SCIENCE & TECH
Why are some restored teeth sensitive
and others are not?
IN THIS MONTHLY FEATURE,
Dr. Gordon Christensen addresses the most frequently
asked questions from Dental Economics readers. If you
would like to submit a question to Dr. Christensen,
please send an e-mail to email@example.com.
There are numerous reasons that could potentially explain
the problem you are experiencing. I will discuss them
below to provide some answers for your issues with
QUESTIONABLE PULPAL HEALTH
Often, it is difficult to estimate the vitality of teeth in
older patients who have significantly receded pulps, or
in patients of any age who have deep caries (figure 1).
Teeth with minimal pulp tissue visible on the radiographs
can be either nonvital and necrotic or in the process of
becoming nonvital—you cannot determine that condition from radiographs. The trauma of tooth preparation
and restoration placement can stimulate a painful condition for patients, even in relatively shallow tooth
When planning to prepare a tooth with deep caries,
it is nearly impossible to determine from the radiograph
how much dentin is present between the depth of a deep
caries lesion and the pulp. Excavating the caries is the
only reliable way to determine lesion depth.
The solution to reducing or eliminating sensitivity is
elusive. There is not a predictable solution, and because
of that, there is need for patient education and adequate
informed consent. When treating patients with either
minimal root canals visible on the radiographs or deep
carious lesions, it is best to advise them of the potential
for postoperative pain and the possible need for endodontic treatment.
DDS, MSD, PhD,
is a practicing
Provo, Utah. He is
the founder and CEO
of Practical Clinical
in 1981 for dental
cofounder (with his
wife, Dr. Rella
CEO of Clinicians
I DO NOT UNDERSTAND why some of my restorations are sensitive and others are not. I use
current generation bonding agents routinely for my composite restorations. I use both in-office
milled crowns and some indirect restorations made in the conventional manner, and I am careful
not to abuse the teeth when prepping. But sensitivity is unpredictable and very frustrating to me.
It is especially annoying to my patients. What am I doing wrong?
DEEP CARIOUS LESIONS
Dentists encounter this situation nearly every day of
clinical practice. A significant challenge when treating
deep caries is interpreting the current generation of
digital periapical or bitewing radiographs. It is well-known
that digital radiographs show only a portion of actual
caries depth or none at all, even in deep caries situations.
In cases involving deep carious lesions, explain to patients
that you must excavate the lesions to assess the actual
depth of diseased tooth structure due to the limitations
of what you can see on digital radiographs.
Figure 1: The mandibular first premolar tooth has
caries that could be a pulp exposure. The maxillary
first premolar has an apparent pulp exposure, but
the caries could be facial or lingual to the pulp. Both
teeth should be excavated carefully as described in
this article to determine the status of the caries.