If your tooth is biting hard onto this inlay it will be sensitive due to your bite , make sure it is not this .
IF THE PATIENT progresses past the period of pulpal inflammation mentioned above without root-canal intervention, the tooth usually enters a calming period. What this really means is that the nerves or pulp have completely degenerated past the stage of total pulpal inflammation to became necrotic. In this state, pain provoked or sustained by temperature would have disappeared. Constant throbbing pain, or the continuous dull radiating ache usually associated with pulpal swelling or degeneration, also subsides. The tooth may still feel sensitive to pressure, since the PDL may still be inflamed due to the presence of the adjacent irritating necrotic debris of the pulp. Some teeth may become asymptomatic, especially with the help of antibiotics and bite adjustment. However, the tooth will not respond to temperature changes or electronic pulp testing.
This later stage of pulpal death can be view as the calm before the storm. Because of the bacteria residing in the necrotic pulp, the situation always has the potential to transition toward an endodontic abscess. However, the transition can often take months or even years, depending on a variety of factors. Although many dentists try their best to medicate symptomatic teeth in the hope of avoiding root-canal treatment before restoration, the truth is that many of these teeth tend to feel better because they have slowly arrived at this transitional stage of pulpal death.
The sedative dressing or temporary filling usually acts as a nerve blocker (as eugenol does, for example) and is effective as a topical pain medication. Unfortunately, the medication does little to reverse the degenerative inflammatory process that has already begun; pulpal recovery from acute inflammation usually is more dependent on the degree of tissue damage sustained and whether the damage is in conjunction with a bacterial presence. Radiographic evidence may appear within normal limits. However, if teeth stay in this stage for a sustained period of time, the bone around the root apex may resorb in the effort to limit the antigenic irritation from the dead pulp. Periapical radiolucency is then seen from a periapical film of the tooth. Sometimes, if the cortical bone adjacent to the radiolucency is lost, a fistula may develop from the area of inflammation or infection that can be seen clinically as a stoma. Its formation is usually a pain-free event, but the situation could become painful if the stoma became clogged or impacted.
When a tooth develops an endodontic abscess from the transition period of pulpal death, pressure pain slowly becomes more and more pronounced. The tooth may even become mobile. An infrequent or continuous ache can also arise, not from the swelling of the pulp (which is already dead) but from a swollen periodontal ligament or from a buildup of pressure surrounding the periapical tissues of the tooth. Edema, with a subsequent buildup of pus, usually creates pressure that translates into pain. Swelling or tenderness is usually seen intraorally adjacent to the root apexes. If the infection is not allowed to drain (via a pulpal opening, fistula, or an incision), extraoral swelling and lymph node involvement may develop as the abscess spreads beyond the local confines of the periapical area and into the facial planes. Radiographically, a noticeable radiolucency can usually be seen beneath the abscessed tooth.
From this short discussion of pulpal deterioration, you can see that the process is a continuous and dynamic one. As dentists we are usually presented with a “snapshot” of the state of the pulp in time. This basic understanding of the tooth’s pulp has given me more assurance in my endodontic diagnosis. Although there are always some exceptions, the symptoms that a patient presents with usually must fall into the pulpal timeline discussed above if root-canal treatment is to be helpful or meaningful. In the end, the root-canal treatment only accomplishes the removal of the inflamed, degenerative, or dead pulpal tissues from the tooth—and by doing so removes the source of pulpal pain or limits the potential for future ligamental inflammation and periapical bone destruction.
