New crown, experiencing pain and no answers

[Kovan]

I do not like going to the dentist, but go regularly as I have a fear of losing my teeth and tooth pain. I have been seeing the same dentist for over 20 years and he has been good and helpful through the years. No issues for most of that time until 2 years ago at a routine checkup he told me I had 2 cavities one in each of my back molars. He does the procedure for those and I am on my way. Except that my mouth is very sensitive and I return and he tells me he does not see anything and to wait and see if the discomfort worsens. A couple of trips more and then he sends me to an endodontist. There I am told I possibly have a small fracture in the molar next to the tooth that had the cavity fixed and my options are to wait until pain meds do not manage the pain or I can do a root canal. I do not want the pain so opt for the root canal. Things clear up after that.

About two months ago I felt a pain on my 5th tooth on the top right side when biting on some gum and when I went to my dentist to look at it, he referred me to a the endodontist. After X-rays and the bite test/cold test I was advised that there is likely a small fracture (that could not be seen). I was told I could wait until the pain was worse, get a crown or do a root canal. Then I was asked what I wanted to do. I said that is why I was there and would like direction and advice as to what would be the best course of action. He said it was up to me, then he started to suggest something and then said, it depends on what quality of life I would want. I did not know what to reply and repeated I was looking for some direction and he said several things and then said, I should try a crown and then go from there.

It took a week to get in to my dentist which gave me too much time to think and I asked my dentist if a root canal would be better as I don’t want to have pain or come back later just to have to do that anyway. My dentist told me I needed the crown and we have to start there and if needed a root canal can be done through the crown.

The two weeks in the temp crown was extremely uncomfortable and each day was a new set of of discomforts ranging from the roof of my mouth feeling very agitated and painful to the teeth on the same side all going through ranges of sensitivity and discomfort to the root canal tooth below feeling pressure and sensations. And I would have some days of no pain or irritations. I told my dentist this when I went in for the permanent crown and he told me to give the permanent crown a bit of time to see if this calms down.

I had some days that felt fine and some days that were as uncomfortable as with the temp crown. I went in after a week and my dentist looked and made a small bite adjustment as I was noticing the discomforts narrowing to the tooth behind the new crown. That evening was the worst discomfort and then 2 days of feeling fine. Then over the weekend the tooth behind the crown felt tight, had several popping sensations and feeling of being loose and the roof of my mouth feeling agitated. On Monday I planned to call to go in, but then I had no issues. Tuesday started out fine, but early afternoon the discomfort started again and my mouth by the crown felt hot, sensitive and very uncomfortable, and it seems to stem from the tooth behind the crown. I call my dentist and they tell me he can’t do anything and said to go to the endodontist. I was able to get in the following day.

The endodontist (same office, but different Dr. than the month prior) does the cold test, bite test, looks at it and ask me questions. I try to share what I have been experiencing and he does not seem interested. None of the tests looking for cracks and or root damage show anything positive and the endodontist tells me I can wait until the pain is unbearable, do a crown or do a root canal, what do I want to do now? I try to ask some questions about what he would suggest and he starts to seem agitated and frustrated. He says we don’t see anything so it is up to you. I tell him I would like a few minutes to think about it and I mention how the tooth behind the crown sometimes feels like it hits my bottom tooth and he looks at it, then starts “polishing it” with the tool and then says, now does it hit? I test it and tell him no, but then I touch the tooth with my tongue and it feels rough and has sharp edges in the front and back and he says I will be back and huffs and walks out. I am a little caught off guard and then I look at his assistant and say I don’t mean to frustrate him, I just don’t understand what is going on. She says it’s okay, it’s my mouth, it’s just that nothing is showing conclusive. I ask what did he do to my tooth and she says he didn’t do anything wrong I assure you.
I am thinking, I don’t understand what is going on?

The endodontist returns a bit later and says, what do you want to do? I try to ask some more questions like, is this something you see often, how many root canals should one have (I have 2 already), what tooth is the issue etc. he says we can do the root canal, and you will never sense hot or cold again, you may have to do a root canal also under the new crown and he rambles on a little, then says, go have a crown put on it and then we can see what happens. He then says we can do another 360 scan, but your last one does not show a crack. He tells the assistant to not charge me for it and he will let me know if he see’s anything.

I go back to my dentist to schedule the crown and he sends his assistant out to tell me, he won’t do a crown on a tooth with no issue. I was scheduled the following morning to pick up a night guard as they said I may be grinding.

