Possible for infection to not show up on xrays?

[Kns]

I have a first upper premolar that had a root canal performed a little over a year ago. The journey of that tooth started with pain about a year earlier than that. I had intermittent sharp pain in that tooth that my dentist couldn’t explain. He said there was a little decay but that it wasn’t in an area on the tooth that typically causes pain. I had it filled and the tooth immediately felt worse, like it had something stuck in it. My dentist said to wait and give it time. I ended up seeing an endodontist about three times after and he couldn’t determine if it needed treatment or if it was a different tooth causing issues. It kept getting worse - stabbing pain and very painful to cold. Finally he agreed to root canal it and said during treatment that it looked like the nerve was being squeezed and called it partially necrotic. About a month after the root canal (done in two parts), I had boring pain spontaneously for about 10 minutes in that tooth while I was at work. I went back three times over the next year to the endodontist about this tooth, as the pain continues. The pain is nearly constant and worsening with pressure on the side or biting. I have odd on and off sensory sensations around that area - numbness, pain, a feeling of cold. It hasn’t reacted to endo ice. He did two CBCT scans over the past year and said he saw no signs of infection. He recommended leaving it be or trying a muscle relaxant since I clench (it is out of occlusion though) or perhaps an apicoectomy (although he said that would only have a 50% chance of getting rid of the pain). He said it might be a neuropathy and that root canals are often sore when pressed on the side. I have had a small bump on my cheek on the side of my face that appeared two years ago around the time the tooth first began giving me trouble. I saw a doctor and dermatologist who gave me antibiotics and injected a steroid in it, saying it was a sebaceous cyst. It went down in size and they didn’t want to take it out since it could scar and they couldn’t really see it any longer. I can still tell it’s there but I’m not sure it’s noticeable to anyone else. One dermatologist couldn’t feel it any longer, although I still can and it is sore when I press on it. I know none of this can be diagnosed online but I am wondering if this cyst and my tooth pain could be related? I’m not a doctor or a dentist, but I would think an infection this long would appear in scans by now. Could a tooth have an infection that leads to a small facial cyst and the infection still not show up on an xray or CBCT? I feel like I am going crazy trying to find pain relief when neither my dentist or endodontist can find infection or a reason for my pain. This endodontist is highly respected but I am not sure what to do, who to turn to or trust or how to find relief.

 

[Gordon]

It's very unlikely that an infection big enough to cause symptoms wouldn't show up on the tests you've had done. Sounds like it's something else, but trying to figure out what that is without seeing you is pretty much impossible.

 

[Kns]

Thanks! That helps me worry less, at least about a possible dental infection...and helps me trust my dentist and endodontist more!