Ongoing pain after root canal. How is crack diagnosed?

K

Kns

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I have posted my story before, but I still can’t find relief. I had a root canal on an upper premolar about a year and a half ago. Around a month after it was finished, I got a wave of intense pain without stimulation and it’s been painful ever since. It hurts every day. Sometimes only slight background pain, but at other times in the day it can feel very intense. It wakes me up at times. My dentist amd endodontist have checked it and have done more than one CBCT scan. But nothing shows up wrong. They are sending me to a faculty orofacial pain specialist at the dental school and hospital in my state, as they keep suspecting a neuralgia. My doctor gave me a gabapentin prescription to see if that would help, but I am reluctant to take it without knowing what’s going on. The faculty dental specialist can’t see me until the end of November. Meanwhile I am having a difficult time managing the pain. I can’t eat on that side of my mouth. That entire side is out of occlusion and I can only touch the top and bottom teeth when I really force/contort my jaw to the side. One thing I noticed is that wearing my nightguard is often uncomfortable, as it puts pressure on my tooth. Pressure from the side seems to make it a lot worse. When I remove my nightguard, I feel or maybe even hear what feels/sounds like a crack. It almost feels like the toith could snap. I am wondering if a crack that could give me these symptoms could still go undetected in xrays and scans?? I am *desperate* for relief because my symptoms of pain and odd sensations (coldness, numbness, pinching, sometimes burning in the whole area/side) are taking a huge toll on my life amd sleep. What can I do or what could likely be going on? I feel like I’m in a twilight zone of pain, consults, and no set answers or relief.
 
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MountainMama

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So sorry you are still dealing with this. You and I have had a rough time of it.

Obviously I can't give you dental advice, but what you describe sounds a lot like my exoerience with my front tooth. Root canal looks perfect, pain with nightguard, clicking feeling when taking nightguard out, and looks perfect on x ray, with no sign of active infection.

I gave up and am getting it out, and getting an implant. The pain is draining and I can't handle it anymore.

I hope you can find a solution, and be out of this misery soon.
 
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Mazey

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I’m sympathetic because I am also dealing with a mysteriously painful root canal tooth (slightly different symptoms). Having pain every day really grinds you down overall.

I understand your reluctance to try the gabapentin, although I wonder if it is worth trying even if just so you can cross it off the list and help the doctors eliminate nerve issues as the source of irritation?
 
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Jmh552

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I have posted my story before, but I still can’t find relief. I had a root canal on an upper premolar about a year and a half ago. Around a month after it was finished, I got a wave of intense pain without stimulation and it’s been painful ever since. It hurts every day. Sometimes only slight background pain, but at other times in the day it can feel very intense. It wakes me up at times. My dentist amd endodontist have checked it and have done more than one CBCT scan. But nothing shows up wrong. They are sending me to a faculty orofacial pain specialist at the dental school and hospital in my state, as they keep suspecting a neuralgia. My doctor gave me a gabapentin prescription to see if that would help, but I am reluctant to take it without knowing what’s going on. The faculty dental specialist can’t see me until the end of November. Meanwhile I am having a difficult time managing the pain. I can’t eat on that side of my mouth. That entire side is out of occlusion and I can only touch the top and bottom teeth when I really force/contort my jaw to the side. One thing I noticed is that wearing my nightguard is often uncomfortable, as it puts pressure on my tooth. Pressure from the side seems to make it a lot worse. When I remove my nightguard, I feel or maybe even hear what feels/sounds like a crack. It almost feels like the toith could snap. I am wondering if a crack that could give me these symptoms could still go undetected in xrays and scans?? I am *desperate* for relief because my symptoms of pain and odd sensations (coldness, numbness, pinching, sometimes burning in the whole area/side) are taking a huge toll on my life amd sleep. What can I do or what could likely be going on? I feel like I’m in a twilight zone of pain, consults, and no set answers or relief.


I am right there with you!!! I am going on about a year of front tooth root canal pain. Had a re treat about a month ago and still hurts. Did you have a retreat? I went to an oral surgeon recently and he threw out neuralgia and so did my endo. I go back in three weeks for the final filling and I may need to go to a pain clinic before any more work. I have done a lot of research and they say getting the tooth out of if is neuralgia could cause more pain. But I know...I want to rip this front tooth out. I am so angry at the situation and I am drained daily. It has really impacted my life. I get exactly where you are. How do you manage the pain daily?
 
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Jmh552

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So sorry you are still dealing with this. You and I have had a rough time of it.

Obviously I can't give you dental advice, but what you describe sounds a lot like my exoerience with my front tooth. Root canal looks perfect, pain with nightguard, clicking feeling when taking nightguard out, and looks perfect on x ray, with no sign of active infection.

