Tooth pain after a filling: what's normal and when to call

What’s probably going on

A filling is a small repair, but the tooth still notices it. The dentist drilled out decay, dried the tooth and packed in new material. A few days of complaints afterward is common.

The most useful clue is which way the pain is heading. Pain that eases a little each day is usually healing. Pain that stays the same or gets worse needs a second look.

The usual causes, most common first:

• Normal sensitivity while the tooth settles. Minor sensitivity to cold, heat, sweets or air, plus a sore gum near the tooth, is normal after a filling. Cleveland Clinic says it usually fades within a week or two. The American Association of Endodontists allows a little longer: wait two to four weeks, and get it checked if it persists or gets worse.
• A filling that sits a little high. If the new filling is slightly taller than the tooth around it, it takes extra force every time you bite. The tooth can feel sore when you chew. Your dentist can fix this by reshaping the filling.
• A deep filling near the nerve. When decay was close to the pulp (the soft center that holds the nerve), the pulp can stay irritated for a while. Brief sensitivity that fades quickly usually settles down.
• An inflamed nerve that isn’t settling. Sometimes the pulp was already damaged by the decay, or a filling doesn’t seal well and bacteria get in. Heat, cold or sweets then cause pain that lasts more than a few seconds, and the tooth may throb on its own. See tooth sensitive to heat.
• An allergic reaction. This is rare. Some people are allergic or sensitive to the mercury or other metals in silver (amalgam) fillings. The FDA says this can cause sores or other reactions in the mouth. Tell your dentist if you know you have a metal allergy.

If the pain is mostly when you bite, see tooth hurts when biting. If it’s mostly a quick zing with cold, see tooth sensitive to cold.

What to do tonight

For normal sensitivity after a filling, time does most of the work. These steps can make the first days easier.

1. Chew on the other side for a few days. It gives the tooth a rest.
2. Go easy on very hot, very cold and sugary foods and drinks. Let things cool to lukewarm, and skip ice water.
3. Brush and floss as usual, gently. A soft brush around the filling is fine. Keeping the area clean helps the gum settle.
4. Take an over-the-counter pain reliever as the label directs, if you need one. For adults and teens 12 and up, anti-inflammatories such as ibuprofen or naproxen, alone or with acetaminophen, are a usual first choice. Ask a pharmacist first if you take other medicines, are pregnant, or have stomach, kidney or bleeding problems.
5. Keep track of the pattern. Note whether it’s better, the same or worse each day, and whether pain lasts seconds or minutes. That’s exactly what your dentist will ask.
6. Call if your bite feels off. If your teeth don’t close the way they used to, or one spot hits first, don’t wait weeks. Reshaping the filling is usually a short visit.

What not to do

• Don’t grind through a high bite. Chewing hard on a filling that sits high keeps the tooth sore. Call the office instead.
• Don’t put aspirin on the tooth or gum. It burns the tissue.
• Don’t take leftover antibiotics. They won’t calm an irritated nerve, and only a dentist or doctor should decide whether you need them.
• Don’t feel awkward about calling back. Checking a new filling is a normal part of the job.

How a dentist fixes it, and what it costs

The fix depends on what’s causing the pain.

• Normal sensitivity. Nothing needed but time. Your dentist may suggest waiting another week or two.
• A high bite. The dentist reshapes the filling so your teeth meet evenly again. This is usually a short visit.
• A leaking or broken filling. It gets repaired or replaced. If a filling falls out, see lost a filling.
• A nerve that won’t settle. If pain lingers after heat or cold, or the tooth throbs on its own, the pulp may be damaged past healing. The tooth usually needs a root canal, and sometimes a crown afterward. If the tooth can’t be saved, it’s taken out.
• An allergic reaction. The dentist can talk through other filling materials. The FDA advises against removing silver fillings that are in good shape unless a health professional says it’s medically necessary.

If you need more work, ask for a written estimate before it starts. See root canal cost and crown cost. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can cut the price at participating dentists.

How to keep it from coming back

The best way to avoid pain after a filling is to need fewer fillings, and smaller ones.

• Brush twice a day with a fluoride toothpaste, for two minutes.
• Clean between your teeth once a day.
• Cut back on sipping sugary or acidic drinks through the day.
• Get regular checkups. A cavity caught early needs a shallow filling, which is less likely to bother the nerve.
• Have old fillings checked at each visit, since a filling that doesn’t seal well can let bacteria back in.
• If you grind or clench, ask about a night guard. See grinding.

For help with the first habit, see the best electric toothbrush.