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Post root canal pain - side of tooth

R

Ravenes

Junior member
Joined
Jul 19, 2008
Messages
3
After many, many years of not going to the dentist, I finally braved it three months ago. The dentist gave me a treatment plan, all was going well until #18 was worked on. The initial work was for a crown, but after I started feeling pain in #19 (which had a filling), the dentist diagnosed #18 as the troublemaker after tests. The next time around (most of the work except for a crown fitting and the routine original exam has been under IV sedation), he did a root canal on the tooth. This was about 5 weeks ago. The tooth was immediately permanently crowned as the crown was ready.

The pain has been diminishing, but seems to have reached a plateau. I have pain (dull pain that goes away as soon as the percussion isn't applied) when I tap the crown on the sides, near the front. I also (for some reason, especially on weekends) feel like I'm feverish, though my temperature never tops 99.1F, and this weekend has never topped 98.6F. I have an overbite, so I always hit the sides of my teeth when I eat, causing it to hurt. My dentist thought, last time I mentioned it, that I might have a cracked tooth. He re-x-rayed the tooth and says that there's no problem with the root canal. The tooth above it is also permanent crowned (done after the problem tooth was crowned).

When I google, I can find plenty of causes. The #1 seems to be that the crown is too high. Cracked teeth seem to come up when the dentist hits the tooth on the top and it hurts - but it doesn't now (it did the first time) when my dentist does the cotton test. But I'm not finding anything on the google searches on what might be the problem when the sides hurt. My dentist has never suggested it might be a too-high crown.

It took me a month to work up the courage to call the dentist in the first place, so I'm terrified to go chase down another dentist or endodontist for a second opinion, but this is really annoying. Has anyone seen anything like this before? Is there something my dentist might have missed? Is it time to find a new dentist?
 
You could have a bite problem caused by the crown not being adjusted properly. Maybe you are grinding against it in your sleep so when the dentist checks your bite it seems ok, but in your sleep you slide into it so it is more intense. Could be an idea to get a nightguard to see if it helps. You don't have to put much pressure on a tooth for it to hurt when it's been root treated. I had the same problem when I had a hard nightguard that fitted over an upper root treated tooth and it was causing pressure against it. I was in constant pain. I have a soft guard on my lower jaw now and it's fine. You don't need much contact to cause a lot of pain.

Your fever could be completely unconnected. Have you seen your doctor about it?
 
Good post annie778!

A couple of other thoughts:

If it is a crack or fracture in the tooth, often the pain will be felt on releasing the bite. This means that if you bite on a cotton roll, it feels ok, but as you open and release the pressure, it is painful. It is almost impossible to see small hairline fractures on xrays, so it is very hard to diagnose.

The dentist probably checked the bite, but this can be hard to do. The standard carbon paper checks have the problem that the carbon marks will show where the teeth bite together, and help diagnose if the crown is stopping all the teeth meeting properly. Sometimes however, if a crown is only slightly high, it will hit first if the bite, and then the jaw kind of adjusts and moves to allow the other teeth to meet. Again quite a tricky thing to pick up. Our practice is about to invest in high tech equipment called a 't-scan' to try to help in cases like this. You also mentioned that your bite does feel out when you eat- causing pain. I think that this is probably significant and there may well be a problem with the occlusion. Something like an NTIs splint would help in the meantime until the problem with the occlusion could be corrected. Again this would best be dealt with by someone who does alot of work with occlusion- and maybe has a t-scan.

As annie778 said, a night guard may help. If you are grinding or clenching your teeth, then you will be putting pressure on the newly root treated tooth before it is getting a chance to settle. A nightguard would actually also help if, as I talked about above, the bite seems ok but these teeth bite first very slightly. This is because during the day our teeth are actually very rarely together. Only when eating is there any real force between them even then we are evry good at avoiding excessive force on them because of the feedback we get from the nerves around the teeth as we bite. While you sleep however, if you do clench or grind, even if only a little, the forces on the teeth is substantially greater than any force put on them during the day. Is your pain worse first thing in the morning by any chance? A mouthguard would keep the pressure off the tooth. Speak to your dentist however, as it is important that you get the right design of mouthguard (eg soft splint/hard splint/NTIs splint etc) if it is to help- if he is unsure then ask him to refer you to someone who works with occlusion or with bruxism (grinding/clenching).

Finally- if you have a fever just now- it is possible that you could have some issues with your sinuses. Sinusitis can often feel like toothache as the roots of the teeth are very close to the floor of the sinus. If this tooth is close to the sinus, and the sinus is inflammed- then this could be causing your symptoms.
Use the old remedy of inhaling steam from hot water in a basin with a towel over your head. If you can add some eucalyptis oil, all the better. When you sleep, try to avoid lying on your side, avaoiding having the sore side of the face against the pillow- keep that side up if you can. If the pain continues and you suspect that it could be the sinus- see your doctor (or dentist) who could prescribe some doxycycline to help clear it.

Once again- it is impossible to know what is happening without a look, but these are the things I would be thinking about if you were in my chair!

Good luck with it all!

Dr Mike
 
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Thank you, annie778 and Dr. Mike!

I'm seeing my dentist this coming week, but unfortunately it's for a third round of dental work with IV-sedation (which I think is great, but doesn't make for great talks with the dentist!). I'll see if I can get in after that to talk to him about possible bruxism and improper bite. The crown was set while I was in IV-sedation, so it's possible that neither the dentist nor I noticed at the time if the crown was too high. (And I think it's this crown and not the one above it, as it was having problems before that crown came on - though the change from plastic to metal-porcelain probably didn't help.)

I have been sleeping with the root canaled tooth up - it's oddly more painful in the evening in the morning. Again, I'll have to see... which will probably be the week after this, when I've had some recovery from the procedures I'm doing this week.
 
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