I gave up and am getting it out, and getting an implant. The pain is draining and I can't handle it anymore.

I hope you can find a solution, and be out of this misery soon.

Did you have multiple retreats by chance? I had to get a bottom night gaurd made because I can’t wear the top with my front tooth. I just had my front tooth retreated. My tooth is not responding. I went to an oral surgeon and everything looks good and he said he would not take tooth out. Did anyone give you an issue for wanting to take it out?
 
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MountainMama

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Did you have multiple retreats by chance? I had to get a bottom night gaurd made because I can’t wear the top with my front tooth. I just had my front tooth retreated. My tooth is not responding. I went to an oral surgeon and everything looks good and he said he would not take tooth out. Did anyone give you an issue for wanting to take it out?

I couldn't wear an upper nightguard for a long time. In fact, I held off on getting a custom one made until we got the front tooth figured out. I ended up buying an OTC one (actually 2). One was a hard one that you heated and molded and it hardened around your teeth. It actually didn't hurt the front tooth as much as the custom one did, because there was no wiggle room. The dentist ground out the bottom of it where the front tooth was and it didn't press on it. I also got a rubbery one that you boiled and molded. I cut it in half and only used half. It didn't even touch my front tooth on that side, as it fit the other half. That was my best short term option. I actually used it after my surgery for awhile too.

No one ever found a reason on the x ray, but the surgeon found infection when he went in and removed the tooth. The ENT is actually the one who recommended taking the tooth out. He said the pain alongside my nose was due to inflammation on the trigeminal nerve. It didn't show up on the x ray, as since I had already had a root canal, it just looked like the blank place where the infection had been previously.
 
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Rio I

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Hi Mountain Mama,

Since i read your experience about retreatment of root canal, i want to ask some question

1. My endo said will do re-rct on my infected tooth,he will do it through the crown since my Rct already crown (did initial rct 5 years ago), is it common procedure just drill through the crown and not remove it? did your endo do the same ?

2. Did you directly put the new crown after the re-rct ? my endo said the drilled crown is better to replaced after finish the re-rct, but see from your experience i think its better to wait until its really settle before spend another $$$ for something that can be failed but on the other hand, i am afraid if i am waiting until tooth settle the crown can be crack because it lost strength from drilling. Can you share your experience ?
 
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MountainMama

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Hi Mountain Mama,

Since i read your experience about retreatment of root canal, i want to ask some question

1. My endo said will do re-rct on my infected tooth,he will do it through the crown since my Rct already crown (did initial rct 5 years ago), is it common procedure just drill through the crown and not remove it? did your endo do the same ?

2. Did you directly put the new crown after the re-rct ? my endo said the drilled crown is better to replaced after finish the re-rct, but see from your experience i think its better to wait until its really settle before spend another $$$ for something that can be failed but on the other hand, i am afraid if i am waiting until tooth settle the crown can be crack because it lost strength from drilling. Can you share your experience ?

I actually still had my temporary crown at the time of the retreat of the root canal. I actually had the crown made, but didn't ever get it put on, mostly because it hurt too much just to try to take the temp crown off! The retreat didn't work, so I ended up wasting money on a crown when the tooth ended up extracted.

My dentist and endodontist both said that it wouldn't be difficult at all to drill through the permanent crown to do a retreat or a root canal, though. They would just put a composite filling in the hole when done.

In your situation, I would probably have them drill through the crown, but not replace it unless it breaks or cracks for some reason. Then wait and get it replaced at a later time if it needs it. My husband has had a root canal done through a crown (that had been there for 6 years), without having to replace the crown.
 
A

Acheygirl

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Oh my gosh I sympathize with you all I am in the exact same boat.

I started with a tooth ache when I would pull the dental floss out. It felt like the tooth was fractured. I saw my dentist who removed the filling but did not see a crack. He recommended me to an endo if the pain came back. It did so I saw the Endo. He was low pressure and sent me home a few times to just see if it would pass. It got so bad we decided to treat the tooth. It felt ok for a week and pain was back, he retreated it and placed medication in it twice. It never felt right since. He did a cone 3d xray on the tooth and saw no fractures and while inside the tooth he mentioned with his microscope he saw no fractures. But due to ongoing pain we concluded that the neighboring tooth was the problem as it tested to cold. Completed that tooth which was really inflammed in the pulp. I thought I would be ok but no the pain is now back. I have been dealing with this since September.

I think I am going to have it pulled but I read about Neuralgia and maybe that's the problem. On top of the ache and the strange uncomfortable sensation I get when tapping on the tooth I get a icy cold sort of vicks mentholated sensation in the tooth root and around the gums. I am at a loss. It does not wake me up at night and I have some good moments. I am in about 3k so far with root canals and one permanent crown which will probably end up being extracted

MountainMoma, if I can ask when you had your tooth pulled was it fractured at all? I am so tired. I am starting to wonder if this is neuralgia in my case perhaps I never needed any of the root canals and it was some atipical face pain. I am going to see my primary doc and ask about a low dose antidepressant and see if maybe that quells the pain.
 
