What could be causing my pain? At this point I will take ANY suggestion.

[Polarpurplebear]

I know I have a separate thread about high bite specifically but hope it's okay to ask a more general question here. I am literally sitting here crying because I cannot take any more pain.

I have had 3 root canals on my front tooth which began hurting after being fitted with a porcelain veneer. First and second RCTs were done by my dentist and the 3rd by a top endo - he admitted the original job looked perfectly good but re-did it anyway. I am still in pain.

- Xray looks perfect - no sign of any infection or anything that might be causing this.
- A cracked root is unlikely - tooth has never suffered any knock/trauma
- Neighbouring teethare ruled out - all are fine, there's no decay on any other tooth in my mouth

Our latest attempt was to adjust my bite as the affected tooth appeared to be slightly longer/thicker after the veneer was fitted. It now feels less tender to touch/pressure but continues to ache. I will give it time but I just have a feeling that this isn't going to help me.

Does anyone have ANY ideas about what this could be? My dentist is extremely reluctant to do apico as nothing suggests there is any infection at the root. He won't give up on me and is determined to find the cause of this but at this stage I will take any suggestion. I have been in pain for a year, and I am desperate! Please help.

 

[comfortdentist]

Re: What could be causing my pain? At this point I will take ANY suggestion.

As I understand the root canalon your top front tooth looks fine on normalxrays with no widening of the ligament or any periapical lesion and this tooth has been done over 1 year ago and it was a retreatment. If that all is true and the bite has been verified as not an issue. Now there are two possible issues.
1. A low grade periapical infection that you body is fighting so it has never grown beyond the cancellous bone so it is not readily visible in the xray
2.A crack or even a micro crack can cause persistent pain

What to do now?
Reevaluate the occlusion in all .movements.
Take 2 periapical Digital xrays from different angles. Manipulate the settings to try and maximize the information in those radiographs.At times by changing the contrast, value and color in a digital system you might see something that you normally can not see. I am assuming that this is being viewed on ahigh contrast monitor.
If nothing then consider a cone beam ct scan set on limited field at maximum resolution.
I just saw a beautifully performed root canal in a patient where a crack couldonlybeseen in the cone beam ct.
If the cone beam ct is not possible or nothing is gained then explore surgically. I am assuming that the endodontist used amicroscope in performing the root canal.
After all above remove the tooth clean out socket well and perform a bone graft. I would delay implant placement.

 

[Polarpurplebear]

Re: What could be causing my pain? At this point I will take ANY suggestion.

Thank you very much - you nearly have it right! I have been in pain for a year but did not have the RCTs until more recently. The first one was 5 months ago but the 3rd one was only completed 2 weeks ago. All of your suggestions sound ideal - I will wait and give things time to settle down before going down these routes as I want to make absolutely sure I have given it every chance to heal. I feel like I'm an unusual case as I didnt even have an absecess originally - just pain. I have no decay anywhere in my mouth, not a single filling, no gum disease, nothing. Think my dentis is really struggling to work out why I'm having problems here. Thanks again for your advice. I hope I dont lose the tooth.

 

[comfortdentist]

Re: What could be causing my pain? At this point I will take ANY suggestion.

Thank you very much - you nearly have it right! I have been in pain for a year but did not have the RCTs until more recently. The first one was 5 months ago but the 3rd one was only completed 2 weeks ago. All of your suggestions sound ideal - I will wait and give things time to settle down before going down these routes as I want to make absolutely sure I have given it every chance to heal. I feel like I'm an unusual case as I didnt even have an absecess originally - just pain. I have no decay anywhere in my mouth, not a single filling, no gum disease, nothing. Think my dentis is really struggling to work out why I'm having problems here. Thanks again for your advice. I hope I dont lose the tooth.

Two weeks ago then absolutely WAIT. Post root canal pain can vary widely two weeks is not unusual. You could have soreness and inability to chewon that tooth for a couple of months and still be fine at the end. Be patient typically at this point the pain will only get better.

 

[Polarpurplebear]

Re: What could be causing my pain? At this point I will take ANY suggestion.

Thank you...I am trying so hard to be patient! After a year in pain I keep thinking I can cope with more of it, but I just keep thinking it will never end. Nothing has helped so far.

 

[Polarpurplebear]

Re: What could be causing my pain? At this point I will take ANY suggestion.

After my bite being adjusted the pain was the same.
In desperation I put in a whitening tray to act as a temporary night guard - the pain vanished and I had 4 days totally pain free.
Then the pain came back, unexplained - I had continued to wear this temp night guard. My dentist said it was probs because the whitening tray was too flimsy and he made me something specifically for the job. After 3 days wearing it I am no better.
I have now had 3 root canals, a bite adjustment and wear a night guard and am in the same pain I was in before all of them, and a hell of a lot poorer.

I guess I'll give it a couple more weeks before requesting this high tech xray....unless anyone can suggest anything else? I feel so desperate right now it's taking all my energy not to start crying.

 

[Polarpurplebear]

Re: What could be causing my pain? At this point I will take ANY suggestion.

UPDATE MAY2012...

I'm pretty much at the end of my tether - does anyone have any further suggestions?

