Quick question before appointment with endodontist

[MountainMama]

If I do have Trigeinal Neuralgia, would teeth test positive with percussion and/or endo ice? I do not want to get unnecessary root canals.

I have not gotten a straight answer from my new dentist, and he has decided to send me straight to the endodontist before seeing me.

My former dentist was considering the diagnosis of trigeminal neuralgia, because I was having pain in teeth that would change location. The endodontist said the front tooth needed an apico (before doing the cone beam scan), and that it was not TM.

Three of my first molars have started hurting off and on, dull aching with occasional sharp aches. It comes and goes, lasting for 30 minutes to an hour. It switches teeth, sometimes left, sometimes right side, sometimes upper on left. The bottom second molar is also impacted. It aches as I type this. Nothing bad enough to need painkillers, maybe an occasional tylenol...more annoying. Last night I woke up at around 2, and then had pain for a few minutes in my right first molar. I also have pain occasionally in the two extraction sites of the molars that were pulled in October.

The lower left first molar has been sensitive to heat and cold. The others have not. My endodontist does a good job, but is quick to jump to a treatment plan.

I do not want to walk out of her office next week with extractions and root canals scheduled without knowing if it could possibly TN instead. I feel really helpless right now, because the new dentist seems to want to not deal with me, and I don't know what is going on. I cannot afford three root canals, so I would have to get at least one extracted with no replacement, and would have to cancel the implant I was going to get on my previous extracted tooth. I am overwhelmed!

 

[Gordon]

The switching location makes it NOT sound like TN, it's usually very site specific, also the duration of pain is wrong, it's normally short and sharp, not continuous.
Without actually examining you, it's impossible to come up with any kind of diagnosis from here.

PS Endo ice and percussion are not reliable, the most accurate way to check vitality is with an electronic pulp tester and even then it's not 100%. Using all 3 together would give the best chance of a correct result...

 

[MountainMama]

The switching location makes it NOT sound like TN, it's usually very site specific, also the duration of pain is wrong, it's normally short and sharp, not continuous.
Without actually examining you, it's impossible to come up with any kind of diagnosis from here.

PS Endo ice and percussion are not reliable, the most accurate way to check vitality is with an electronic pulp tester and even then it's not 100%. Using all 3 together would give the best chance of a correct result...

Thank you! She has always just done percussion and endo ice, then said I needed a root canal. I will have to ask about the electronic pulp tester. If it isn't an option, should I just wait it out and see if they get worse instead of going through with treatment? The bottom left first molar is heat and cold sensitive, so I know it will test positive to the endo ice.

I know you can't diagnose...I just want to make sure I am not going to get rope into root canals and extractions I don't need!

 

[Kns]

I’m not a doctor or a dentist but have had a similar journey. I have had multiple procedures and seen three dentists, three endodontists, my doctor, a neurologist and an ENT. Some say trigeminal neuralgia, some say TMJ/clenching and I still am feeling like it’s issues with teeth. The neurologist and ENT did echo what Gordon said about usually the pain is specific to a trigger spot and not all over the place - and shorter in duration. My pain has moved around a little but is majnly related to two teeth on one side - setting in worse after root canals. It’s a constant low, burning pain. Xrays and scans all look good. But I have had some quick stabbing/electric pain in the same spots. Right after my last two root canals I had searing pain that came on quickly, was severe, and ran the path of the nerve. Luckily I haven’t had a lot of that since. Atypical trigeminal neuralgia or TN2 supposedly is more constant vs the classic TN that you probably have heard about. I still don’t have a diagnosis but live in fear of not knowing what to do or what not to do. I have heard that trying tegretol or gabapentin can relieve TN pain but won’t really make a difference if it’s a tooth issue. My endodontist and dentist aren’t quick to do treatment as they have always suspected TN. But the last root canal I had was put off by the endo for months as I complained of pain because of that suspicion and it was actually “ischemic “ when he finally went in to do the RC. He said it looked like the nerve was being squeezed. So now I don’t know who to trust or how to know what to do. I have been following your story hoping you find solutions and I can find similar relief! I understand your dilemma. Hang in there! Can you get a second opinion or see your general doctor for their thoughts? Or do the one thing that seems most urgent and wait on the other teeth to make sure treatment is necessary?

 

[MountainMama]

I’m not a doctor or a dentist but have had a similar journey. I have had multiple procedures and seen three dentists, three endodontists, my doctor, a neurologist and an ENT. Some say trigeminal neuralgia, some say TMJ/clenching and I still am feeling like it’s issues with teeth. The neurologist and ENT did echo what Gordon said about usually the pain is specific to a trigger spot and not all over the place - and shorter in duration. My pain has moved around a little but is majnly related to two teeth on one side - setting in worse after root canals. It’s a constant low, burning pain. Xrays and scans all look good. But I have had some quick stabbing/electric pain in the same spots. Right after my last two root canals I had searing pain that came on quickly, was severe, and ran the path of the nerve. Luckily I haven’t had a lot of that since. Atypical trigeminal neuralgia or TN2 supposedly is more constant vs the classic TN that you probably have heard about. I still don’t have a diagnosis but live in fear of not knowing what to do or what not to do. I have heard that trying tegretol or gabapentin can relieve TN pain but won’t really make a difference if it’s a tooth issue. My endodontist and dentist aren’t quick to do treatment as they have always suspected TN. But the last root canal I had was put off by the endo for months as I complained of pain because of that suspicion and it was actually “ischemic “ when he finally went in to do the RC. He said it looked like the nerve was being squeezed. So now I don’t know who to trust or how to know what to do. I have been following your story hoping you find solutions and I can find similar relief! I understand your dilemma. Hang in there! Can you get a second opinion or see your general doctor for their thoughts? Or do the one thing that seems most urgent and wait on the other teeth to make sure treatment is necessary?

Yes, your story sounds similar! My endodontist seems quick to jump to procedures, but I have to trust she knows symptoms what to look for, because she is supposed to be one of the best in the area. I don't want to get root canals that I don't need, but I am so tired of living with pain, too. I feel bad griping about it, because it isn't stabbing pain, or "get this tooth out of my mouth" pain. It just wears on you after so long, which I am sure you feel also.

I think that if she tells me I need more than one root canal, I am going to find another dentist for a second opinion. There are only a handful within an hour drive that take my insurance, but if I need even one root canal, my insurance is gone anyway, so it won't matter.