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MountainMama

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Oh my gosh I sympathize with you all I am in the exact same boat.

I started with a tooth ache when I would pull the dental floss out. It felt like the tooth was fractured. I saw my dentist who removed the filling but did not see a crack. He recommended me to an endo if the pain came back. It did so I saw the Endo. He was low pressure and sent me home a few times to just see if it would pass. It got so bad we decided to treat the tooth. It felt ok for a week and pain was back, he retreated it and placed medication in it twice. It never felt right since. He did a cone 3d xray on the tooth and saw no fractures and while inside the tooth he mentioned with his microscope he saw no fractures. But due to ongoing pain we concluded that the neighboring tooth was the problem as it tested to cold. Completed that tooth which was really inflammed in the pulp. I thought I would be ok but no the pain is now back. I have been dealing with this since September.

I think I am going to have it pulled but I read about Neuralgia and maybe that's the problem. On top of the ache and the strange uncomfortable sensation I get when tapping on the tooth I get a icy cold sort of vicks mentholated sensation in the tooth root and around the gums. I am at a loss. It does not wake me up at night and I have some good moments. I am in about 3k so far with root canals and one permanent crown which will probably end up being extracted

MountainMoma, if I can ask when you had your tooth pulled was it fractured at all? I am so tired. I am starting to wonder if this is neuralgia in my case perhaps I never needed any of the root canals and it was some atipical face pain. I am going to see my primary doc and ask about a low dose antidepressant and see if maybe that quells the pain.
My tooth did not have any cracks when it was extracted. However, the oral surgeon said the gums were “angry”. No infection present just irritated gums. It is interesting that you mention the Vick’s vapor rub feeling. My tooth had a fuzzy feeling, cold like but also like carbonation. No one could explain it but so far I have had that feeling with two teeth and all have ended up extracted after nothing shows up on x rays (with perfect root canals that failed). It is mystifying to the endodontist and the oral surgeon. I also thought neuralgia but the pain stopped when the teeth were extracted. The oral surgeon and dentist both said it wasn’t neuralgia.
 
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AshNaz

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I will also add in here with what I think is a similar story - I had two neighboring teeth that had fillings that were replaced. Before the fillings were replaced neither tooth had pain - after the fillings I had pain in the area that I thought was from one tooth. Series of appointments with dentist and endo - root canal in the one tooth that was having pain for sure - root canal did nothing - literally no difference in the pain that I was having. No one could explain it - but it was horrible horrible pain - could not talk and my tongue just brushing up on the tooth would stop me in my tracks. Ultimately the tooth was pulled because I could not take it anymore - neither my new dentist or endo could explain it.

BUT I still had pain in the area - dentist saw nothing wrong on the xrays and thought neauralgia (I am starting to think that this is a bit of a go to when there is no obvious other explanation). So - I went to facial pain specialist, more dentist appointments and ultimately tooth was pulled because the pain was ultimately isolated to the tooth nerve by the specialist.

Five month ordeal - loss of 2 teeth, which I really do believe now was due to a cracked tooth from the refilling and irreversible pulpitas from the second tooth. I am now pain free and waiting to spend a few more $$$ on an implant.

Hopefully this helps a bit - it is exhausting. I wish you the best.
 
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Acheygirl

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Thank you both!! Mountainmama that is so odd that the tooth looked fine no cracks. Ashnaz how about your two extracted teeth were they cracked?

I have a few theories. The first a mechanical issue with the tooth ie: small crack or perhaps mild over fill or instrumentation. However I had a very trained e
Endo do the procedure so the likely hood of this is pretty darn low and the x-rays look excellent. The other theory is an immune response to the dead tooth or the gutta percha within the tooth. From my understanding the body accepts this material pretty well as it is organic but I think my body is rejecting the teeth?

I really am leaning towards extraction I think the only thing holding me back from running out tomorrow and having them pulled is the fear it will not correct the pain. Of course the cost is not an easy thing to take as well. As you both know in the thousands.

I see my GP this week and will ask about amiltriptiline. I am very health conscious and hate to put drugs in my body but I have been on lots of tylenol and advil over the months for this. I am thinking to try it and if it does not work then pull them. Dental pain is not like foot pain where you can put an ice pack on it or soak it in epsom salts... it's maddening. :(
 
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AshNaz

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I do understand - it is so hard, especially when there is no answer or feels like there will not be an answer. For both of my teeth - there was never really a diagnosis to determine if the tooth was cracked or not so I am not sure, but I have decided that I think that my first tooth was cracked which was why the RCT did nothing and why the pain went away for that tooth after it was pulled.

