Persistent Tooth Pain After a Filling: Causes and What to Do

Mild sensitivity after a filling is normal for days to weeks. Persistent pain at 3 weeks warrants dental re-evaluation.

Common Causes of Prolonged Post-Operative Pain

1. High occlusion (bite interference): Filling too tall → periodontal ligament trauma → cold/pressure sensitivity. Fix: simple occlusal adjustment.
2. Deep caries near pulp: Irreversible pulpitis may develop despite liner/base. Fix: root canal or extraction.
3. Microleakage: Incomplete seal → bacterial ingress, sensitivity. Fix: replacement with better isolation.
4. Cracked tooth syndrome: Pre-existing crack flexes under load. Fix: crown, root canal, or extraction.
5. Referred pain: From adjacent tooth, sinus, TMJ, muscle.
6. Allergic reaction: Rare (composite monomer, amalgam mercury). Patch testing available.
7. Galvanic shock: Dissimilar metals (amalgam + gold) creating electrical current.
8. Incomplete caries removal: Residual bacteria → persistent inflammation.

Diagnostic Steps at Re-evaluation

• Percussion, palpation, cold/heat testing, electric pulp test.
• Bite articulation paper check.
• Periapical X-ray or CBCT (assess proximity to pulp, periapical pathology, cracks).

When to Return Immediately

• Spontaneous, throbbing, night-waking pain.
• Swelling, pus, fever.
• Pain on biting release (cracked tooth sign).

Do not endure persistent pain—early intervention preserves tooth vitality and prevents complications.