6 year history of episodic left lower molar pain

Discussion in 'Patient Forum' started by danzig, Dec 13, 2018.

  1. danzig

    danzig

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    Hey guys, I was wondering if anyone could shine some light on a problem that I have been having for years now. Any advice or insight would be immensely appreciated.

    I’m a 27 year old that has been dealing with chronic intermittent episodes of lower left molar toothache since around 2012 (6 years or so).

    The pain is a constant dull ache, always worse at night, fairly localisable to the lower left-sided back teeth. No sensitivity whatsoever. The weird thing about these episodes is that they are episodic: I will get 2-4 month spells of this pain (dull, aching, worse at night), which will eventually subside and I may then be free of pain for as much as two years. Over the past 6 years, I have been getting these 2-4 month episodes of pain at worst every 6 months, and at best once every 2 years.

    My past dental history is that I have had x2 fillings of my first left lower molar (composite in 2010, amalgam in 2016) and a wisdom tooth extraction on the left lower side in 2015. I also have an overbite with some frontal crowding of the lower teeth.

    In 2015 the pain was attributed to an impacted left lower wisdom tooth which was extracted. However since then I have still been having these recurrent episodes of pain unchanged from before. On 3 occasions since 2015 (post wisdom tooth extraction) I have been to my dentist regarding similar toothache: no signs of infection, annual x-rays show no damage to the teeth, filling of the first molar healthy, with no nerve involvement. The usual outcome is that I have a course of oral antibiotics which doesn’t resolve the problem, however the pain will usually subside independently of this at a later date.

    I attended my dentist again last week who took another x-ray of my left lower teeth, and has told me (for the first time) that the filling is slightly deep, and there is features of inflammation of the underlying ligament underneath the first molar. Again I have been advised to ride this out with a course of oral antibiotics, however this time I was told that the next option would be root canal treatment as a filling replacement would only increase my infection risk.

    What does anyone make of this? I have spent many hours doing (uninformed) research about this – whether this is chronic pain post-wisdom tooth extraction, tooth decay, nerve involvement from the fillings, sprained tooth syndrome. I am just a bit sceptical about the fact that I have experienced zero sensitivity with all this, and pain that is always associated with lying down flat. Literally every time I lie flat (either in bed or on sofa) I can feel the pain coming on within minutes. None of this appears to be common in any of the literature that I have read. The aching feels very much like toothache however I have been reassured by numerous x-rays that there is no evidence of tooth decay.

    Any thoughts on what the underlying problem is/what I should do what be of huge help.

    Dan
     
    danzig, Dec 13, 2018
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  2. danzig

    honestdoc Verified Dentist

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    Did your dentist do a pulp/vitality test on the tooth in question? How intense is your pain on 1 to 10 scale? Are you experiencing any unresolved stress? Maybe you can provide x-rays if possible?
     
    honestdoc, Dec 13, 2018
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  3. danzig

    danzig

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    Hey, thanks for your response. Unfortunately I do not have access to the x-rays that have been taken, and no vitality/sensibility tests have been performed. I would say the pain during the day time is 6/10, but at night/lying down is 9/10. This doesn't seem any different to me when compared to how it has been episodically for the past 4-5 years.
     
    danzig, Dec 13, 2018
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  4. danzig

    honestdoc Verified Dentist

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    If dentists aren't able to locate the dental source i.e. teeth/oral structures, it may be of neurological origins like trigeminal neuralgia. You may visit a neurologist for possible evaluation.
     
    honestdoc, Dec 13, 2018
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  5. danzig

    MattKW Verified Dentist

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    Antibiotics are a waste of time. A pulp test is necessary as a minimum, and there is no such thing as a "sprained" ligament for teeth. I would get a second opinion - take along copies of your records including X-rays. Would love to see an X-rays posted up here.
     
    MattKW, Dec 13, 2018
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  6. danzig

    danzig

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    Thanks - to be fair though the sprained tooth syndrome was not something my dentist suggested, that was just part of my misguided research. Are pulp tests routinely performed as part of pre-assessment before root canal treatment? This wasn't suggested by my dentist. I've read that they aren't very reliable though - if I have a good response to vitality testing that could still represent a false reading and the vascular integrity could still actually be quite poor right?

    I think I will seek a second opinion. If I get access to the x-rays I will upload them here.
     
    danzig, Dec 14, 2018
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  7. danzig

    MattKW Verified Dentist

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    The other way around - you can get false negatives to pulp tests. So, if the dentist puts a cold pellet on your tooth and you feel it, then your tooth is still alive. If you don't feel it, then it may be dead (abscessed) OR it may be a tooth that doesn't feel cold easily - which is why it's important to also test adjacent teeth to get a baseline.
     
    MattKW, Dec 14, 2018
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  8. danzig

    honestdoc Verified Dentist

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    Many inexperienced dentists use Q-tip instead of cotton pellet to test cold. Q-tip does not get cold enough to get accurate results.
     
    honestdoc, Dec 14, 2018
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