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Gum pain around back molar - infection or neuralgia?

K

Kns

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Sep 6, 2017
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129
I have an upper second molar that has been increasingly painful around the gum. There’s no swelling or pimple indicating an abscess visually. I have seen my dentist recently and my endodontist. The dentist noted that the gum and cheek tissue looked irritated/inflamed like I have braces (I don’t). He took an xray and did percussions tests which didn’t hurt. It’s not cold or heat sensitive. It’s a molar with old large fillings and some recurrent decay (no root canal), so it’s slated for a crown at some point. It feels like the tooth and gums hurt, but when I press on the tooth it’s not painful. The endodontist did percussion and bite tests, too. The endodontist was evaluating the entire upper left area as I have had two premolar root canals already for pain on that side recently and still have pain on that side of my mouth. He has suspected a neurological issue for a while, although one of those RC teeth did have a pinched nerve dying inside. The dentist and endodontist rederred me to a faculty orofacial pain specialist at a dental school. I have developed an open bite over the last two years. My jaw joints were just scanned and nothing was noted by an oral surgeon. I’m waiting to get in to the faculty specialist and I am not sure what the wait will be. In the meantime, that back tooth wakes me up at night and has a painful burning sensation around it that I can’t ignore and doesn’t respond well to Tylenol. The tooth is worn a bit to the gumline it seems on the palatal side. Could a neuralgia cause bad gum pain around one tooth? Or is it hard for dentists to diagnose an abscess or need for root canal or extraction when only pain around the tooth exists (rather than tapping pain)? I’m going on a road trip soon and I am terrified this pain will become even more severe and ruin it. Or worse, a horrible abscess is lurking and spreading. My anxiety wishes I could have an antibiotic or treatment of some sort to help immediately. But my dentists are conservative about over treatment since I have had a lot of continued pain and odd sensations on that entire side of my mouth for the last two years (numbness, dull and stabbing pain, burning, sensations of pinching and cold without stimulus). Is it hard to distinguish a bad infection from a neuralgia? Sorry for the long post, I am just in pain and worried!
 
Judythecat

Judythecat

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Mar 7, 2018
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643
Not a dentist, but I have a diagnosis of atypical facial pain, which is essentially neuralgia. Mine presents mainly as a burning sensation, pins and needles, or a tickly feeling, depending on how severe it is on any given day. It can be in my gums or my teeth, sometimes my lips or even into my nose. Sometimes it is proper toothache, which makes me panic, so I have been put onto three monthly checkups.

The big difference from “normal” toothache for me is that it shifts about my mouth, although mainly staying on one side, and it generally is in a “region” of my mouth, covering several teeth, as opposed to on one specific tooth/gum.

I’m not sure if that helps at all, and as I say, I am absolutely not a dentist. As an aside, if I am worried about whether it is the nerves or a tooth gone bad, a surefire way to tell is that the neuralgia damps right down or disappears if I have a couple of glasses of wine. (Not advocating medicating with alcohol, obviously, it is just something I have noticed if I have a drink at the weekend!)
 
K

Kns

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Sep 6, 2017
Messages
129
Thanks for your response Judythecat! It’s hard because I have several teeth with old filing fillings that will need treatment. But they also suspect a neuralgia, so I never know if it’s actually one of the teeth going rapidly downhill. They don’t want to overtreat (unnecessary root canals). But I want to be out of pain!

I’m a “frequent flyer” at my dentist and have had a lot of work done, so my teeth get looked at a lot. But when pain remains, it makes me question everything. My primary care doctor suggested I take gabapentin and if that helps, we know it’s a neurological issue. But that could take weeks for it to “work”, if it does. And one tooth hurting rather than an area, like you said, makes me worried.
 
M

MountainMama

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Jul 1, 2018
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2,387
Oh man, I know you have been dealing with a lot, just like me, and anything new is definitely stressful. I would be worried as well, since it is localized. I have no dental advice, but I really hope it isn't anything serious. My previous dentist had thought my pain in my front tooth was neuralgia, after the root canal did not fix the pain, but then it turned out the infection wasn't gone. However with my abscess, the tooth was incredibly painful to the touch, to where if I accidentally brushed my tongue against the tooth it hurt. That was after it was discovered. Previously it had absolutely no pain at all and was undetected.
Have you had an x ray on the tooth? I would guess an abscess would show up pretty easily.
 
Judythecat

Judythecat

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Mar 7, 2018
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643
Thanks for your response Judythecat! It’s hard because I have several teeth with old filing fillings that will need treatment. But they also suspect a neuralgia, so I never know if it’s actually one of the teeth going rapidly downhill. They don’t want to overtreat (unnecessary root canals). But I want to be out of pain!

I’m a “frequent flyer” at my dentist and have had a lot of work done, so my teeth get looked at a lot. But when pain remains, it makes me question everything. My primary care doctor suggested I take gabapentin and if that helps, we know it’s a neurological issue. But that could take weeks for it to “work”, if it does. And one tooth hurting rather than an area, like you said, makes me worried.
I was offered a medication in the same family, but didn’t want to take it because of side effects. I take a supplement called alphalipoic acid, which helps a lot. (I read about it online, and then discussed it with the maxillo facial consultant that I see.) The idea is that you start with a large dose - three tablets a day - then reduce it after a month to one tablet a day. I use the Solgar brand which I buy from an independent health store, but I know you can also get on Amazon here in the U.K. High doses of one of the vitamins - I think B - are supposed to help, but blood tests showed my levels were A-OK so I don’t take those.
 
K

Kns

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Joined
Sep 6, 2017
Messages
129
I was offered a medication in the same family, but didn’t want to take it because of side effects. I take a supplement called alphalipoic acid, which helps a lot. (I read about it online, and then discussed it with the maxillo facial consultant that I see.) The idea is that you start with a large dose - three tablets a day - then reduce it after a month to one tablet a day. I use the Solgar brand which I buy from an independent health store, but I know you can also get on Amazon here in the U.K. High doses of one of the vitamins - I think B - are supposed to help, but blood tests showed my levels were A-OK so I don’t take those.
Thanks for the suggestion! I’m still worried that this pain could be an infection because of the solid pain, but I also feel embarrassed to call back either the endodontist or dentist about it when I just saw my dentist last week and the endo the week prior. Just overwhelmed by pain. It’s the very back upper molar and the pain is making me gag a little too, which worries me about how I will ever get through treatment in that area. I do appreciate your comments, as the back and forth with the dentists and doctors around a possible neuralgia vs infection makes me feel like I am going crazy!
 
K

Kns

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Sep 6, 2017
Messages
129
I’m starting to think the tooth has to be infected as the pain is increasing in the surrounding gums. I feel overwhelmed and frustrated because I have gone to the dentist and endo multiple times lately for pain in the area and they continue to be conservative about treatment. Wouldn’t something very painful be obvious on visual examination or xray? The pain is fairly localized and getting way more intense. I wish I had some pain relief or answers! Tylenol isn’t doing anything. It’s excruciating.
 
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J

Jmh552

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Sep 26, 2019
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This sounds similar to me!!! Any updates for you?
 
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