Persistent Tooth Pain: Seeking Answers After Multiple Dental Consultations

Q: Persistent Tooth Pain: Seeking Answers After Multiple Dental Consultations

Hello： It is advisable to consult at the same medical center, as they can consolidate information from various specialties and follow the physician's recommendations from that hospital. <br>Otherwise, running around to different places may not help identify the true cause of the

I have seen several specialists for my toothache?

Three years ago, I had a crown placed on my first molar, along with a post.
After the crown was done, I developed a dental abscess between the first and second molars, but it resolved on its own.
Since last year, I've been experiencing intermittent discomfort.
At times, the pain has been severe enough to disrupt my sleep, and I even feel pain radiating to my cheek.
I consulted several dental clinics, and they all said there was no issue.
Later, I went to an ENT specialist, suspecting it might be a salivary gland inflammation, as I feel discomfort shortly after eating, which lasts all day.
Brushing my teeth at night sometimes provides temporary relief.
However, after a CT scan, the doctor indicated only mild inflammation, which shouldn't cause such pain.
The doctor then suggested I see an oral surgeon.
I did, but they didn't provide much information and just recommended heat compresses and medication.
I also consulted a neurologist, who ruled out trigeminal neuralgia.
Recently, I found a dental clinic specializing in microscopic root canal treatment.
The crown was removed, and the dentist mentioned that the previous cavity was deep, which might have caused the crown to be placed too deeply, making cleaning difficult.
However, after taking X-rays and 3D imaging, they confirmed that the tooth appeared fine and advised me to observe for three months.
Even using mouthwash causes pain.
What could be the issue? Could it be related to the dental abscess? Should I proceed with the microscopic root canal treatment instead of waiting three months, as I am already quite frustrated with the pain?

Hui Ping, 40~49 year old female. Ask Date: 2022/11/20

Dr. Lin Jiayong reply Dentistry

Hello: It is advisable to consult at the same medical center, as they can consolidate information from various specialties and follow the physician's recommendations from that hospital.
Otherwise, running around to different places may not help identify the true cause of the problem or effectively address the pain.

Reply Date: 2022/11/20

More Info

Persistent tooth pain can be a frustrating and complex issue, especially after multiple dental consultations that yield no clear answers. Based on your description, it seems that you have been experiencing discomfort in your first molar for an extended period, which has led you to seek help from various specialists, including ENT and oral surgeons, without a definitive diagnosis or solution.

To begin with, it’s important to understand that tooth pain can arise from various sources, including dental, periodontal, and even neurological issues. Given that you have a history of dental work, including a crown and a previous abscess, it’s possible that the pain could be related to the underlying tooth structure or the surrounding tissues.

1. Possible Causes of Pain:
- Residual Infection: Even if the X-rays show no significant issues, there could still be a low-grade infection or inflammation in the area that isn't easily visible. This could be due to a previous abscess or deep decay that was not fully addressed.

- Periodontal Issues: Gum disease or inflammation around the tooth can cause pain, especially if there is a pocket of infection or if the gums are receding.

- Occlusal Issues: If the crown is not properly aligned with your bite, it could lead to discomfort when chewing or even at rest. This misalignment can cause undue stress on the tooth and surrounding structures.

- Nerve Sensitivity: Sometimes, the nerves in the tooth can become hypersensitive due to previous trauma or dental procedures, leading to persistent pain.

2. Next Steps:
- Consult a Specialist: Since you have already seen various specialists, it might be beneficial to consult an endodontist (a specialist in root canal treatment) who can perform a thorough examination, including possible retreatment of the root canal if necessary. They can assess whether the previous treatment was adequate or if there are any hidden issues.

- Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another dental professional who specializes in complex cases may provide new insights.

- Diagnostic Imaging: Advanced imaging techniques, such as a cone beam CT scan, can provide a more detailed view of the tooth and surrounding structures, potentially revealing issues that standard X-rays might miss.

3. Managing Pain:
- While you are waiting for further evaluations, managing your pain is crucial. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort. Additionally, applying a warm compress to the area may provide some relief.

- Be cautious with oral hygiene products, as you mentioned that mouthwash can exacerbate the pain. It may be worth trying a saltwater rinse or a gentle, alcohol-free mouthwash to see if that helps.

4. Long-Term Considerations:
- If the pain persists despite all interventions, it may be necessary to consider more invasive options, such as redoing the root canal or even extracting the tooth if it is deemed non-restorable. However, this should be a last resort after exhausting all other options.

In conclusion, persistent tooth pain after dental work can stem from various causes, and it often requires a multidisciplinary approach to diagnose and treat effectively. It’s essential to advocate for your health and seek the appropriate specialists until you find a resolution. Your comfort and quality of life are paramount, and addressing this issue comprehensively will help you achieve relief.

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