Occasional Tooth Pain: Causes and Concerns

Q: Occasional Tooth Pain: Causes and Concerns

Hello： It is advisable to first investigate potential causes in the lower left area (after all, the upper left molar has already undergone root canal treatment). <br>This includes checking if there is an excessively deep dental implant in the lower left that may be affecting the

Dull toothache?

Hello, doctor! I occasionally experience a dull pain in my lower left first molar.
There is no redness or swelling, but sometimes I feel a sharp pain when yawning.
When I bite down hard, I feel a sharp pain on the side of the tooth, but not towards the back.
Pressing or tapping with my finger and drinking hot or cold water does not cause pain.
It’s not like the previous pain I had when I had a cavity that reached the gum, which was a sharp, noticeable pain when pressed.
The gum on the lower left feels a bit itchy (though I'm not sure, as sometimes I don’t feel much).
I have a horizontally impacted wisdom tooth on the lower left, and my upper left first molar has undergone root canal treatment.
It still feels different from my other teeth and can be sensitive to tapping.
Although I had an X-ray and a CT scan a month ago that showed no issues, there is some calcification.
Could these two factors be related? Previously, when the nerve in my upper left tooth died, I felt pain in my lower left tooth, which is similar to the sharp pain I feel now when biting down hard (back then, it hurt every time I bit down, but now it only occasionally flares up).
The pain later shifted to the upper left, so I’m wondering if this could be related to referred pain?

Niming, 20~29 year old female. Ask Date: 2023/05/26

Dr. Lin Jiayong reply Dentistry

Hello: It is advisable to first investigate potential causes in the lower left area (after all, the upper left molar has already undergone root canal treatment).
This includes checking if there is an excessively deep dental implant in the lower left that may be affecting the proprioceptive nerves.
Is there a large and poorly placed composite filling in the lower left that cannot withstand occlusal forces? Are there multiple metals with differing electrochemical potentials in the lower left or throughout the oral cavity (such as silver amalgam, old metal crowns, orthodontic wires, etc.)? Additionally, excessive teeth grinding at night or clenching during the day due to work stress could also be contributing factors.
Pain in the left shoulder and neck may also indicate a cardiac issue (further consultation with a rehabilitation specialist may be warranted).

Reply Date: 2023/05/26

More Info

Tooth pain can be a perplexing issue, especially when it occurs intermittently and without obvious signs of inflammation or infection. In your case, the occasional discomfort in your lower left first molar (tooth 36) can be attributed to several potential causes, some of which may be related to your dental history and the presence of a horizontally impacted wisdom tooth.

Possible Causes of Occasional Tooth Pain
1. Dental Sensitivity: Given that you experience pain during specific actions like yawning or biting down, it may indicate dental sensitivity. This can occur due to enamel erosion, gum recession, or even minor cracks in the tooth structure. The fact that you do not experience pain when drinking hot or cold beverages suggests that the nerve endings in your tooth may not be severely compromised, but there could be localized sensitivity.

2. Impacted Wisdom Tooth: The presence of a horizontally impacted wisdom tooth can exert pressure on adjacent teeth, potentially leading to discomfort in the first molar. This pressure can cause intermittent pain, especially when biting down or during certain movements of the jaw.

3. Referred Pain: Your history of nerve issues, particularly with the upper left tooth that underwent root canal treatment, raises the possibility of referred pain. This phenomenon occurs when pain is perceived in one area of the body due to issues in another area. The nerves in the jaw are interconnected, and problems in one tooth can sometimes manifest as pain in another.

4. Gum Issues: You mentioned a slight itchiness in the gums around the affected tooth. This could indicate early signs of gum disease or localized inflammation. Even without visible swelling, the gums can be sensitive and may contribute to the discomfort you are experiencing.

5. Previous Dental Work: The history of root canal treatment in your upper left first molar may also play a role. Sometimes, the treatment can lead to changes in the surrounding teeth or even cause sensitivity in adjacent teeth due to changes in bite or pressure distribution.

Recommendations for Management
1. Regular Dental Check-ups: Since you recently had X-rays and a CT scan that showed no significant issues, it’s essential to continue with regular dental visits. If the pain persists or worsens, further evaluation may be necessary, including a more detailed examination of the impacted wisdom tooth and the surrounding structures.

2. Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort when it occurs. However, it’s crucial to use these medications as directed and not rely on them long-term without consulting a healthcare professional.

3. Oral Hygiene: Maintain excellent oral hygiene practices, including brushing twice a day and flossing daily. This can help prevent gum issues and reduce the risk of further complications.

4. Consult a Specialist: If the pain continues or if you notice any changes in your symptoms, consider consulting an oral surgeon or a specialist in dental pain management. They can provide a more comprehensive evaluation and may suggest treatments such as wisdom tooth extraction if deemed necessary.

5. Monitor Symptoms: Keep track of when the pain occurs, its intensity, and any accompanying symptoms. This information can be invaluable for your dentist in diagnosing the issue.

In conclusion, while occasional tooth pain can be concerning, understanding its potential causes can help in managing the discomfort effectively. Given your dental history and the presence of an impacted wisdom tooth, it’s advisable to stay vigilant and seek professional advice if the situation does not improve.

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