When I go in, my dentist tells me he connected with the endodontist and that he wants me to wait 2 weeks and then if I still have issues he can do a crown, but insurance won’t cover it as there is no identifiable issue with the tooth. He does not seem interested in anything I am trying to ask or share about how it feels.

I don’t know what is going on as the discomfort comes and goes, but it is clearly isolating to the tooth behind the new crown. I have lost 15 pounds over the past 2 months as I eat only when I am starving because of the anticipation of discomfort from disturbing my mouth. My dentist, nor the endodontist can find anything, and they can’t seem to advise me what to do to get my mouth back to normal. The dentists. Do not seem to want to hear what I ask or tell them I am going through. Is it in my head? I just want my mouth not to feel so much discomfort if nothing is actually wrong. I don’t want to have unnecessary procedures if it does not solve the issues. I am very worried about worst case scenario and going back to be told again that nothing can be found to fix.

What do I do?

 

[Gordon]

Try a different general dentist and see if you think they are listening to you properly?

 

[Kovan]

Thank you Gordon. I am looking into some options for another dentist and a second opinion. Is it normal that I am having these issues after the new crown? I am concerned at the discomfort I am experiencing, but nothing seems to be noticeable for what is causing the discomfort and pain.

 

[Gordon]

If it's an actual cracked tooth then they can be terribly unpredictable, crowns/RCT are not guaranteed to help. Some cracks are just not treatable other than by extraction.

 

[Kovan]

That’s what I am afraid of. I have no idea how I may have cracked a couple of teeth. What I am hoping for is a diagnosis to clarify so I can get the appropriate treatment, and not add crowns or root canals where they are not needed. And the constant sensations in my mouth make everything uncomfortable. Not knowing and being told to wait each time I go in is adding to my worry. And every day when a new sensation or perceived pain, I Google it and we’ll, we know that never helps. I wish I knew what to do and I wish that the issue could be identified so the treatment could be completed.

 

[Kovan]

Is it possible it’s in my head and I am over reacting to the discomfort and pain? The dentist and Endodontist tell me to come back if the pain throbs and or wakes me up at night. I have not had that, but part of my concern is I don’t want that.

 

[Gordon]

Pain is a weird phenomenon, we really don't understand much about the mechanisms behind it. Chances are all the stress it's causing you is adding to the problem, but it's a vicious circle
Unfortunately there's not a lot I can do to diagnose your problems via the internet, see if you can get an appointment with a different dentist ASAP and take things from there?

 

[Kovan]

I am hoping to get in today with another dentist and get a second opinion. My hope is to be able to find a dentist that will listen. And I hope I can describe the discomfort and pains without to many un important details. I think that is part of my worry with seeing dentists, is I go into too many details and may miss the key problems.

I feel bad looking for a second opinion after being confident in my current dentist and working with him for so long. Hopefully I can find a dentist that will listen and also provide some good advice. I worry about trusting a bad dental advice as I have had in my past that added to my discomfort with dental work and lost a tooth due to it before I found a great dentist who helped me. I don’t want my worry for that to cloud my judgement of trusting a good dentist and diagnosis. Any tips on what to ask or watch out for?

You are right about the pain phenomenon and the loop that creates. I am working to sort that down so perhaps the real issue and or healing can be more clear

I appreciate you taking the time to respond Gordon, and your direct responses without hypothesizing as the “inter webs” so often do adding more worries to what could be the problems are appreciated.

 

[Feel Jubilant]

@Kovan

Hello. To be brief and leaving out details, I had an unusually shocking, horrible experience at a dentist office March 2023. Since then, day and night, that tooth, the gums, and the crown hurt tremendously, so that I cannot sleep or work. The pain is much more than when I originally went to the dentist. That crown visually looks OK, including gums and x-rays. I am now scheduled to get a new crown in the coming weeks, with a dentist who is booked up almost half a year in advance. Because of my unfortunate experience, I can personally relate to your unfortunate situation.

Like you have described yourself, you are a very loyal person. You felt loyalty to the previous dentist. What I realize that I must do is take care of myself, stand up for myself, support myself, speak up for myself, and demand help for myself. I would surely do that for others. No one takes care of me except myself. With all the energy and effort that you have left, make a list of questions, get on the phone, and call local dentist offices, and ask questions. While you are still able to speak and talk, interview dental offices, and interview your local family and friends who have had serious dental treatments. This is no time to be bashful, because it is your life.

