Winter Park Dentistry- Toothaches Podcast
Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our podcast. Today I have my special guest Dr. Thao Le. Our topic today is a common topic, something that every dentist on the planet knows about, toothaches. While we could go on and on about toothaches, we’re going to try and keep things somewhat introductory for people watching this. A little bit of background on you, Dr. Le. You have a pretty extensive dental education, you’re ultra-geek for sure, you started off in dental school, then you went I think and did a year of general residency with a lot of surgery out in California, and then you got into your specialty training for root canals, called an endodontist, clearly all endodontists deal with toothaches, and then you’re such a geek, that wasn’t enough, three years of Harvard, then you spent two more years doing an implant fellowship for three more years at Harvard.
So, boy, I’m really glad you’re here, clearly you’ve dealt with every aspect of a toothache, so I’m really excited to hear what you have to say, because there’s a lot of people out there watching this, hopefully watching this, that have had a toothache, has a sensitive tooth, so let’s get right into it… Toothaches have a range, they go from sensitivity to the all night aching, excruciating pain, misery toothache, tell people watching this a little bit of a brief spectrum of toothaches.
Dr. Thao Le: Yeah. The majority of patients who come to our office come with emergency dental pain, usually come with severe pain that they’ve experienced in the last couple of days, even last night for instance, they can’t sleep, they have throbbing pain, and then there’s another spectrum of patient who come with a slight sensitivity, they’re hot, cold, and also patients who have recent fillings or crowns that were done, they come in with discomfort, minor discomfort, and generally I see what’s going on. My job as endodontist is just to diagnose the problem and determine whether or not they need root canal therapy, it’s something that we have to monitor, or there’s other treatments we do before we recommend root canal therapy. For instance, some patients may develop a cracked tooth syndrome, where for instance they may bite in a particular aspect, where they’re chewing and it hurts, and that generates very low or great pain, and doesn’t necessarily require root canal therapy, and as I mentioned before patients who recently had fillings, they come back with sensitivity, hot or cold…
Dr. Ramzi Matar (Winter Park Dentistry): Is that like deep cleanings, when people have deep cleanings?
Dr. Thao Le: Yeah when people have deep cleanings, they come back and say “my tooth really hurts”, and we kind of do our diagnostic protocols to try to determine what the source of discomfort is, and the majority of discomforts that we kind of deal with, you know… Once in a while we have a patient who comes in with severe swelling, and we have to handle those emergencies, and adjust from there. There’s a range of patients who come in with numerous number of discomforts.
Dr. Ramzi Matar (Winter Park Dentistry): What are the ones that you more typically watch, what are the highlight ones with which patients shouldn’t wait? Clearly there’s some things that can be monitored and then obviously, with a lack of you being able to diagnose and see a patient, clearly I just want general guidelines for somebody watching this, when should somebody start to worry, when should somebody maybe think okay, I’m going to leave this for maybe a few more days, to see if it settles down, and then when is it that you need to get somewhere quick kind of pain?
Dr. Thao Le: If the patient recently just had, say you just came in for a filling or came for a tooth crack or crown, if you think about it, it’s kind of like trauma to the tooth, it’s like getting a bruise to your hand, usually it lasts around 6 weeks for it to subside, but if the pain is progressively works, let’s say on a scale of 1 to 10, if a patient rates it as 8, 9, 10, or if the pain is a throbbing pain, in a way that keeps them awake at night, generally those are the signs and symptoms that we look for where we kind of diagnose in terms of how severe the nerve of the tooth, which is called the pulp, how inflamed it is, usually there’s two different signs or symptoms that we’re looking for, depends on the type of nerve and what is activated inside the pulp. Just as a general overview of this, this nerve within the pulp, one we call our c fibers, the other ones are going to be called as a delta fibers, to distinguish between the two, the majority of discomfort in a slight sensitivity pulp is used by a delta by usually a quick burst of pain, if you have recession for instance you drink cold, those are the pains that are activated by this delta fiber.
Dr. Ramzi Matar (Winter Park Dentistry): So that’s kind of like when you bite on an ice cream cone and you get that little zing, and then you put on there it goes away, those are a delta, they come and go pretty quickly.