I ended up having a hightech scan done, 3D of my upper teeth. There is no crack, but the scan showed that the root of my painful tooth is curved and sits against the bone (buccal plate) where the other teeth roots are straight and do not. The endo explained that this could be the cause of my problem e.g. bone against bone has caused bruising, and my grinding is making it worse.
I had yet another nightguard made to stop me making contact with the front tooth at all in the night - it has made no difference.

The endo is now suggesting an apico to remove the root - he thinks this will work but I am TERRIFIED. I am so nervous and this is up there with procedures I do not want done.
The tooth is ALWAYS painful to pressure/touch so I cannot eat on it, and some days it just aches all day long, a sore bruised feeling. Other days it is fine, and on some days the pain comes and goes.

If anyone can think of anything I haven't tried other than, apico, I am willing to listen.

Thank you.

 

[brit]

Re: What could be causing my pain? At this point I will take ANY suggestion.

UPDATE MAY2012...

I'm pretty much at the end of my tether - does anyone have any further suggestions?

I ended up having a hightech scan done, 3D of my upper teeth. There is no crack, but the scan showed that the root of my painful tooth is curved and sits against the bone (buccal plate) where the other teeth roots are straight and do not. The endo explained that this could be the cause of my problem e.g. bone against bone has caused bruising, and my grinding is making it worse.
I had yet another nightguard made to stop me making contact with the front tooth at all in the night - it has made no difference.

The endo is now suggesting an apico to remove the root - he thinks this will work but I am TERRIFIED. I am so nervous and this is up there with procedures I do not want done.
The tooth is ALWAYS painful to pressure/touch so I cannot eat on it, and some days it just aches all day long, a sore bruised feeling. Other days it is fine, and on some days the pain comes and goes.

If anyone can think of anything I haven't tried other than, apico, I am willing to listen.

Thank you.

I can tell you from personal experience that an apico is nowhere near as bad to have done as it sounds/looks. So long as you are properly numbed, it is fine. Access is an important issue and with a front tooth that is easy. You don't even have to keep your mouth open neccessarily, you bite on some cotton wool and they lift your lip back for you so that makes it easier to relax.

However I would probably only have it done in your shoes if I were on the point of extracting the tooth and having an implant. It does sound though as if the bone touching bone could be the cause of the pain and so that is a logical reason to give it a try. Afterpain was minimal with my apico.
Hope this helps a bit. Sounds like you have had a bad time of it.

 

[carole]

Re: What could be causing my pain? At this point I will take ANY suggestion.

polarpurplebear, you have my sympathy, I know what it is like trying to get to the bottom of teeth problems and still being in pain, I am sorry I don't have any answers for you, just and understanding of how the pain can get you down a bit.
I wish you good luck in whatever treatment you decide to have done, and I hope it is successful.

Best wishes

 

[Polarpurplebear]

Re: What could be causing my pain? At this point I will take ANY suggestion.

I forgot to check back on this thread...thank you for your responses, Brit for your reassurance on the apico and Carole for your understanding. The past two years have been so hard, being repeatedly told 'Aha, I bet this is the problem' only to have it fixed and then still be in pain. And it has cost me a fortune and there is worse to come!

I am going to see a bite specialist on Monday - this was recommended to me by someone, as the tooth may still be catching slightly without me really noticing, and I want to rule out any bite problems.

If this doesn't reveal anything, I think it is looking like an apico.

Does anyone (dentists in particular) have any further thoughts, anything at all I might not have done?

It is so hard to believe that this could happen from simply having a veneer, and that all of these experts cannot figure it out. I can't tell you how many times I've wondered if this is all in my head.

I would never in a million years recommend anyone getting a veneer after this. NEVER. I would have rather had my shitty, ugly, yellow front tooth and a crappy smile than go through all of this.

 

[carole]

Re: What could be causing my pain? At this point I will take ANY suggestion.

I really do know how desperate you feel, I am glad that your dentist is trying to help you though. I hope you do manage to get to the bottom of this and I hope soon it is just a distant memory for you, and that you will feel pleased that you did have the veneer.

The very best of luck to you and I hope all this ends soon, it really is depressing and has you thinking it is in your head, but you know what, trust in your feelings and pain, it needs solving, and soon.

 

[goldy]

Re: What could be causing my pain? At this point I will take ANY suggestion.

Hi, I'm new here, but know exactly what you are going through. I had all front crowns over 30 years ago and 6 years ago had an infection right high up in the gum of the second one next to the front. This turned into an abcess and I had to have an apicoectomy. That was honestly not as bad as it sounds. Since then Ive had an infection in the gum that they could'nt reach, and after all this time, it has now started giving me trouble. Ive been on 500mg amoxycillin for 2 weeks and Im in pain, but will not let the dentist do the root canal he keeps on at me to get. I honestly think taking off a crown and opening up the root after all those years is asking for trouble. I worry (and he told me this could happen) that the original crown post will break and I will then have to have either a bridge or a false tooth. Im hanging on to see whether the infection clears on its own without resorting to root canal. I could write a book on my life in the dentist chair. When I was 17 I was talked into having a crown on a bottom tooth, that got infected due to the inadequate dentist and it got abcessed. The pain I will never forget (worse than childbirth), and I was rushed to hospital where the dental students proceeded to remove ALL the left side of my lower teeth!!!! they made a mistake and ive had to have a bridge ever since.The cost of all this has run into thousands. Moral of my story is, NEVER have crowns or veneers just for vanity. The long term problems are just not worth it.