Gum Pain and Bite Discomfort: Possible Causes and Solutions

Gum pain and occlusal pain?

Hello Doctor: I had a root canal treatment on my molar 20 years ago and have a crown for protection.
About two years ago, the surrounding gums started to hurt, but there was no redness or swelling.
The dentist cleaned the gums, but there was no improvement.
Recently, I had the crown removed to address the decay and had a new crown made, but there is still no improvement; the gums around the tooth continue to hurt.
After getting the new crown, I experienced biting pain about a week later.
X-rays did not reveal any issues.
The dentist removed the crown and suggested letting the gums rest, with a follow-up in two weeks.
After removing the crown, I do feel somewhat more comfortable, but the gum pain and biting pain persist.
Could you please explain what might be causing the gum pain without redness or swelling? Is it possible that there is a crack in the tooth root?

Mr. Wang, 30~39 year old female. Ask Date: 2019/12/01

Dr. Huang Tingfang reply Dentistry

Dear Mr.
Wang,
Hello! Based on your description, it is very likely that the tooth root has cracked.
A clinical examination or a dental CT scan is necessary.
Thank you! Take care and I wish you all the best!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2019/12/01

More Info

Understanding gum pain and bite discomfort can be quite complex, especially when there are no visible signs of inflammation or infection. Based on your description, it seems that you have been experiencing persistent discomfort around a tooth that has undergone root canal treatment and has a prosthetic crown. Here are some possible causes and solutions for your symptoms.

Possible Causes of Gum Pain and Bite Discomfort
1. Residual Infection or Inflammation: Even if there are no visible signs of redness or swelling, there could still be residual infection or inflammation in the surrounding tissues. This can occur if the root canal treatment did not completely eliminate all the bacteria or if there is a small area of infection that is not easily detectable on X-rays.

2. Gum Recession or Periodontal Issues: Over time, gum tissue can recede, exposing the tooth root and leading to sensitivity and discomfort. This can happen due to various factors, including aggressive brushing, periodontal disease, or even the pressure from a poorly fitting prosthetic.

3. Mechanical Issues with the Prosthetic: If the new crown or prosthetic is not fitting properly, it can create pressure points on the gums or adjacent teeth, leading to discomfort when biting. This misalignment can cause the gums to react even in the absence of visible inflammation.

4. Cracked Tooth Syndrome: A crack in the tooth, especially in a tooth that has undergone root canal treatment, can lead to pain when biting. The crack may not be visible on X-rays, and it can cause the tooth to flex under pressure, resulting in discomfort.

5. Nerve Sensitivity: After a root canal, the nerves in the surrounding area can sometimes remain sensitive for an extended period. This sensitivity can manifest as pain, especially when pressure is applied during chewing.

Recommended Solutions
1. Follow-Up with a Specialist: Since your symptoms have persisted despite previous treatments, it may be beneficial to consult with an endodontist (a specialist in root canal treatments) or a periodontist (a specialist in gum diseases). They can provide a more thorough examination and may utilize advanced imaging techniques to identify any underlying issues.

2. Adjustments to the Prosthetic: If the new crown is causing discomfort, your dentist may need to make adjustments to ensure it fits properly. This may involve reshaping the crown or adjusting the bite to relieve pressure on the gums.

3. Gum Care: Maintaining good oral hygiene is crucial. Use a soft-bristled toothbrush and gentle brushing techniques to avoid further irritation to the gums. Additionally, consider using an antimicrobial mouthwash to help reduce any potential bacterial load in the area.

4. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort. However, it’s essential to consult with your dentist before taking any medication, especially if you have underlying health conditions.

5. Observation Period: Since your dentist has recommended a two-week observation period after removing the prosthetic, it’s important to monitor your symptoms closely. If the pain persists or worsens, follow up with your dentist promptly.

6. Consider Other Treatments: If the pain continues, your dentist may explore other treatment options, such as a different type of prosthetic or even a referral for possible surgical intervention if a cracked tooth or other structural issues are suspected.

Conclusion
In summary, persistent gum pain and bite discomfort can arise from various factors, including residual infection, mechanical issues with prosthetics, or even cracked tooth syndrome. It’s crucial to work closely with dental professionals to identify the underlying cause and develop an appropriate treatment plan. Regular follow-ups and open communication with your dentist will be key in managing your symptoms effectively.

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