Persistent Pain After Tooth Extraction: Is It Just Inflammation?

Q: Persistent Pain After Tooth Extraction: Is It Just Inflammation?

Hello Ms. <br>Nan： Based on the symptoms you described, I would recommend that you complete the root canal treatment and maintain good oral hygiene. <br>After that, we can reassess whether the pain has improved to facilitate further evaluation. <br>Thank you for your inquiry.

The tooth adjacent to the wisdom tooth is inflamed, and after undergoing a root canal treatment (which is not yet completed), the pain remains unbearable?

On the lower right side of my cheek, the tooth next to my wisdom tooth has been in increasing pain since I had the wisdom tooth extracted last September.
I first visited Dr.
A in October, who diagnosed it as sensitive teeth.
After two or three visits, there was no significant improvement in my symptoms.
The pain continued to worsen, becoming a persistent throbbing pain, occasionally accompanied by sharp pain in the gums.
I also experienced pain when exposed to hot or cold stimuli.
Therefore, this year, I consulted another dentist, Dr.
B.
After taking a full-mouth X-ray, Dr.
B noticed a shadow beneath the tooth and suggested a root canal.
However, I was hesitant to proceed with the root canal immediately and decided to monitor the situation at home.

About four days later, one night, the pain escalated to the point where the entire left side of my face was in pain, including my ear.
In an emergency, I visited a nearby dentist, Dr.
C, the next morning.
After taking an X-ray of that tooth, the dentist explained that the pain was due to a missing tooth directly above it, causing malocclusion and resulting in chronic inflammation.
The gap between the teeth had already swollen.
The dentist adjusted my bite by grinding down the tooth, applied medication, and prescribed anti-inflammatory and pain relief medication, but my condition did not improve.

The pain was unbearable, so I returned to Dr.
B for the root canal.
After the first root canal treatment, there was slight improvement, but after eating and cleaning my teeth, the pain returned, affecting the nearby gums and causing tightness in the muscles of my cheek, with my ear also hurting.
The pain persisted for three months, intensifying to the point where the entire left side of my face would hurt.
I would like to ask the doctor if this condition is simply due to inflammation, or if I should consult a specialist in another field.

Nan, 20~29 year old female. Ask Date: 2021/01/16

Dr. Huang Tingfang reply Dentistry

Hello Ms.
Nan: Based on the symptoms you described, I would recommend that you complete the root canal treatment and maintain good oral hygiene.
After that, we can reassess whether the pain has improved to facilitate further evaluation.
Thank you for your inquiry.

Reply Date: 2021/01/16

More Info

Persistent pain after tooth extraction, especially following the removal of wisdom teeth, can be a complex issue that may stem from various underlying causes. In your case, the pain that has intensified since the extraction of your wisdom tooth and the subsequent dental evaluations suggest that there may be more than just inflammation at play.

Firstly, it’s essential to understand that after a tooth extraction, particularly of wisdom teeth, the surrounding tissues can experience trauma. This trauma can lead to inflammation, which is a natural response of the body to injury. However, if the pain persists beyond the expected healing period (usually a few days to a week), it may indicate complications such as dry socket (alveolar osteitis), infection, or issues related to the adjacent teeth.

Dry socket occurs when the blood clot that forms in the socket after extraction is dislodged or dissolves before the wound has healed. This condition can lead to severe pain that radiates to the ear and jaw, similar to what you are experiencing. Symptoms of dry socket typically include a throbbing pain that can start a few days after the extraction, along with a foul taste in the mouth or bad breath.

In your situation, the pain radiating to your ear and the facial muscles could also suggest involvement of the temporomandibular joint (TMJ) or the muscles of mastication. The TMJ can become strained due to altered bite mechanics following tooth loss, especially if there is a missing tooth above the extracted wisdom tooth, as you mentioned. This misalignment can lead to muscle tension and pain, which may explain the discomfort you feel in your face and ear.

Moreover, the sensitivity to hot and cold, along with the persistent pain, raises the possibility of pulpitis or other dental issues in the adjacent teeth. If the tooth next to the extraction site has been affected by decay or trauma, it could lead to inflammation of the dental pulp, resulting in pain that can be mistaken for post-extraction discomfort.

Given that you have already consulted multiple dentists and received varying opinions, it may be beneficial to seek a comprehensive evaluation from a dental specialist, such as an endodontist (root canal specialist) or an oral surgeon. They can provide a more detailed assessment, possibly including advanced imaging techniques like a cone beam CT scan, to evaluate the bone structure and the health of the surrounding teeth and tissues.

In addition to dental evaluations, if the pain persists and is affecting your quality of life, it might be worth consulting with a pain management specialist or a neurologist to rule out any nerve-related issues, especially if you experience symptoms like facial pain or discomfort that does not correlate directly with dental problems.

In summary, while inflammation is a likely contributor to your pain, the persistence and nature of your symptoms suggest that a more thorough investigation is warranted. It’s crucial to address any potential complications from the extraction, evaluate the health of adjacent teeth, and consider the possibility of TMJ involvement. Seeking a multi-disciplinary approach may provide you with the best chance of finding relief and addressing the underlying causes of your discomfort.

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