Persistent Tooth Pain: Possible Causes and Solutions

Q: Persistent Tooth Pain: Possible Causes and Solutions

Dear anson123P： Hello! As mentioned, your condition is more complex and requires a detailed examination and treatment at the hospital. <br>Wishing you safety! Sincerely, Dr. <br>Huang Ting-Fang, Dentistry.

I would like to know where the problem lies?

Hello, Doctor! Here’s the situation: I currently have pain in this tooth.
I had a root canal due to a cavity, but after the procedure, I still felt significant pain.
The dentist who treated me suggested that I get a crown, which should alleviate the pain.
I went ahead and got the crown, but afterward, I couldn't bite down on anything with that tooth; even touching it with my hand caused pain.
I returned to the same dentist, who performed another root canal.
However, after that, the pain persisted.
I endured it for a while, but biting down on anything still hurt, even soft foods.
During this time, I visited another dentist who also performed a root canal, but the pain remained the same.
I went back to my original dentist, who then suggested extracting the tooth.
I agreed, and he mentioned that the extraction was difficult due to the long root.
After the extraction, I waited for the wound to heal, but even after the tissue grew back, I experienced pain when pressing on the area or eating something sweet, which felt numbingly painful.
The extraction site was painful, even though the tissue appeared to cover the wound.
Subsequently, I went to a large hospital's dental department.
The first dentist there cut open my gum and mentioned that he removed some necrotic tissue, which was sent for biopsy, but the results came back normal.
After some time, the surgical site healed, but my condition remained unchanged.
I then visited another large hospital.
After hearing my situation, the dentist arranged for a CT scan.
Strangely, the entire oral cavity appeared normal, except for the painful area, where the gum was white.
However, the doctor couldn't explain why this was the case.
He performed another surgery, cutting the gum again, but he stopped digging deeper when I expressed pain.
He suspected it might be related to the trigeminal nerve and prescribed me anticonvulsant medication, but there was no improvement.
Since then, it has been about 5 to 6 years! Whenever I think about it, both my head and the area around the gum hurt.
I’m at a loss as to which specialist to see next.
I even consulted a neurologist, but my symptoms don’t resemble typical trigeminal neuralgia; the pain is localized without facial pain.
I would like to ask if this persistent pain could be due to improper treatment of the tooth nerve or if there might be another dental issue? Does the presence of the white tissue in the gum have any relation? Thank you, Doctor, for your patience in reading this.
How can I resolve this issue? Thank you!

Anson, 30~39 year old female. Ask Date: 2016/06/02

Dr. Huang Tingfang reply Dentistry

Dear anson123P: Hello! As mentioned, your condition is more complex and requires a detailed examination and treatment at the hospital.
Wishing you safety! Sincerely, Dr.
Huang Ting-Fang, Dentistry.

Reply Date: 2016/06/02

More Info

Persistent tooth pain can be a frustrating and debilitating experience, especially when it continues despite multiple treatments. Based on your description, it seems that you have undergone various dental procedures, including root canal treatments, extractions, and surgeries, yet the pain persists. This situation can arise from several underlying causes, and understanding these can help guide you toward a solution.

Firstly, it’s important to recognize that tooth pain can stem from various sources. After a root canal treatment, some patients may still experience discomfort due to residual inflammation in the surrounding tissues or incomplete removal of the infected pulp. If the pain persists after a root canal, it may indicate that the procedure did not fully address the issue, or there may be additional complications such as a missed canal or a fracture in the tooth.

In your case, after the extraction of the tooth, the ongoing pain in the area could be attributed to several factors. One possibility is that the extraction site has developed a condition known as dry socket (alveolar osteitis), which occurs when the blood clot that forms in the socket is dislodged or dissolves before the wound has healed. This can lead to severe pain and is often accompanied by a foul taste or odor. If the pain worsens with pressure or certain foods, it might be worth discussing this possibility with your dentist.

Another consideration is the presence of nerve-related issues. You mentioned that the pain is localized and does not resemble typical trigeminal neuralgia, which is characterized by sudden, severe facial pain. However, it’s possible that the pain could be related to the trigeminal nerve or other neural pathways, especially if there has been trauma or irritation to the nerve during previous dental procedures. In such cases, a referral to a specialist in orofacial pain or a neurologist may be beneficial for further evaluation and management.

The white tissue you described in the gum area could indicate several things, including necrotic tissue or a possible infection. If the tissue is not healing properly, it may require further intervention. It’s crucial to have a dentist or oral surgeon evaluate this tissue to determine if it needs to be removed or treated in some way.

Given that you have seen multiple specialists without resolution, it may be time to seek a comprehensive evaluation from a multidisciplinary team. This could include an oral surgeon, an endodontist (root canal specialist), and a pain management specialist. They can work together to assess your situation holistically and develop a tailored treatment plan.

In the meantime, managing your pain is essential. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort. However, if the pain is severe or persistent, prescription medications, including nerve pain medications, may be necessary. Additionally, maintaining good oral hygiene and avoiding irritants like hot, cold, or sweet foods can help minimize discomfort.

In conclusion, persistent tooth pain after multiple dental interventions can be complex and multifactorial. It is crucial to continue advocating for your health and seeking answers. A thorough evaluation by a team of specialists may provide the insights needed to finally address the underlying issues contributing to your pain. Remember, effective communication with your healthcare providers about your symptoms and concerns is key to finding a resolution.

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