Lower left pain in teeth/gums

[GeorgeNelson1989]

Hello All -

For a couple of weeks I've been having pain in my lower left teeth/gums. It's hard to pinpoint where exactly the pain is coming from, but more recently the gums between my last two teeth are swollen and burning. (The pain feels good when flossing). I had a broken filling redone in September 2018, could this be related? I went to the dentist a couple of weeks ago because of the pain, and she gave me periogard rinse (2x per day) but the pain has only gotten worse.

I'm going back to see her next week but am wondering if anybody can tell me what the problem might be?

I'm attaching the x-ray she took the last time I was there...

Any help would be appreciated.

Thanks,
George

 

[honestdoc]

Could you provide an image of your gums? I'm not seeing anything significant in the x-rays other than possible pooling of bond on distal margin #19 (Lower left first molar). #19 mesial filling could be polished little more to create a better occlusal embrasure. I expect the teeth to have some cold sensitivity (not too intense) which indicates the health of the pulps/root canals. Other possibilities may be the filling is biting too high, you may be grinding and/or clenching, and/or you may have traumatized your gums.

 

[GeorgeNelson1989]

Could you provide an image of your gums? I'm not seeing anything significant in the x-rays other than possible pooling of bond on distal margin #19 (Lower left first molar). #19 mesial filling could be polished little more to create a better occlusal embrasure. I expect the teeth to have some cold sensitivity (not too intense) which indicates the health of the pulps/root canals. Other possibilities may be the filling is biting too high, you may be grinding and/or clenching, and/or you may have traumatized your gums.

Thanks so much for the reply, much appreciated. Here are some images, not sure if they are detailed enough but again thanks so much for your time.

George

 

[MattKW]

Hello All -

For a couple of weeks I've been having pain in my lower left teeth/gums. It's hard to pinpoint where exactly the pain is coming from, but more recently the gums...
Thanks,
George

Gums don't give pain like that. I think it's much more likely it's related to the work done in Sep. The most recent work done is always a flag for me. Also, the filling in the last molar is closest to the pulp horn (nerve). Your dentist should not just take X-rays, but also pulp and percussion tests. I'd also be thinking about a possible crack which might show up on transillumination.

 

[GeorgeNelson1989]

Gums don't give pain like that. I think it's much more likely it's related to the work done in Sep. The most recent work done is always a flag for me. Also, the filling in the last molar is closest to the pulp horn (nerve). Your dentist should not just take X-rays, but also pulp and percussion tests. I'd also be thinking about a possible crack which might show up on transillumination.

Thanks for the info. She did do percussion tests the last time I was there, but I didn't have any pain and there wasn't sensitivity to cold. I should mention that the filling was redone because I had a back piece of my last molar break off in June, they say from clenching. That spot in my tooth looks dark to me, do you think that could be causing the pain?

 

[MattKW]

Darkness may not mean anything at all, and doesn't justify treatment on its own. You have to look at all the factors before making a treatment decision. When you say it wasn't sensitive to cold, did she use cold spray, or just blow air? And did she compare the response from a number of teeth? This is the assessment guide I use.

 

[GeorgeNelson1989]

So a lot has occurred since I last posted here...and I'm still having pain.

I went back to the dentist on October 31st and had the first part of a crown procedure done. I was in a lot of pain after that procedure so I ended up going back in a week later on November 7th and the endodontist said I should do a root canal. They squeezed me in that day. Since then, the pain has been worse, and pretty much constant. It's all in the left side of my jaw/tooth. I've been on amoxicillin & clindamycin since this all started, now done with both. On Monday 11/26, endo told me to see a periodontist to make sure nothing is wrong with the gums. I went there today 11/28, and she said she didn't see any signs of infection or gum disease. I'm going back to my regular dentist tomorrow to get the permanent crown put on my root canal'd 2nd molar. I'm attaching various x-rays taken over the last few months...and I'm wondering if anyone sees anything? After I left today I noticed a dark spot on one of the x-rays...I pointed to it with an arrow on the attached image. If anyone has any insight, that would be great...

My main question at this point is...why am I still in pain?

(The pain is in my left back molar, and underneath the left side of my jaw. At times it radiates to the back of my head, up to my temple, and down the front/side my neck. It's a dull aching that lasts pretty much all day, but doesn't wake me up at night. It's usually better in the morning and gets worse as the day goes on.)

 

[honestdoc]

My first impression of that dark spot is normal bone trabeculae. It doesn't appear like a cyst or similar and other images just doesn't confirm anything. The root canal looks good. Has your pain changed after the root canal procedure or remains the same? The radiating pain on lower left jaw and neck area may be remotely cardiovascular. You may check with your physician to rule that out...hopefully not a heart attack.

 

[MattKW]

This is not adding up. I was surprised to see that you've ended up with an RCT, but it's hard to assess in a forum where we can't test teeth ourselves and have to rely upon what you can tell us. Antibiotics were probably unjustified, as there never seemed to be evidence of a ful-blown infection.
A nice-looking RCT. The darkness is probably submand gland depression and all looks quite OK.