I have found that in-demand dentists, who have WOM "word of mouth" positive recommendations, are booked up many months or almost a year in advance, so that it is virtually impossible to have a timely dental appointment with them. Those are the dentists that you want to find for yourself. While you are still healthy enough to have strength and energy, and with recent x-rays that you can provide, eagerly, wtih boldness, go visit dental clinics and try out any consultations or first appointments that you can get. You have got to find a capable, expert dentist who is going to care about you. Put your energy into doing that. Then after you have one good dentist, keep going to find a second dentist, so that if something happens to the first one, you're on the list as a patient at the other dental clinic. Don't put your life, your hopes, and dreams into only that one dentist, a mere person, who could die, or move away, or have some other situation, so that you're suddenly without a dentist.

Also, I enjoy using a food blender, to only eat pureed or soft food, to avoid cracks in teeth. I have more than one food processor, so that when one suddenly stops working, I can immediately use the other one. That is important to me, and it keeps me alive.

 

[Kovan]

I was able to get in for a second opinion and the dentist was very helpful and listened to what I had to share about the things I have been going through. Long story short the dentist took time to look closely and share my options with me, the pros and the cons. I am going to have a root canal and we will go from there.
I hope to share next that progress was made and things are feeling better.
Thank you again Gordon sharing some of your time and perspective with me.

 

[Kovan]

Update- I went to another endodontist expecting to have a root canal, and he took the time to look at everything, asked lots of questions and then said he did not want to to a root canal as an exploratory option. He did all of the bite tests, cold test, X-rays etc and advised said that there is not any infections or indications of a fracture. He then said he wanted me to see a TMJ/OFP specialist. Interestingly enough the discomfort subsided over the next week before my appointment for that.
The specialist looked at a number of things with my jaw and asked a lot of questions. He showed me an exercise for my jaw, told me to continue wearing my night guard and to return in a month. He hypothesized that it may be a muscular issue that is triggering some nerve issues. He said I may still have a tooth issue, but he thought that was only a small chance that it was.
Oddly enough, since the appointment Friday, the agitation has increased a little bit. Starting to wonder if it is in my head, but the location of the tooth behind the new crown is consistent and I am having a difficult time trying to decide if I wait or go back to have it looked at.
Seeking a second opinion was good and helpful. But I still don’t have a clear answer and sensations in my mouth each day varies and is taking a lot of energy and focus away from so much.
Not sure where to go from here.

 

[Gordon]

Oddly enough, since the appointment Friday, the agitation has increased a little bit. Starting to wonder if it is in my head, but the location of the tooth behind the new crown is consistent and I am having a difficult time trying to decide if I wait or go back to have it looked at.

I assume the TMJ bod did some work moving your jaw around and generally poking about with your bite? This may have temporarily stirred things up a bit, so personally I'd just try to relax about it for a few more days and see how it goes. Remember stress really winds up TMJ issues (and it's a stressful time of year right now anyway!).

 

[Kovan]

Thanks @Gordon

I honestly did not think of that, but yes he did poke and prod at my jaw a bit. As the agitation started, the mind then went to more worry about the issue than I want to admit. And thinking back to the week after the endodontist advised that he would not do the root canal, I was off from work and more relaxed. Now I am back to work and the stress of that and the time of year I am likely more tense.
I wish I had more knowledge of TMJ and may be looking for info for understanding, but once again Google is more confusion and rabbit holes of doom. I am working to avoid that as I know that is un needed stress. The specialist used language like, hypothesize and root canal/extraction may still be needed. I perceived that he did so because my symptoms and explanations of experiences don’t match up with the typical list of symptoms or what have you.

Do you know of any good and verified source of info for that by chance?

I know I need to try and not over focus, as that causes stress, as the waiting game adds to my worries about all of this. I never thought I would be in a place of just praying for one day of peace and not noticing anything coming from my mouth and teeth.

Thank you for sharing your time and support. It is helpful.

 

[Gordon]

TMJ dysfunction is a horrible rabbit hole of quackery and misinformation. Basically we don't know why it happens, it can come and go almost at random and so the effectiveness of almost any treatment is difficult to establish (is the treatment effective or is it just the syndrome spontaneously improving?).

We are fairly sure that some things make it worse in some cases, stress being one of them. But not in every case for every person. In fact I once had a patient whose symptoms got worse when the stress in her life went away down after she retired (AARGH! See how frustrating this is?).

