Hi tre,

Your symptoms could be due to the nerves dying in the first molar and/or to a possible dry socket or infection in the extraction site.

The first molar..... The cold sensitivity on a tooth that has deep decay indicates exposed nerve chambers or tubules (of which there are many hundreds in every tooth) which react unfavorably to cold temps. A pulpotomy does not necessarily remove the decay in the tooth at the time of that procedure, it just removes a portion of the infected pulp chamber. So the tooth still has nerves that are very much alive and inflamed. The cold temp sensitivity may change to hot temp sensitivity as the nerves becomes more inflamed. Sometimes the exposed nerves die off to the point where there is no pain but then this is usually followed by swelling and further infection.

The only choices you have with the first molar are root canal or extraction. A root canal does not remove the dead and infected nerve tissue from the dentin tubules therefore rendering the tooth chronically infected. The extraction of the tooth is a permanent solution as the source of the infection, which is the tooth, is removed. However, you may want to know what your options are about replacing that tooth.

The second molar extraction site.... due to the extensive decay in that tooth, the infection from the decay may have spread beyond the tooth. If that infection and the periodontal ligament was not scraped out during the extraction procedure, then the site could still be infected. Not performing the debridement can lead to a dry socket and/or a bone infection. It is imperative that a tooth socket be thoroughly debrided after a tooth is extracted to avoid post operative infection and complications. Unfortunately not all dentists are thorough with the debridement. Not that a patient would know to request this on their own, I always recommend that patients tell their dentist or oral surgeon to be sure to thoroughly debride the socket of all tooth remnants, diseased tissue, ligament and bone.

The best you can do at this point is to keep the area clean and the rest of your mouth clean. Rinse well with a cup of warm salt water 5-6 times a day. Do not use mouthwash as the chemicals are irritating to the oral tissue and can prolong the healing time. Avoid eating on that area of your mouth and it would be best to get in to see the dentist on Monday for sure.

I am attaching a diagram of the anatomy of a tooth which clearly shows the many hundreds of microscopic dentin tubules throughout the tooth that contain nerve tissue and are not accessible during a root canal procedure. Each brown line represents a single tubule.

Hope this information helps and I hope your pain calms down over the weekend. Please let us know how you do at the dentist on Monday.

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