PDL sprains lingering?

[thisisme]

I’ve been dealing with what I think are PDL sprains in a couple molars for months. I went through a really tough patch mentally where I felt like one refinement tray altered my smile that I panicked and went back to the old retainer for 4 months, mostly full time. It just seemed so much easier than going back to my ortho given my past dental anxiety. My teeth went about 80% back to how they were. About two months into wearing the old retainer, I noticed one molar would ache in the morning and that molar and the one on the other side would be tender to brushing. Both upper teeth, second to last molar. One molar would get a sharp pain if I pushed a fingernail in there.

I then had a new retainer made from that new position because I reached a point I needed to do something. My ortho said my bite was fine (the refinement was only front teeth/cosmetic).

During that time, the morning ache mostly resolved and the pain with brushing and flossing improved but never fully went away. Occasionally I’d be more aware of the worse molar but it’s never been bad or throbbing pain.

After 3 months in the new retainer, I went back and my ortho said it was “tighter than he like.” He trimmed the height of the retainer and drilled holes into the molars.

It’s been 7 weeks since the retainer adjustment. Brushing and flossing pain seem totally gone and morning ache has resolved. I’m only feel it if I bite down hard with the retainer in on the bad molar.

My dentist did bitewings at my last appointment (4 weeks ago) and I had him tap on the “worse” tooth and it was fine. I had no pain. I actually thought I was cured and all was good. But then I ate pork… and it started this cycle of checking it again.

I mostly feel it now if I clench (I try not to but sometimes my brain is like test it) or if I’m chewing something really chewy like pork. My right upper side seems mostly fine unless I test clench but my left upper side can be more sensitive to tough foods like pork. It’s what triggered my brain again.

I’m a lot more hesitant on my bad side again because it feels like I shouldn’t bite down. Like my teeth are afraid.

I’m kind of worried I’ll always have some kind of pain in these teeth given how long I wore the bad retainer. Teeth have always been a trigger for me. I avoided dentists for 17 years, finally got a smile I wanted, and feel like I threw it all away.

Could anything else be causing this pain? If I did have unwanted forces on my teeth for that long, how long could it realistically last? I really don’t want to see a ton of dentists due to fear and given my general “safe” dentist didn’t see anything alarming, but I’m still alarmed.

And I know, stop test clenching. It’s just feeding my anxiety and making the pain worse.

 

[Gordon]

Night time clenching is a pretty common reaction to stress, so it could be you're doing this and it's stopping things from settling down completely. The bite on this area may not be quite right, so it's throwing up the tenderness. It doesn't need to be "off" by much (fractions of a mm) to trigger some PDL pain if it's getting hit by clenching regularly.

Otherwise I've not got much to add, sorry.

 

[thisisme]

Thank you! I think I’ll give it a few more weeks or if it stays mild, just ask at my next appointment for a bite test. The good news is since the retainer was modified I don’t wake up with an ache or when tapping my teeth together.

I think I’m just worried this is as good as it gets and just forever avoid chewy meats on my left side. I didn’t realize teeth were so complicated. I thought cavity, root canals, extractions, not nerves and sensations.

 

[Gordon]

I think I’m just worried this is as good as it gets and just forever avoid chewy meats on my left side. I didn’t realize teeth were so complicated. I thought cavity, root canals, extractions, not nerves and sensations.

The masticatory system is insanely complicated, but luckily for us dentists, it's also normally fairly tolerant to changes.

As an example, if you bit down on 2 human hairs, your masticatory system could detect when you had bitten through one of them and not the other.
The muscles of mastication (which you chew and talk with) are unique amongst the whole body in that they get motor signals from sensory nerves, this doesn't happen to any other muscle.
The TMJ is unique in that it both slides and rotates, no other joint does this.

Sorry, my inner geek got out for a bit there, I'll go and pacify him with a couple of pages from the Encyclopaedia Britannica

 

[thisisme]

I appreciate it! I didn’t know about any of this aside from teeth things have scared me more than half my life, and I just returned to dental appointments 7 years ago. I think I’m going to give it a few more weeks, avoid the worse side with chewy food, and try not to test clench. If it doesn’t settle, I’ll just ask for a bite test and go from there. All while trying not to panic that I destroyed all my teeth from wearing my old retainer.

The strangest sensation is I can feel the “worse” molar pull/tug if I’m rubbing my lips together at times.

I really regret the refinement and then trying to reverse because I’m not happy with how my front teeth look now or how my molars feel. I just hope I can return to a normal baseline someday.