continuous pain after composite filling

[Natura]

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Our school clinic is closed until may 17th and my patient called me this morning. She said she's been in continous pain for two days and taking mortrin every 4 hours. I cannot see her until the clinic opens in may so I told her to go to hospital dental clinic or local dentist to get treatment. I told her that I would pay for the services. But I did 4-5 composite fillings before and never had this problem, so I want to hear from you what might cause this problem. Is it moisture contamination or shrinkage pressure? Any ideas? And will the pain be relieved if the filling is re-done? And what would you do if you were in my place beside suggesting to pay for the treatment outside of school? 😡

 

[OceanDMD]

Our school clinic is closed until may 17th and my patient called me this morning. She said she's been in continous pain for two days and taking mortrin every 4 hours. I cannot see her until the clinic opens in may so I told her to go to hospital dental clinic or local dentist to get treatment. I told her that I would pay for the services. But I did 4-5 composite fillings before and never had this problem, so I want to hear from you what might cause this problem. Is it moisture contamination or shrinkage pressure? Any ideas? And will the pain be relieved if the filling is re-done? And what would you do if you were in my place beside suggesting to pay for the treatment outside of school? 😡

Why would you pay for her services if you dont know what you did wrong? This patient chose to be seen in a student clinic for a reason. Its less expensive but may come at the cost of longer treatment, and possibly compromised quality (no offense). As far as what the problem could be from, how in the hell is anyone gong to be able to figure that out without history, radiographs, and an exam?

Dont sweat it. It happens. Isnt there an emergency clinic open at your school?

 

[briansle]

Our school clinic is closed until may 17th and my patient called me this morning. She said she's been in continous pain for two days and taking mortrin every 4 hours. I cannot see her until the clinic opens in may so I told her to go to hospital dental clinic or local dentist to get treatment. I told her that I would pay for the services. But I did 4-5 composite fillings before and never had this problem, so I want to hear from you what might cause this problem. Is it moisture contamination or shrinkage pressure? Any ideas? And will the pain be relieved if the filling is re-done? And what would you do if you were in my place beside suggesting to pay for the treatment outside of school? 😡

If your school's closed, then its closed.

You did the right thing telling her to go seek treatment immediately at any dentist available.

You did the wrong thing suggesting to pay for treatment outside of school. I'm sure your school's administrators would have a problem with you paying for a patient's tx outside of the school, since its in direct relation to work done at the school. If your patient wants free re-tx, then she needs to wait until May and then the school can cover all costs. Otherwise, tell your patient, this is unfortunate, and just go to a local dentist for tx immediately.

Ask her what type of pain she is feeling. Throbbing/lingering or sharp/shooting? If it's throbbing/lingering (irrv pulp), Tell her to just go see a dentist and take care of it. These things can happen. If it's sharp/shooting (rev pulp). tell her give it a few more days, see if it resolves.

 

[tinman831]

Post-op sensitivity is a complication that can occur in patients despite meticulous attention by the best dentists. Causes can range from contamination, incomplete caries removal, or pulpal irritation during preparation (pulp exposure or excess heat). Hopefully the pain will resolve itself after 2 weeks or so. Tell your patient that sensitivity after a filling is normal for the first two weeks. If the pain continues and lingers (irreversible pulpitis) then a root canal may be necessary unless you know that you made a mistake during the procedure (poor isolation, pulpal exposure, etc) which case you may opt to redo the filling first.

 

[daisy25]

You should definitely ask all the questions suggested, but it could also be something simple as hyperocclusion. You should not have to pay for outside tx, the professor signed you off for the tx so it's not your fault. Stuff happens.

 

[tinman831]

You should definitely ask all the questions suggested, but it could also be something simple as hyperocclusion.

Probably the most common cause of post op pain. OP, why is your clinic closed for the next 4 weeks? Makes no sense. Isn't there at least an ER clinic at your school?

 

[gte1974]

Can you tell us more:

what type restorations I,II,III etc
and how deep?
prior restored teeth?
did you place a base, what type?
was there pain during the procedure?
Was there pain before procedure?
Was there a prior restoration in the teeth you worked on?

Did you check occlusion? centric, lateral excursions, protrusive? Did you check occlusion before restoring teeth to make it was back in the place after restorations?
Did you seal the restorations after you were done? before polishing?
Did you disinfect your prepared cavity after prep?
How long did you etch?
Did you follow the etching, priming, bonding instructions according to the generation of bond used and manufacturer?
Did you use water from your handpiece at all times?( It is surprising how many people will turn the water off for extended periods of time)
Did you use new burs?
Did you use slow speed to finish cavity?
Did you polish the restoration? if so with what system? with water?


Also you mentioned moisture, did you isolate with rubber dam or only relative isolation?

why don't you walk us thru what you did step by step, and start with diagnosis of patient, what you remember.

Without more information on what you did, it would be very hard to speculate and learn from it.