. Patients question the cause of post operative pain and who or what is responsible.

A short histology lesson will aid in understanding dental pain. A tooth is made of three layers. The outside of the tooth is enamel. Enamel is a very hard glassy material that is resistant to chemicals and abrasion. Enamel does not feel sensations like pain. People loose enamel by abrasion or grinding by eating coarse food such as natural grain with a high sand or husk content, or by grinding the teeth together (dentists call tooth grinding bruxing.)

Inside the enamel is the dentin. Dentin is not as hard as enamel due to the presence of very small tubes that run the width of the dentin and normally contain parts of sensory cells or nerve endings. Dentin is not resistant to abrasion and decay. Additionally, exposed dentin can be very sensitive. Exposed dentin is easy to treat with a variety of agents, toothpastes and dental bonding.

The inner layer of the tooth is the pulp. The pulp resides inside the root canal. Root canal treatment involves removing the pulp and replacing it with a filling. The pulp consists of the dental nerve and blood vessels. Normally, about a quarter of an inch or more of dentin and enamel protects the pulp. When accident or decay exposes the pulp, or trauma injures the pulp as when a baseball hits a tooth, the pulp usually dies causing pain and infection.

Teeth need restoration (fillings, crowns, etc.) for a variety of reasons. Often, the reason for the restoration determines the likelihood of post operative pain. For example, deep decay that approaches the pulp may allow bacteria to enter the pulp causing infection and pain later.