I strongly advise against going down the Google route on this stuff, the amount of plain lies out there is really concerning.

Best advice I can give you is to try to find that a few simple things which work for you, so you could try working your way through this list, but try just one thing at a time, if it works stop there, if not try another.

Boring but won't do you any actual harm!

TMJ Pain, Clenching and Grinding

What can you do about TMJ pain, clenching, and grinding? We've collected tips from our readers and from dentists!

www.dentalfearcentral.org

 

[Kovan]

Thank you Gordon!
That is a resource that will help.
I can not imagine going through what your patient went through, with less stress, stressing the pain and all.
I appreciate the support and info as the pain today was at a peak. Everyday it is challenge because everyday it is different. The pain and agitation has similarities and many differences. I am trying to jot down and track it all so I can see what may be triggering it and so I can identify the similarities and avoid any of the triggers.
Mentally it has been taxing this week, because the week after the endodontist indicated it may not be tooth related it really felt better and I took it as being on the right track. So much so that when I saw the specialist I could not really duplicate any of the pain from the previous month. Then this past week it has hit new pains that I initially just grinned and bared it, but the past two days have really put me to the test, and I needed pain meds. The mind is on high alert and seems to wander to the worst case scenarios as this happens.

Are there things I should pay attention to that can help me know if it is tooth related or TMJ related? That is the biggest challenge in the mind when the pain hits that “I just can’t do this anymore” point? I start to wonder if it is the hidden cracks or infections and then want all my teeth pulled out. But I know that won’t solve anything.

I do truly appreciate the info, knowledge and time you share Gordon.

 

[Gordon]

The biggest give away that it was tooth related would be either the tooth in question being slightly mobile/loose in the socket or even a bit of localised swelling.
TMJ pain is generally a bit more diffuse and harder to localise. At the risk of throwing up another rabbit warren, has anyone considered trigeminal neuralgia for your diagnosis?

 

[Kovan]

Good to know.
Fortunately there has been no swelling and no looseness.
I have thought that one of the main culprits has had a sense of looseness when touched with my tongue, but if I try to wiggle it, it does not move and both endodontist said it was okay.
The other tooth that has been giving me trouble is the root canal below that tooth. A type of dull aching and occasionally when chewing it feels odd like it moves, but again when I try with my fingers, no movement. That tooth causes the most worry, because each time I have mentioned it, they say they don’t know why that tooth would have feeling in it.

Trigeminal neuralgia has not come up, but the specialist for TMJ also works with oral facial pain. Is that a diagnosis in that realm, or is there another specialist to see for that?
I am trying not to Google it so I don’t go down another hole.
I am going to try and get in again for another look, as I feel like, the fact I was feeling good they day I was in, that more guessing was done as I did not exhibit any obvious TMJ signs. The Dr used the words, he was hypothesizing, and to come back in a month with the night guard for another look.
I am hoping to get some more specific answers/diagnosis with some type of treatment or plan, because this waiting for something is not a healthy mental thing right now.

 

[Gordon]

Trigeminal neuralgia has not come up, but the specialist for TMJ also works with oral facial pain. Is that a diagnosis in that realm, or is there another specialist to see for that?

No, he should have it as part of the differential diagnosis process, true trigeminal neuralgia is rare but needs to be considered.

 

[Kovan]

Thanks Gordon!

I will inquire once I get back in for another look.

It is crazy how many things it could possibly be. All this started with a small crack and a crown procedure. Some days I wish I had just ignored it because that discomfort was nothing compared to it all since.

 

[sudzs]

Can I butt in and give my take on TMJ disfunction.....

A few years ago I had 2 crowns fitted, one on each side of my mouth. Well both were a little big/high which made my bite weird and I developed a problem with the TMJ. After the crown issue was fixed I continued to have TMJ pain and discomfort. The only thing that helped was Valium which relaxed the muscles involved and the rest of me too!

All my life I've carried tension in different parts of my body. Clenched fist, spastic colon (nice old fashioned term you don't hear anymore!). Jaw clenching. Pelvic floor muscles. TMJ.... So for me the TMJ problem which started with the change in my bite carried on as an anxiety response. The more I felt the jaw pain the more tense it became. In the end I bought a book, Taking Control of TMJ which had some jaw exercises in it which I did for a few months. I think that helped rectify any problems with the muscles caused by the tension and by then I had a new tense bit of my body so the problem was solved.

Good luck with it all @Kovan