Why Do I Still Feel Tooth Pain Despite No Issues Found by Dentist?

The doctor said there is no problem with my teeth, but I still experience pain?

I'm really at a loss and would like to ask for a doctor's opinion.
When I was a child, I had two small front teeth that were quite deeply decayed, but fortunately, they were filled, and everything was fine for several years.
Recently, my left front tooth started to feel uncomfortable again, so I went back to the dentist for a filling.
The dentist said it had decayed again and filled it once more.
I noticed a small cavity on the adjacent front tooth, so that was filled as well.
The pain in my small front tooth disappeared, but now my large front tooth sometimes has sharp pain in the filled area.
I returned to the dentist for a re-filling, but it was still the same.
I didn't want to bother the dentist again, so I endured it for another year, thinking it would eventually get better.
However, the pain seems to be increasing, and now it sometimes feels like a throbbing pain.
Despite tapping on the teeth, taking X-rays, performing vitality tests, and blowing air, everything seemed fine (including the left small front tooth), so the dentist was hesitant to do anything further.

This is the first tooth.
I previously mentioned that my other small front tooth was also deeply decayed.
After a long time without issues, that tooth started to feel uncomfortable frequently, and even my right front tooth began to feel cold and uncomfortable.
An X-ray revealed that the dental nerve had undergone chronic necrosis, so it had to be extracted (though it was discovered quite late).
After the extraction, I thought everything would be fine as long as I maintained good hygiene, but six months later, the extracted tooth started to throb again, and the pain gradually moved to the right front tooth.
Even though I was only paying attention to the small area of the right front tooth, it also started to throb (the central nerve was throbbing), yet after a series of examinations, it was still not severe enough to require a root canal, so I could only observe it.
What’s even more frustrating is that recently, even the canine tooth next to my left front tooth (which had a small cavity at the root) has started to throb (very intensely, causing my whole body to tremble).
I visited the dentist, who examined it but said there were no signs of nerve inflammation, so I was just advised to get a cleaning.
My left large front tooth, left canine, and right large front tooth have small cavities but often throb, and even the dentist is hesitant to perform a root canal.
This is driving me crazy.
My right small front tooth has already been treated with a root canal, and I need to schedule another one in March.
I keep wondering if the left small front tooth is the culprit (it has a large cavity and sometimes hurts, though rarely).
However, after tapping, blowing, and vitality testing, everything seems fine, and I'm hesitant about whether I should proceed with a root canal.
Please, doctor, help me.

Jiang Xiaojie, 10~19 year old female. Ask Date: 2016/01/26

Dr. Zeng Guanghui reply Dentistry

Whether it's a central incisor or a lateral incisor, if there is still a sensation of soreness or discomfort after filling, it indicates that the dental nerve may be inflamed.
If the symptoms persist, root canal treatment is necessary.
This typically requires several visits to thoroughly clean the root canal, apply disinfectant medication, and wait until the symptoms completely resolve before filling the canal.
If pain continues after root canal treatment, it may suggest that the tooth has a crack or is completely fractured, in which case the tooth cannot be saved and extraction is necessary.
It is advisable to consult a dentist for further detailed examination and treatment.

Reply Date: 2016/01/26

More Info

Tooth pain can be a perplexing issue, especially when dental examinations reveal no apparent problems. Your situation highlights the complexity of dental health, where pain can persist despite thorough evaluations. Here’s a comprehensive overview of potential reasons for your ongoing discomfort and suggestions for managing it.

Possible Causes of Tooth Pain Despite No Findings
1. Nerve Sensitivity: After dental procedures, especially those involving fillings or crowns, the nerves in the tooth can become hypersensitive. This sensitivity can manifest as sharp pain or discomfort, particularly when exposed to temperature changes or pressure. Even if X-rays show no issues, the nerve may still be reacting to the treatment.

2. Referred Pain: Dental pain can sometimes be referred from other areas. For instance, issues with your jaw or surrounding teeth can cause discomfort in seemingly unrelated teeth. This phenomenon can make it challenging to pinpoint the exact source of pain.

3. Chronic Inflammation: If a tooth has had previous decay or trauma, it may develop chronic inflammation. This condition can lead to intermittent pain, even if the tooth appears healthy on X-rays. The inflammation can be due to residual bacteria or a previous infection that has not fully resolved.

4. Cracked Tooth Syndrome: A crack in a tooth may not always be visible on X-rays. This condition can cause significant pain, especially when chewing or when the tooth is exposed to temperature changes. If you suspect a crack, a thorough examination, possibly including a cone beam CT scan, may be necessary for accurate diagnosis.

5. Gum Disease: Periodontal issues can also lead to tooth pain. Inflammation of the gums can affect the surrounding teeth and cause discomfort. If you have a history of gum disease, it’s essential to ensure that your periodontal health is being monitored and treated appropriately.

6. Psychosomatic Pain: Stress and anxiety can manifest as physical pain, including dental discomfort. If you are experiencing significant stress, it may exacerbate your perception of pain or lead to habits like teeth grinding, which can further irritate the teeth and gums.

Recommendations for Management
1. Seek a Second Opinion: If your current dentist is unable to identify the source of your pain, consider consulting another dental professional. Different dentists may have varying approaches and diagnostic tools that could uncover underlying issues.

2. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage discomfort. However, consult your dentist before taking any medication, especially if you have other health conditions.

3. Maintain Oral Hygiene: Continue to practice good oral hygiene, including regular brushing, flossing, and using an antibacterial mouthwash. This can help prevent further issues and manage existing inflammation.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including when the pain occurs, its intensity, and any triggers. This information can be invaluable for your dentist in diagnosing the issue.

5. Consider a Specialist: If pain persists, consider seeing an endodontist, a specialist in tooth pain and root canal treatments. They have advanced training in diagnosing and treating complex dental pain.

6. Stress Management: If you suspect that stress may be contributing to your pain, consider stress-reduction techniques such as mindfulness, meditation, or counseling.

Conclusion
Tooth pain can be a multifaceted issue that requires a comprehensive approach to diagnosis and treatment. While it can be frustrating to experience pain without clear findings, understanding the potential causes and exploring various management strategies can help you find relief. Always communicate openly with your dental care providers about your symptoms and concerns, as this collaboration is key to achieving better oral health outcomes.

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