What is causing my pain? I’m at my wits end!

Discussion in 'Endodontics' started by GlowGal, Mar 21, 2019.

  1. GlowGal

    GlowGal

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    In 2006, I had my second bottom left molar crowned. My only symptom at the time was pain upon biting. My dentist sent me to an Endodontist who took X-rays and performed testing on the tooth. The X-ray showed a widened PDL space but nothing else so the Endodontist advised my dentist to crown the tooth which she did (gold crown).

    I’ve had some level of pain on biting since the tooth was crowned but the pain always went away once I had my teeth scaled and cleaned (every 6 months without fail). The tooth is good / pain free for a good
    5 1/2 months afterwards and then acts up again only to go away after scaling.

    Fast forward to October 2018 and the biting pain is back again but this time the pain didn’t go away after my cleaning/scaling. I started having a dull ache in my jaw that radiated up to my ear with sensitivity to cold and sometimes to sweet and hot. In November 2018, my dentist sent me to the same Endodontist who I saw in 2006. He tested the tooth, took a new X-ray and compared it to the X-ray from 2006. He noted that while the PDL space had widened slightly more compared to the 2006 X-ray, there was nothing he could see that required a root canal. He suggested that I get a new custom nightguard. He also noted some gum recession on that crowned tooth. As an FYI, I’m a clencher and grinder and have worn a custom nightguard (lower) since 2006.

    I got a new custom nightguard in February 2019 - Thermoplex material - but I still had the jaw and ear ache. Went back to the dentist last week who adjusted my crown, adjusted my nightguard and also applied de-sensitizing material to the gum line of the crowned tooth as well as all the other teeth on the bottom left. The sensitivity to cold, sweet, hot has abated quite a bit and the biting pain has also lessened but it’s still there to some degree as is the jaw and ear pain (I also get a crunching sound in that left jaw joint when I open and close my mouth).

    My dentist is sending me back to the Endodontist because she’s at a loss as to what’s going on. She took another X-ray and again, other than a widened PDL space, there’s nothing new. I’ve had no signs of infection or abscess or gum swelling of any kind during these past few months. The pain/ache I feel does not wake me up at night....I’m able to sleep through the night no problem. But....my ache starts upon waking.

    Could I have a sprained tooth? Could a widened PDL space and receding gums be the cause of what I’m experiencing (considering symptoms have slightly improved)? Is this an occlusal issue? Could menopause be causing increased thermal sensitivity? Do I need a different kind of nightguard, maybe an upper as opposed to a lower? Do I need a RC? I don’t want to get a RC unless it’s absolutely necessary, especially if it won’t take away the ache. I’m in tears most days as I’m frustrated because of this.

    Sorry for the long-winded post....I wanted to provide as much background information as possible. I appreciate any and all comments / suggestions. I feel like I’m truly at my wits end.
     
    Last edited: Mar 21, 2019
    GlowGal, Mar 21, 2019
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  2. GlowGal

    honestdoc Verified Dentist

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    Did the endodontist test for cold? If so, how did the tooth respond? I'm suspecting possible crack in the roots. Did your dentist or hygienist periodontal probe for attachment loss?
     
    honestdoc, Mar 21, 2019
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  3. GlowGal

    GlowGal

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    Hi Honestdoc,

    He tested for cold and deemed it a normal response...no lingering pain. He also checked each cusp with a tooth sleuth but there was no biting pain so I don’t know why I get a pain when I bite down when eating...and not all the time. How is attachment loss checked...is this the probe that they use in the gum around each tooth to check for pockets / recession? If so, then yes, the dentist does but she’s never indicated any issues.

    If it is a crack in the root, is extraction the only treatment? Could a 3D X-ray show a crack or is a crack only detected when the Endodontist is in the process of doing a root canal?

    Thank you so much for taking the time to respond and trying to help.
     
    Last edited: Mar 22, 2019
    GlowGal, Mar 22, 2019
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  4. GlowGal

    honestdoc Verified Dentist

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    X-rays, Ct scans, etc, may detect cracks only if the fragments are separated. The endodontist may have a microscope to aid in detection. If you have a root fracture, after 1-2 months, the x-rays may reveal bone damage. How intense is your pain on 1 to 10 scale? If it is low grade and infrequent, it may just be recession and grinding/clenching. Another source is TMJ dysfunction best evaluated and treated by the appropriate specialist. Do you have unresolved stress? If so, seek proper management.
     
    honestdoc, Mar 22, 2019
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  5. GlowGal

    GlowGal

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    It’s not really a pain, per se....more of a dull ache...low grade and infrequent as you stated. If I had to rate it as pain, I’d say no more than a 5 at its worst. Taking Advil or applying Vanilla Extract to the gum area always takes care of any ache/pain that I have. I’ve had 4 X-rays in a span of 6 months so I’m thinking someone would have mentioned bone loss if there was any?

    I will seek out a TMD specialist to see if that might be a factor. My bite on the lower left doesn’t feel quite right so perhaps that is part of the issue. I have an issue with managing my stress so if clenching and grinding can cause these symptoms, then that could be an issue as well.

    Honestdoc, thank you so much for your help. It’s truly appreciated! I now have some additional avenues to explore.
     
    GlowGal, Mar 22, 2019
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