Persistent Tooth Discomfort: Nerve Issues and Treatment Options

Q: Persistent Tooth Discomfort: Nerve Issues and Treatment Options

Hello： If you have a habit of nighttime teeth grinding, prolonged jaw clenching, or chewing betel nut, it may lead to pulp calcification. <br>It is advisable to consult an oral surgeon at a medical center for confirmation, and you may also inquire whether further examination of t

The teeth appear normal, but there is persistent discomfort?

Hello, the issue began one early morning when I woke up feeling a tingling and discomfort in my right teeth.
I had experienced something similar before, so I didn't think much of it and figured it would pass.
However, this time the symptoms persisted throughout the day, with a constant tingling sensation on the right side, and even my right cheek felt uncomfortable.
That evening, the symptoms disappeared, so I didn't visit the dentist.
However, when I lay down to sleep, the situation worsened compared to the daytime.
Pain relievers didn't help, and I ended up using a lot of toothpaste to cool my mouth, which, combined with my exhaustion, allowed me to fall asleep.
The next morning, the original tingling had turned into a sharp pain.
Realizing something was wrong, I made an appointment with a dentist for the afternoon.
During lunch, it became evident that I couldn't bite down on anything; there was pain when my upper and lower right teeth touched.
After an examination at the dentist's office that afternoon, I was told that there were no cavities or fillings, and the teeth appeared normal externally.
However, the nerves of the teeth were almost invisible on the X-ray, leading to a suspicion of calcification or other issues.
The dentist recommended root canal treatment.
That night, I still couldn't sleep, as the thought of undergoing a root canal was quite serious.
I didn't want to make a hasty decision based solely on one dentist's advice, so I consulted another dental clinic.
On the third day, the dentist at the second clinic reached the same conclusion as the first: the teeth were fine, but the nerves were nearly undetectable.
He suggested that bacteria might be growing in a blind spot between the molar and the problematic tooth, causing inflammation, and recommended seeing another specialist to confirm whether root canal treatment was necessary.
At my request, he prescribed pain relievers similar to acetaminophen, but they didn't alleviate the pain.
Just touching my right teeth together was painful enough that I couldn't continue eating.
On the fourth day, the tingling sensation lessened, leaving only slight discomfort (I hadn't taken any pain relievers).
However, I still couldn't bite down without pain, and I was only able to eat liquids or very soft foods that didn't require chewing.
My right cheek would occasionally have a twitching sensation, but it didn't last long.
Both dentists performed vitality tests on the problematic tooth, which showed no response at all.

In my memory, tooth pain is usually severe enough to disrupt normal life, but in my current situation, as long as my upper and lower teeth don't touch, I can almost forget about the pain.
The twitching in my cheek is present but not very uncomfortable.
I'm genuinely confused; is this really a nerve issue with my tooth? Both dentists seemed puzzled as well, spending a long time examining the X-rays before reluctantly concluding that there might be an issue with the nerve inside the tooth.
Even the recommendation for root canal treatment was presented as something to consider, without a definitive answer.

Hua, 20~29 year old female. Ask Date: 2022/07/02

Dr. Lin Jiayong reply Dentistry

Hello: If you have a habit of nighttime teeth grinding, prolonged jaw clenching, or chewing betel nut, it may lead to pulp calcification.
It is advisable to consult an oral surgeon at a medical center for confirmation, and you may also inquire whether further examination of the trigeminal nerve is necessary.

Reply Date: 2022/07/02

More Info

It sounds like you're experiencing a complex and distressing situation with your dental health, particularly concerning persistent discomfort in your right side teeth. Based on your description, it seems that the discomfort has evolved from a dull ache to a more acute pain, especially when biting or chewing. This could indeed indicate an underlying issue with the dental nerve or surrounding structures.

Understanding the Symptoms
The symptoms you're describing—tingling, numbness, and pain when biting—could suggest several potential issues:
1. Nerve Damage or Irritation: The fact that two dentists have noted that the nerve is difficult to visualize on X-rays could indicate that there is some form of nerve damage or irritation. This might not be visible through standard imaging techniques, especially if there is inflammation or a condition like calcification affecting the nerve.

2. Pulpitis: This is an inflammation of the dental pulp, which contains nerves and blood vessels. It can be caused by decay, trauma, or other factors. If the pulp is inflamed, it can lead to significant discomfort, especially when pressure is applied.

3. Periodontal Issues: Sometimes, the discomfort can stem from issues related to the gums or the bone surrounding the teeth. If there is an infection or inflammation in the periodontal tissues, it can cause referred pain that feels like it's coming from the teeth.

4. Referred Pain: The sensation of pain in the face or jaw can sometimes be referred pain from other areas, such as the jaw joint (TMJ) or even from muscle tension in the neck or shoulders.

Treatment Options
Given the complexity of your symptoms and the inconclusive findings from the dentists, here are some steps you might consider:
1. Seek a Specialist: If you haven't already, consider seeing an endodontist, a specialist in root canal treatments. They have advanced training in diagnosing and treating nerve-related issues in teeth.

2. Further Imaging: Sometimes, a 3D imaging technique like a Cone Beam CT scan can provide more detailed information about the tooth's internal structures and surrounding tissues than standard X-rays.

3. Pain Management: Since over-the-counter pain medications haven't been effective, discuss with your healthcare provider about other pain management strategies. This might include prescription medications or even nerve blocks if the pain is severe.

4. Observation and Monitoring: If the pain subsides and you can manage your diet, it might be worth monitoring the situation for a short period. However, if the pain returns or worsens, prompt follow-up is essential.

5. Consider Non-Dental Causes: If dental evaluations continue to yield no clear diagnosis, it may be worth exploring other medical evaluations to rule out conditions that could cause facial pain, such as neuralgia or temporomandibular joint disorders.

Conclusion
Your situation is understandably frustrating, especially given the lack of definitive answers from the dental professionals you've consulted. It's crucial to advocate for your health by seeking further evaluations and possibly different specialists. Persistent dental discomfort can significantly impact your quality of life, and addressing it comprehensively is essential. Don't hesitate to seek a second opinion or further diagnostic tests to get to the root of the issue. Remember, your comfort and health are paramount, and you deserve thorough care and attention.

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