Dr. Thao Le: Yeah. They’re all activated quickly in the pulp. But when the nerve becomes extremely inflamed, the other fibers, the C fibers, get very sensitive, such as say as in a sunburn, usually you touch the skin it doesn’t burn, but when the C fibers are activated, that’s when you start having those dragged out throbbing pains. Usually it’s a dull ache, in contrast to the A delta fiber, which is a quick zing and it goes away. So those are the general symptoms that we look for. There is a diagnose for a tooth that is severely inflamed, sometimes a tooth that is clean, a tooth that has no symptoms sometimes patients may have just a biting pain, and we obviously have to test it to see that the pulp is still alive. Patients who have trauma for instance in their front teeth can go for years without developing any symptoms and suddenly they have some mild discomfort in that particular tooth, we have a test to run to determine whether that nerve is dead or alive.
Dr. Ramzi Matar (Winter Park Dentistry): You said something about immediate pain that wakes you up at night, because I have patients who tell me that. What is that characteristic of, the C or the A delta?
Dr. Thao Le: In the middle of the night, it’s a spontaneous pain, that would be activating the C fibers.
Dr. Ramzi Matar (Winter Park Dentistry): So the dull pain, middle of the night pain, belongs to the C fibers, that’s the deeper trauma or problematic, those are more serious on a generalized perspective. Can those ever get better sometimes or does that mean that the nerve might need a root canal? Or the tooth may need to come out or something more advanced than for example sensitivity toothpaste?
Dr. Thao Le: Generally, once you have those throbbing pains, that lingering pain that doesn’t go away, those are the key indicators that you’re going to need root canal therapy. If you have a minor hot sensitivity, or cold sensitivity for instance, especially after fillings, that can go away. You’ve got to watch it for quite some time, that’s why on the scale from 1 to 10 we ask the patients how would you rate it. If they say 4 or 5 generally it’s something that we would monitor overtime. The higher end of the spectrum, those are indicators that the tooth needs superior treatment.
Dr. Ramzi Matar (Winter Park Dentistry): More or less how long after a filling, if it’s going to go away, is there sort of a range of time?
Dr. Thao Le: Generally I like to wait from 4 to 6 weeks or so. It can be a little while, it can go on for quite some time. If it’s just a cold sensitivity, especially after a deep cleaning for instance, I generally recommend trying some sensodyne, that kind of helps with the sensitivity they experience afterwards.
Dr. Ramzi Matar (Winter Park Dentistry): Okay, as long as it stays in that A delta, cold, quick, none is throbbing, dull pain, that’s the pain that can go away, give it four to six weeks, it should start to get better with sensitivity toothpaste. Of course I realize toothaches have such a spectrum, from wisdom teeth to cracked teeth, and some stuff like that, even some of the major highlights that I wanted to get into… I’ve got a last question for you, I’ve heard something about in the north, when the cold comes, there are more toothaches. Is there any truth to that or is that a tale, that with the cold and the winter all the toothaches start coming? And you trained in Boston, so you probably know the answer to that.
Dr. Thao Le: That’s actually a very good question because, patients who develop a cold for instance, may develop sinusitis, and sinusitis is inflammation of your sinuses and essentially the inflammation of empty spaces in there, above your back teeth, that’s where your sinuses are, and generally patients come in with pain in the whole region. And they may have a cold at the same time, for instance we tap on the teeth on the whole back side, and all their teeth will hurt. With seasonal changes, it may be an indicator that it may be a sinus problem, and so that’s why I think people are saying that they may have more tooth pain when it comes to a colder weather, meaning it’s due to sinusitis, more than to the tooth itself. Because they’re so close to each other, that the sinuses get referred to the tooth, and that’s what you may experience, but it’s not.
Dr. Ramzi Matar (Winter Park Dentistry): So does that mean in Ecuador there are no toothaches, because if never gets cold? *laughs* I wonder if that’s the case! Listen, Dr. Le, thank you, I hope everyone watching this enjoyed this video, hope you learned something for the video, I hope to have you back for more and more episodes, because there’s such a scope when ti comes to root canals and so many things you can teach the people watching this, so this is kind of a teaser, anybody out there watching us, I hope you enjoyed it, hope you learned something, you can contact either one of us with the information on the screen, we’re also always happy to try and respond back to comments. Dr. Le, I really do appreciate your item.