I am back-question about old filling and AFP

[MountainMama]

I have thankfully been having a fairly pain free experience with my teeth the past few years. I have my atypical facial pain under control for the most part and only take meds occasionally.

However, I have had pain in my upper right first molar off and on for years. Nothing wrong on x-rays so dentists have written it off as AFP and said not to worry about it, so I haven’t. I have two fillings in the tooth, neither large. The past six months it has started causing a twinge of pain when biting something hard, and I can pinpoint the pain the the back center, right where I have one filling. I mentioned it at my last dental appointment and the dentist said he saw nothing wrong and didn’t want to mess with my fillings as it would aggravate my AFP. The fillings are amalgam and over 20 years old.
I have a dentist appointment tomorrow and all the fear is flooding back. I am terrified there is going to be a cavity or the filling needs replacing and it starts the cycle of never ending pain that only stops once the tooth is extracted. I was eating a pastry today that had almond flakes and a tiny piece of almond got in that place where the filling was and when I bit down it sent a shock of pain that has lingered as a nagging pain for hours.

With my condition the dentist has always been on the cautious side and prefers to keep the filling I have. Should I think about replacing it? Is it possible that there is decay under the filling? The filling goes down the inside of my tooth so if it needs replacing will they want to do a crown?
Sorry the picture is dark. I had a tough time getting one in focus and couldn’t get better lighting on it.

 

[Gordon]

There's a couple of areas on the amalgam that look a bit suspiciously shiny, so you might just need the bite adjusted there, aside from that it looks reasonably OK from that photo, but you can never really tell from a photo...

 

[Maggs]

@MountainMama I’m curious how you were able to get the pain under control for your AFP?

 

[MountainMama]

There's a couple of areas on the amalgam that look a bit suspiciously shiny, so you might just need the bite adjusted there, aside from that it looks reasonably OK from that photo, but you can never really tell from a photo...

Thanks Gordon. My dentist said the fillings look fine and that most likely the tooth is cracked…there is a suspicious line on the side, but that he would prefer to leave it alone unless I am having constant pain. I know that tooth is on a count down but I want it to last as long as possible.

 

[MountainMama]

@MountainMama I’m curious how you were able to get the pain under control for your AFP?

Physical therapy helped the most. I went to a physical therapist that had done special training for TMJ issues. The main thing that caused flare ups for me was that I would move my jaw constantly trying to get relief, but that would cause the joint to act up, which triggered the AFP. I have daily exercises I still do for my jaw and face. I also got a prescription for gabapentin to take as needed, not daily. So if I have a flare up I take it for a week or so.