Tooth Pain: Differentiating Pulpitis from Gum Issues

Methods for diagnosing pulpitis, gingivitis, or other causes of tooth pain?

Hello, Doctor: Currently, the tooth I have a problem with is the second to last tooth on the upper right side.
This tooth had a cavity on the side, which I discovered in April of this year and have already had filled.
Since then, to prevent further decay, I have maintained a consistent routine of using dental floss, interdental brushes, and mouthwash.
However, starting last Monday, I have been experiencing intermittent pain.
Initially, when the tooth pain started, I felt significant pain when using dental floss in the area of the previous cavity, but now the pain is less localized and sometimes radiates to the front teeth.
The pain is more pronounced in the morning, and I feel a tingling sensation in the right side of my face, sometimes accompanied by brief sharp pains that usually subside quickly.
Additionally, after biting down on something (like meat), the discomfort in the upper right tooth usually temporarily alleviates, but sometimes the pain returns after a while, while other times it remains pain-free throughout the day.

I also had a cold recently, with severe nasal congestion (which has since resolved), and due to preparing for a national exam, my sleep has been somewhat reduced (but I still get at least 6 hours).
I visited the dentist yesterday, and while the dentist tapped on my teeth, I did not feel significant pain, although there was a slight difference in sensation compared to other teeth.
Since the situation was unclear during the visit, the dentist suggested that it could also be a gum issue and recommended monitoring the situation rather than proceeding directly to a root canal.
However, today I still experienced noticeable pain in the morning, but after lunch, the pain seemed to disappear, which is puzzling.
Considering the upcoming national exam and the possibility of flying abroad, I would like to ask: 1.
Does this peculiar pattern of pain resemble more of a gum issue or a pulp issue? 2.
Is there a way to quickly determine whether a root canal is necessary, or should I wait a few days and see the dentist again? 3.
Is it possible that the pain is not actually from the tooth but related to my previous cold and nasal congestion, and should I consult another specialist? 4.
Additionally, hypothetically, if I do need a root canal, since I have been swimming regularly on Sundays (partly to relieve stress for the national exam), do I need to take special precautions regarding the temporary filling material in the tooth with the previous cavity while swimming? For example, is there a risk of it coming loose, or are there any specific considerations I should discuss with my dentist?
Given that the entire situation is somewhat confusing, I will promptly provide any additional information if needed.
Thank you, Doctor.

Wei Ni, 20~29 year old female. Ask Date: 2015/09/01

Dr. Zhang Xiangyuan reply Dentistry

Dear user,
Based on your description, it seems that your upper right molar has experienced side decay and has been filled, but you are experiencing occasional sharp pain or discomfort.
It is common for recently filled teeth, especially if the decay was deep, to be sensitive at times.
I recommend monitoring the pain.
If you experience spontaneous pain that persists, or if the pain continues after exposure to hot or cold stimuli, or if you notice swelling of the gums or other uncomfortable symptoms, it would be advisable to consult a dentist to determine if root canal treatment or other interventions are necessary.
If the filling has come out, please have a dentist examine it and provide a new filling.
Thank you for your inquiry.

Reply Date: 2015/09/01

More Info

Tooth pain can be a complex issue, often stemming from various underlying conditions. In your case, the symptoms you describe could potentially indicate either a pulp issue (pulpitis) or a gum-related problem. Let’s break down your concerns and address them systematically.

1. Differentiating Between Pulpitis and Gum Issues: The pain you experience, particularly when using dental floss in the area of the previous cavity, suggests that there may still be some irritation or inflammation in the pulp of the tooth. Pulpitis can manifest as sharp, intermittent pain, especially when pressure is applied, such as during flossing or chewing. The fact that the pain radiates to other areas, including the front teeth, can also indicate that the nerve is involved. On the other hand, gum issues, such as gingivitis or periodontitis, typically present with pain localized to the gums, swelling, and possibly bleeding when brushing or flossing. Given that your pain is more pronounced in the morning and alleviates somewhat after eating, it leans more towards a pulp issue, but gum disease cannot be ruled out entirely.

2. Determining the Need for Root Canal Treatment: The best way to ascertain whether a root canal is necessary is through a combination of clinical examination and diagnostic imaging. If your dentist did not find significant pain during percussion testing, it might suggest that the pulp is not severely inflamed yet. However, if your symptoms persist or worsen, especially with increased sensitivity or pain, a follow-up visit is warranted. An X-ray can reveal any signs of infection at the root tip or changes in the bone surrounding the tooth, which would necessitate further intervention.

3. Connection to Recent Illness: Your recent upper respiratory infection and nasal congestion could indeed contribute to your dental discomfort. Sinus pressure can cause referred pain to the upper teeth, particularly if the roots of those teeth are close to the sinus cavity. If your pain is accompanied by sinus symptoms, it may be worth consulting an ENT specialist to rule out sinusitis as a contributing factor.

4. Swimming with Temporary Fillings: If you end up needing a root canal and have a temporary filling, it’s essential to take care when swimming. Temporary fillings can be less durable than permanent ones and may be more susceptible to dislodgement, especially if exposed to water pressure. It’s advisable to inform your dentist about your swimming activities so they can provide specific guidance. Generally, avoiding vigorous activities that might disturb the temporary filling is recommended until you can have a permanent restoration.

In summary, your symptoms suggest a possible pulp issue, but gum problems and sinus-related pain should also be considered. Monitoring your symptoms closely and following up with your dentist is crucial, especially if the pain persists or intensifies. If you experience any swelling, fever, or significant changes in your symptoms, seek immediate dental care. In the meantime, maintaining good oral hygiene and managing any sinus issues may help alleviate some discomfort.

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