Root Canal Needed / TMJ Issues?

[Belle35]

Hello,

I’ve had two different opinions about this tooth (lower premolar), both from great dentists, so I’m a little confused. I would hugely appreciate another opinion.

I know you are not able to examine me, but the actual tooth itself on the outside looks great, no visible discolouration or marks etc.

Symptoms right now:
No general pain coming from tooth. Sleeping fine. No pain when lying down.
Tooth seems fine with hot and cold drinks.
When I tap on my teeth, this premolar tooth stands out as being slightly tender. Not painful, but different to the others. When I bite down on it, it also feels different but I wouldn’t describe it as painful.
I have been particularly stressed with a personal issue recently so I am unsure as to whether I have been clenching / grinding. My TMJ does feel tense (had issues with clicking jaw in the past) so I am doing some exercises to help this.

Can you see anything that stands out on the X-ray? One dentist would like to do root canal and one dentist would like to wait and monitor my symptoms for another 4 weeks. I have an X-ray of the specific tooth, and then the same tooth on a scan I had done on my whole mouth and sinus area.

I just fear I am prolonging the inevitable and it’s going to need root canal all along because the tooth is damaged in some way or why else would it be feeling tender to bite down on? I don’t want to sit here waiting for it to get worse if there’s some sort of obvious infection going on.

Thank you in advance for any advice you can give.

P.S - am I right in thinking that the larger black area right at the bottom of the tooth (below the root) is a nerve? I’ve had trigeminal nerve issues in the past and some recent pains / bruised feelings in my temporalis muscle so it just made me wonder about possible nerve connections to this specific tooth.

 

[Brause]

From my own experience: I have a tender tooth and the CBCT shows no abnormality. It started in March, subsided during the summer, and came on again in the fall. Also no hot-cold sensitivity.

I am not rushing as root canal treatment kills the tooth and is irreversible.

Dr thinks tooth is sensitive from nightly bruxism/clenching and recommends monitoring. He thinks that endodontic treatment would not remove the pain.

So far, both my previous root canals went immediately sideways and ended with extractions: painful and expensive.

If it was an endodontic issue (pulpitis), things would become worse with time, probably rather fast, to the point that one has excruciating pain. If this does not happen, it may heal by itself.

German dentists call this "Aggressives Zuwarten" (aggressive non therapy).

In a previous case, it took about two weeks for tooth #21 from going from tender to very painful.

If it was TMJ or similar, you may talk to your GP and ask for an anticonvulsant such as Gabapentin or Carbamazepine...worked beautifully for another tooth of mine.

A custom-made nightguard may also help by eliminating the cause. If I had had one, I would have never needed root canals to begin with.

On the big scale of things, 4 weeks is rather short. Premature action could open a huge can of worms...

 

[Brause]

Generally, if the ligament that holds the tooth in place, is strained/traumatized from bruxing/clenching, this would also cause toothache/tenderness/. Google for "strained ligament".

But this is self healing, and particularly well with a nightguard and/or a muscle relaxant.

Radiographically, this would look exactly the same as a periapical lesion...this ambiguity is probably the reason for one Dr.'s recommended wait time.