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Chronic pain

R

realh

Member
Joined
Jul 30, 2012
Messages
44
I've been getting intermittent pain on the right side of my mouth for a few years now, and it's getting worse. Almost unbearable for the last week or so. No one tooth seems to be especially sensitive to cold or tapping at the moment and I can't tell what's causing the pain. Usually it feels more like the pain is on the top, but occasionally from the bottom. Attacks typically last a couple of weeks and abate for about the same time. Conventional painkillers have little effect, I seem to have to take paracetamol and ibuprofen together or overlapping to get any relief at all. I think it's worse when I'm stressed. Does that sound more like some sort of neuralgia or TMJ than toothache?

About 20 years ago I thought I had toothache near the back of the top jaw on that side, but it turned out to be the lower canine (are the lower ones still called canines?), easily diagnosed when I nearly hit the ceiling when the dentist put a cold swab on it. I got RCT (I think it was at the time when they used to do the whole thing in one appointment, but my dentist at the time didn't have instant X-ray results yet), and I still have that tooth, but it turned grey. Could that root filling have failed? Once or twice that tooth has been painful again, which I could feel when pushing it with my tongue, but it passed after a couple of days.

The only other detectable problem I have in the area now is that the gums between one tooth and those either side of it are chronically inflamed. But I don't think the pain is directly from the gums, they cause a sharper pain when flossed which quickly goes away. The floss sometimes comes out bloody, but not usually smelly or with bits of food. The tooth in the middle is root-filled with a crown. Ditto the one in front. The one behind seems to be almost entirely amalgam filling done years ago. Yes, my teeth are a wreck. Could the sore gums be indicative of a problem in one of those teeth? That's the area where the pain usually feels centered. Also, that root-filled crown had the same problem as I described for the canine, but this one is rather newer. My dentist was going to redo the root filling when that happened a couple of years ago, but by the time of my appointment that pain had gone so we decided to leave it alone.
 
B

badmouth

Member
Joined
Jul 28, 2016
Messages
48
Location
PNW
You could possibly have neurogenic pain, but the first thing to start with is to take care of all possible dental issues and get your mouth as healthy as possible. If floss is making the gums bleed, you probably have some periodontal issues--has your dentist discussed this with you? It sounds like you could have a pretty deep gum infection. You might want to consider seeing a periodontist, as this can be quite painful and cause you to loose teeth.

I would also consider having the old root canal examined by an endodontist. It sounds very likely that the RCT has failed, and this can also cause a lot of pain.

IMHO there is no point in treating/diagnosing neurogenic pain until your dental issues are resolved and your mouth (nerve) has had some time to settle down (from my experience). I would also ask for a CBCT scan of the area that is painful to rule out bone or sinus infection.
 
R

realh

Member
Joined
Jul 30, 2012
Messages
44
I was thinking of asking my dentist to either redo that RCT/crown and/or drill out the deeply-filled tooth behind it (I'm not sure whether that's root-filled) and see if something's wrong there. From what you say, it sounds like we should try the crown first? If there are periodontal problems or a failed RCT, would these be very hard to detect with X-rays?
 
B

badmouth

Member
Joined
Jul 28, 2016
Messages
48
Location
PNW
Personally I would ask for a referral to an endodontist, especially for a re-treatment. No offense to a good dentist, but an endodontist specializes in root canals and ferreting out pain problems in teeth. They will have the best equipment and diagnostic techniques. My dentist is excellent, and I don't think he even does root canals any more.

Don't get a new crown until you are sure that tooth has settled down--very expensive to keep replacing crowns!

Periodontal issues may or may not be visible on standard X-rays. You could ask your dentist if a referral to a periodontist is a good idea, or if this is something that you can work with him on.
 
R

realh

Member
Joined
Jul 30, 2012
Messages
44
My dentist did once mention referring me to a private specialist in case he was unable to successfully replace the root filling, so that looks like a good option. Even if I have private treatment, hopefully I should be able to get a crown done on the NHS, and normally I'm entitled to free treatment.
 
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