My Tooth Didn't Hurt Before...
Hello Everyone,
“But Doc, my tooth didn’t hurt before you worked on it. What’s up with that?”
Teeth are strange. Unlike most medical conditions, problems with the structural integrity of teeth often present without pain. If you break your finger, there is pain. Hit your head, there is pain. Heartburn, back spasms, hangnails...pain, pain, and more pain. But teeth are pretty amazing. They withstand the tremendous forces of chewing, swallowing, acid erosion, grinding, clenching, and often blunt trauma without making us run to the hills in agony. Enamel, the hardest substance in your body, acts like the outer wall to Fort Knox. It buffers a tremendous amount of force and bacterial challenges continually, without reprieve, and successfully insulates the underlying softer layer of the tooth called dentin. Dentin is like the mediator between the protector (enamel) and the protected (nerve and blood supply). Unlike enamel, dentin is alive in the sense that it is cellular, and acts as a secondary insulator for the nerve. In fact, when there is an insult to the tooth (like a crack or decay/caries), the cells inside the dentin produce a substance that further protects the nerve, keeping it from sensing the problem. Thank goodness for this, for we would all be walking around in pain most of the time if it were not for these protective features.
However, when there is a problem even without pain, the problem can’t be ignored. Eventually it will catch up to you. The tooth can only withstand biting forces and decay causing bacteria for so long, and before you know it serious problems occur. Parts of teeth fracture off, teeth fracture in half, decay and fractures reach the nerve, and the nerve dies. Pain ensues or infection festers, and then root canals and extractions happen.
We dentists have a duty to protect you, and that means protect your vulnerable teeth. Fillings are placed in teeth when small amounts of decay are removed and voids need to be filled. Onlays and crowns cover teeth when the natural tooth can’t fully support itself with its own enamel. Ultimately, we protect the core of the tooth so you can keep it for a lifetime. At least that is our duty, within reason.
Now, here’s the kicker. Nerves are connected to the brain. Those nerves in teeth have a sensitive temperament, and any trauma to a tooth, including drilling at very high speeds, can cause irreversible inflammation and sensory overload. As I stated before, the tooth problem needs to be eradicated before it causes serious pain, infection, or both. This is a given. Another given is that the nerve might respond unfavorably after the treatment has been completed. However, the chances are very good that all will be well.
When it comes down to it, treating any part of the body is an exercise of percentages. As a patient to whom I have an obligation to do no harm and a duty to keep safe, you must understand that I make these determinations with much thought and educated discernment. Pain might arise after any procedure and need to be addressed with further treatment, which is always annoying and inconvenient for you. However, even this event is preferable to what can happen to the untreated tooth.
Paul Huddleston, DDS