Tooth Pain: Causes and Solutions for Chewing Difficulties

Q: Tooth Pain: Causes and Solutions for Chewing Difficulties

Hello Ms. <br>Gao： Inability to chew food may be caused by cracked teeth leading to sensitive pulp inflammation, or it could be due to inflammation or injury of the periodontal ligament. <br>There is also a possibility that there is an infection or inflammation at the root apex.

Biting hard objects & occlusal pain

Hello Doctor,
I would like to consult you regarding an issue.
On May 1st, I bit into a small bone from a pig and have since felt subjective pain in my upper right first molar whenever I bite into anything, making it impossible to chew food.
On May 9th, I visited the first dentist, who found no cracks or new cavities.
As a precaution, the dentist opened the existing resin filling to check for decay and refilled it, also adjusting the buccal cusp of the corresponding lower right first molar, and advised me to continue monitoring the situation.

On May 18th, I went to a second dentist who performed a full mouth cleaning and found no cracks, advising me to keep observing.
On June 2nd, I visited a third dentist who adjusted the filling on the upper right first molar, checked for cracks, and again advised me to continue monitoring.
On July 6th, I went to a fourth dentist who disinfected and cleaned the inflamed gingival papillae on the buccal side of the upper right first and second molars, found no cracks, and advised me to keep observing.

On July 20th, I returned to the second dentist and expressed that aside from soft foods like eggs, tofu, and white rice, I experience occlusal pain when trying to chew foods that require more effort, such as meats and vegetables.
Subjectively, in addition to the pain in the upper right first molar, I feel a vibration sensation in the upper right first and second premolars during occlusion, and pain in the upper right canine and first premolar due to pressure from the lower right first and second premolars during biting.
I am unsure if this series of occlusal pain is a reaction caused by the adjustment made on May 9th to the buccal cusp of the corresponding lower right first molar.

The dentist adjusted the occlusal contact of the upper right first molar, found no cracks, and checked for any malocclusion but found none, advising me to continue monitoring.
I would like to ask you, what could be causing my inability to chew food? Is it due to a cracked tooth or another dental condition? It has been nearly three months since the issue began on May 1st.
Are there any advanced instruments available that could determine whether this is a dental issue or related to another condition? I still cannot chew food, and I subjectively feel pain in both the upper and lower right teeth while chewing, but when I perform an occlusal test with a large cotton swab, I distinctly feel pain when pushing or tapping on the cusp of the upper right first molar.

Thank you, Doctor!

Gao Nüshi, 40~49 year old female. Ask Date: 2023/07/21

Dr. Zeng Guanghui reply Dentistry

Hello Ms.
Gao: Inability to chew food may be caused by cracked teeth leading to sensitive pulp inflammation, or it could be due to inflammation or injury of the periodontal ligament.
There is also a possibility that there is an infection or inflammation at the root apex.
It is recommended that you consult a dentist for a pulp vitality test or an X-ray to check for any signs of infection or inflammation in the periodontal ligament or at the root apex.
Dr.
Tseng Guang-hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/07/21

More Info

Tooth pain can be a complex issue, especially when it persists despite multiple dental evaluations and treatments. Based on your detailed description, it seems that you have been experiencing significant discomfort in your right upper first molar after an incident where you bit into a hard object. This has led to a series of dental visits, each aimed at identifying and addressing the source of your pain.
From what you've shared, it appears that the initial injury may have triggered a cascade of dental issues, even if no visible cracks or cavities were found during examinations. Here are some potential causes for your ongoing pain and chewing difficulties:
1. Dental Trauma: The initial trauma from biting into a hard object could have caused microfractures that are not easily visible on X-rays. These fractures can lead to pain when chewing, especially if they affect the tooth's nerve.

2. Pulpitis: If the trauma has caused inflammation of the dental pulp (the innermost part of the tooth containing nerves and blood vessels), this could result in significant pain, especially when pressure is applied during chewing. Pulpitis can be reversible or irreversible, and if it is irreversible, root canal treatment may be necessary.

3. Occlusal Issues: The adjustments made to your teeth, such as the grinding down of the opposing tooth, may have altered your bite (occlusion). If your bite is not aligned properly, it can lead to discomfort and pain when chewing. This misalignment can cause certain teeth to bear more pressure than they should, leading to pain.

4. Periodontal Issues: The inflammation of the gums around the affected teeth, as noted during your dental visits, could also contribute to your pain. If the periodontal tissues are inflamed, they can become sensitive and painful, especially during chewing.

5. Referred Pain: Sometimes, pain in one tooth can be referred from another area. For instance, issues with the lower teeth could manifest as pain in the upper teeth and vice versa.
6. Bruxism: If you grind your teeth, this could exacerbate any existing issues and lead to muscle fatigue and pain in the jaw, which may be perceived as tooth pain.

Given that multiple dentists have examined your teeth and found no significant issues, it may be beneficial to seek a second opinion from a specialist, such as an endodontist (a dentist specializing in root canal treatment) or a periodontist (a dentist specializing in gum disease). They may have access to advanced diagnostic tools, such as cone beam computed tomography (CBCT), which can provide a more detailed view of the tooth structure and surrounding tissues.

In the meantime, managing your pain with over-the-counter anti-inflammatory medications may help. Additionally, avoiding hard or chewy foods until you can get a definitive diagnosis may prevent further irritation.

It's essential to maintain open communication with your dental care providers about your symptoms and concerns. If the pain persists or worsens, don't hesitate to advocate for further testing or alternative treatment options. Your comfort and ability to chew food without pain are paramount, and there are often solutions available that can help alleviate these issues.

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