The thing that ultimately helped me with my second tooth was the facial pain specialist who I saw did a series of tests to isolate the pain (honestly - this could have been done in the dentist office, but the facial pain guy was the one who ended up doing them). Just involved tapping and pressing in certain places inside my mouth and along my jaw and then numbing certain areas one by one to see what pain persisted. After that it was clear that it was my second tooth that was having pain and not anything else. It was just bad luck to have them both go crazy at the same time.
 
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MountainMama

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Thank you both!! Mountainmama that is so odd that the tooth looked fine no cracks. Ashnaz how about your two extracted teeth were they cracked?

I have a few theories. The first a mechanical issue with the tooth ie: small crack or perhaps mild over fill or instrumentation. However I had a very trained e
Endo do the procedure so the likely hood of this is pretty darn low and the x-rays look excellent. The other theory is an immune response to the dead tooth or the gutta percha within the tooth. From my understanding the body accepts this material pretty well as it is organic but I think my body is rejecting the teeth?

I really am leaning towards extraction I think the only thing holding me back from running out tomorrow and having them pulled is the fear it will not correct the pain. Of course the cost is not an easy thing to take as well. As you both know in the thousands.

I see my GP this week and will ask about amiltriptiline. I am very health conscious and hate to put drugs in my body but I have been on lots of tylenol and advil over the months for this. I am thinking to try it and if it does not work then pull them. Dental pain is not like foot pain where you can put an ice pack on it or soak it in epsom salts... it's maddening. :(
My oral surgeon brought up the immune response as well. He said that could play a part, especially since both of my “excellent on x rays” root canals failed. I actually have been undergoing testing for an immune disorder although so far they haven’t found anything conclusive. My ENT and doctor both think it is immune system related, especially since I have also had an outbreak of eczema that is bad enough to send me to a dermatologist. I haven’t had eczema since I was a kid and even then it was mild. It is all around my hairline and neck and behind my ears.

One thing my surgeon brought up is with neuralgia, pain killers will not help at all. Tylenol did help take the edge off my pain. It doesn’t stop it but makes it bearable.
 
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Acheygirl

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My oral surgeon brought up the immune response as well. He said that could play a part, especially since both of my “excellent on x rays” root canals failed. I actually have been undergoing testing for an immune disorder although so far they haven’t found anything conclusive. My ENT and doctor both think it is immune system related, especially since I have also had an outbreak of eczema that is bad enough to send me to a dermatologist. I haven’t had eczema since I was a kid and even then it was mild. It is all around my hairline and neck and behind my ears.

One thing my surgeon brought up is with neuralgia, pain killers will not help at all. Tylenol did help take the edge off my pain. It doesn’t stop it but makes it bearable.


That is so interesting that your oral surgeon also mentioned an immune response. It sounds like you had a tremendous ENT. I might try and get a recommendation to one from my GP. Maybe i'll get a good one like you did.

I am female early 50's going through the lovely change of life. I often wonder if that is also part of this as it could coincide with the time that things started changing hormonally.
 
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AshNaz

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That is so interesting that your oral surgeon also mentioned an immune response. It sounds like you had a tremendous ENT. I might try and get a recommendation to one from my GP. Maybe i'll get a good one like you did.

I am female early 50's going through the lovely change of life. I often wonder if that is also part of this as it could coincide with the time that things started changing hormonally.
It is interesting that you mention the age and loveliness associated with that :) I am in the same boat and had wondered the same thing when this happened to me. I had never ever had any dental problems before, but some amount of dental work, this so it really knocked me and it was hard that I didnt feel like I got good final answers as to why this happened.
 
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Acheygirl

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It is interesting that you mention the age and loveliness associated with that :) I am in the same boat and had wondered the same thing when this happened to me. I had never ever had any dental problems before, but some amount of dental work, this so it really knocked me and it was hard that I didnt feel like I got good final answers as to why this happened.


Oh man that's strange! So maybe there is a connection? As if going through the change is not hard enough LOL. I wonder if estrogen helps the nerves? I know it helps keep our bones strong. Something worth looking into.
 
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Acheygirl

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I am curious if Mountainmama is in our age group? That would be quite interesting if that were the cases.:hmm:
 
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MountainMama

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I am curious if Mountainmama is in our age group? That would be quite interesting if that were the cases.:hmm:

I just turned 40, so not quite there yet, but also had very few dental issues prior to last year.
 
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Acheygirl

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I just turned 40, so not quite there yet, but also had very few dental issues prior to last year.

Lucky girl! Enjoy the next decade and longer it's not fun when the estrogen starts to leave us. sorry again for the dental issues and thanks for the input with you tooth. It's good to know we are not alone in this.
 
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