Root Canal Needed or Sprained Ligament?

[AlisonJ]

I have a crowned molar supporting one end of a bridge (bottom RHS). It has given 33 years service! In May, during Coronavirus lockdown, I started to get an ache in that area of my mouth which quickly escalated to a burning, stinging sensation in my face, more pain in my lower jaw, up in front of my ear to the area of my TMJ, into my temple, across my cheekbone and a one sided headache. All dentists were closed. I managed to speak to a dentist at my practice who suggested antibiotics which didn't help. I spoke to another dentist a couple of weeks later who said maybe a TMJ injury - I then remembered that a couple of weeks before the trouble began, I had somehow managed to crash my teeth together on that side, while eating and thought I must have broken the crown on the tooth but no damage seen and apparently, no harm done - so thought this might be the case. When I was able to see my dentist again in July, he found a small area of decay at the crown margin which he filled. After this, I felt as though I had been punched in the jaw and couldn't touch my jaw area without it hurting - this lasted several days. Now, when I eat on that side, I get pain in that crowned tooth. I was still getting the face pain so went back to my dentist and he found a small crack in a tooth above but not touching the crowned molar - he removed the old amalgam filling and replaced it with a white filling. This tooth is still tender to eat on but seems to be getting better. Meanwhile, suspecting TMJ problems or clenching at night, I bought a moldable mouthguard (put in hot water type) and this seems to have resolved my face pain. But, what this great long essay has been leading up to is that my dentist is suggesting root canal through the crown on this molar to resolve the pain - but I am so scared that this may not be the right solution and I might go through all this for nothing if the problem is actually with a ligament. I have read quite a lot on this forum and note that, I have a constant dull ache under and around this tooth, I have pain if I eat anything hard on this tooth, chewing makes my face ache afterwards and swallowing hard hurts when I press my tongue against the inside of this tooth. My dentist has done x-rays and the root area of the tooth looks healthy (he says) but the top of the tooth is obscured by the metal lining of the ceramic crown. Please, please can you give me an opinion. Root canal needed? Or is it ligament and if so, what can I do to help myself. My dentist has said that he will make me a mouth guard at my next appointment if my face pain is still better with the OTC mouth guard. Thank you.

 

[Gordon]

I might be misreading this, but you seem to be saying that it's improving with the mouthguard and that your dentist says that if it keeps improving then they'll make you a better one, if it isn't then it might be necessary to do the RCT?

Doesn't sound unreasonable to me.

 

[AlisonJ]

Thank you for your reply Gordon, much appreciated. Yes you are right face pain has improved but not the crowned tooth. I am a very anxious patient and I suppose what I'm saying is that I'm hoping against hope that it wont need RCT - my dentist hasn't mentioned ligament sprain and I haven't mentioned it to him as I only read about it after my last appointment. From what I have read, it seems that nerves in the tooth are different from those serving the ligament so I'm also worried that I might have RCT but still have pain if it is ligament. So, I was wondering how long it might take for a ligament problem to resolve and if there was anything I could do to help healing? My dentist also said try to eat normally and I read here to rest the tooth by not eating on it if it is ligament?

 

[Gordon]

The trouble with this kind of vague pain (sorry, not having a go at you!) Is that there's really no simple way to diagnose it, other than by eliminating each cause separately.
If the splint fixes it, then it's more likely to be TMD/ligament issues, if not then it may be that the nerve in the tooth is dying and RCT is needed or it might be both!

I'd eat a fairly normal diet but just try not to batter lumps out of the tender area whilst doing it