Observation: Referred-Pain Extravaganza after Root Canal Treatment

[Brause]

Had a root canal started in upper incisor (tooth 21; not obturated yet) 5 weeks ago, but the periapical abscess does not heal. Either needs revision or extraction.

BUT, interesting observation: pain sometimes moves completely over to tooth 36 (started 4 days after root canal treatment), then sometimes to (former) tooth 46 (recently extracted), also sometimes to tooth 26.

Whichever tooth hurts, the other ones mentioned are simultaneously dormant.

Since tooth 21 is the actual source of the pain ("abscess"), I expect this referral business to disappear once the source of the pain (tooth 21) has been removed.

My family doc thinks [without examination] it is "trigeminal neuralgia" and my endodontist is referring me back to the dentist for a "comprehensive exam" [because he thinks there is nothing wrong with tooth 36...also without exam, but his exams are pricey].

I don't think it is "trigeminal neuralgia" because the pain is not sharp or shrill, and also does not appear in short flares. It is dull and permanent.

To be continued...

 

[smithwilfer]

No, but i really wish you to recover soon.

Thanks.

Vitality tests on adjacent teeth have been conducted: all vital.

I am going to see a periodontist mid month (for an implant) who I will ask for a second/third opinion.

I will also have to go back to my endodontist very soon to decide whether to obturate #21 (it has been 56 days since RCT). I hope the temporary filling is still holding up (the oral surgeon in my family claims they last for at least 6 months).

As probably mentioned, if it is odontogenic pain, it may be too early for imaging to be conclusive as there are no periapical changes yet.

Are you a dental clinician?

No, i saw my mother in pain with similar symptoms and you really made a wise decision. Recover soon .Good luck

 

[Brause]

Please let me know the outcome.

Carbamazepine is usually prescribed for TN1 (the shocks). TN2 the first line is low dose TCA (such as Amitryptiline). But I guess Carbamazepine or Gababentin will work too.

I have been taking Carbamazepine (2*300 mg daily) since 22 March. I'd way it took some time to work, and, initially, I was sleepy. That tiredness subsided after 5-6 days...and the drug also took some time to work properly. But now I am confident to say that it does...it makes the pain much more tolerable.

I read somewhere it could take 2-4 weeks to start relieving pain.

 

[Painful teeth]

Not sure about any progress as I don't know what really helps, the Ibuprofen or the Carbamazepine...and whether the Carbamazepine dose is right.

The worst pain I ever had was before taking the Carbamazepine...since then it has never been as excruciating...nevertheless rather bad today.

I'm starting carbamazepine today too.
I did some extensive research and TCAs are the standard (Amitryptiline the first). Second line is Gababentin/Pregabalin. Carbamazepine is rarely prescribed for atypical odontalgia, only for shock pains TN1.

 

[Painful teeth]

I have been taking Carbamazepine (2*300 mg daily) since 22 March. I'd way it took some time to work, and, initially, I was sleepy. That tiredness subsided after 5-6 days...and the drug also took some time to work properly. But now I am confident to say that it does...it makes the pain much more tolerable.

I read somewhere it could take 2-4 weeks to start relieving pain.

Just checking on you if you have anything new to report.

 

[Brause]

Upped dose to 2*400 mg of Carbamazepine since 18 April. Stopped Ibuprofen on 15 April...which, in retrospect, made no difference.

Essentially knocks pain in tooth 36 completely out, but only reduces sensation on tooth 31 to a pushing type. Tolerable but annoying.

Upping the dose came with tiredness that eased off as of today.

Will see a neurologist next week.

Still have an abscess in tooth 21, that has not healed after pulpectomy on 8 Feb...still needs to be re-treated before obturation or extracted.

Lots of headaches, even when getting out of bed in the morning. No idea, what causes that. I don't think it is a side effect of the meds (as I had it before). Would guess it comes from tooth 21.