Worried about a sore lower molar suddenly sensitive to pressure

[Karenw]

I'm worried.....

I've had a vague sensitivity to pressure in my lower right jaw which, over the last 2 weeks has settled specifically in the lower #7 molar. It isn't throbbing and doesn't have nerve-pain or typical toothache but just doesn't feel right. Pressing the full surface of the tooth causes some intermittent pain but pressing on individual cusps produces a deeper sharper pain, although not always. Tapping the biting surface sometimes produces a slight sensitivity but no sensitivity when tapping on the side of the tooth. The tooth isn't abnormally sensitive to temperature.

As far as I can see, the tooth is in good condition. It was crowned with CEREC 5 years ago and the crown looks intact. There is no tenderness or swelling within the gum. There is an impacted wisdom tooth adjacent which sometimes feels a bit sore but never any gum swelling etc.

My fear is a pulp infection within the tooth needing a root canal and I'm terrified. I am very dental-phobic and panic even during check-ups so the thought of a root canal is a step too far and I'm wondering if there's anything else it could be.

Coincidentally, two years ago in Feb/March I had a spell of 4-6 weeks of sharp nerve toothache in this tooth and the adjacent #6 which was tentatively diagnosed as trigeminal neuralgia and it vanished, never to return. Then last year, same time of year, again I had odd pains in these same teeth which settled after 1-2 weeks but I don't recall any sensitivity to pressure.

I will be contacting the dental surgery on Monday and hoping to get it x-rayed this week but I always need to be prepared.

Could it be anything other than pulp infection/inflammation with an outcome other than a root canal?

Thanks for any thoughts or suggestions.

 

[Gordon]

Could be bite trauma from clenching/grinding causing a bit of inflammation, hopefully the x-rays will give you some answers.

 

[Karenw]

Thanks for your input. I don't think I grind or clench my teeth - at least not that I'm aware of. Or maybe I wouldn't know...?

I underwent quite a detailed bite analysis some years ago then equilibration because I was previously breaking all of my molars.

It's a much more positive angle to think about than what's being going through my mind and I'm hoping to arrange an appointment and x-rays this week.

Thank you.

 

[Karenw]

I've just returned from the dentist who x-rayed my jaw and, bad news, I have an abscess (lower right #7).

I'm hoping to arrange a 7-day course cephalexin from my GP surgery and a local pharmacy tomorrow then I have my first drill appointment on the 26th. To say I'm dreading it all is an understatement....

I noticed that on the earlier x-ray (with fillings not CEREC crowns) there was also a shadow beneath the same tooth and the dentist suspects the cracked tooth also extended into the root leading to a persistent low-grade infection which has flared up several times and been misdiagnosed as trigeminal neuralgia.

 

[Gordon]

Thanks for the update, it's annoying when people don't follow up on these things.

Good luck with the root treatment, I hope it works out for you.

 

[Karenw]

I always strive to update to share an outcome, particularly when the diagnosis isn't quite as expected, ie an infection/abscess which may have been in place for +6 years with occasional flare-ups.

I'm starting the antibiotics now (250mg cephalexin) although I note some sites suggest antibiotics for dental abscesses can be controversial.

 

[Karenw]

An update....

I didn't get on with Cephalexin so took advice from NHS111 who referred me back to my GP surgery who agreed I should stop - to my relief. The antibiotics had become more of a worry than the dreaded root canal.

Having got much of my worrying out of the way in the previous two weeks, I attended the surgery for the root canal treatment (26/2/19) and although my normally low BP was soaring and pulse racing, I was relatively calm - on the surface, at least.

The dentist confirmed there was no need to take antibiotics and they were simply to 'keep me comfortable' while awaiting the appointment.

The local anaesthetic injection was painless and my tooth quickly became numb. Having never previously been numbed for this tooth, this had been a worry but I was assured a different technique is used for root canals.

To my relief, the drilling was painless. Mostly this was via a standard drill but once down to the pulp switched to a very gentle fine titanium drill which just had a light buzz and no pain or vibration. However, what I couldn't tolerate was the use of the small files used for cleaning inside the canals. These are held in the fingertips but I have a small mouth and the dentist was working on my LR7 tooth right beside my jaw joint at the back of my mouth and I found it very uncomfortable, very invasive and a bit 'gaggy'. I wasn't tolerating it at all.

At one point the usually-calm dentist dropped a file, visibly panicked, and I felt it close to my throat. He reached in and retrieved it quickly - phew. Then it happened again. I felt the file drop so sat bolt upright fast and spat it out. Had I inhaled it then the dentist said I would have been off to A&E requiring emergency lung surgery. He said it was too dangerous to continue, the tooth which had a partial cleaning of one canal was sealed up and I was referred to another dental surgery for IV sedation as the only way to continue. Having psyched myself up for it, it was terribly disappointing and a huge backwards step for me. My tooth and jaw have been very sore and sensitive since and, I'd now hoped to be half-way through my root canal treatment but now the start is still +2 weeks away.

It's also becoming a very costly journey - with this 20 minute aborted appointment setting me back over £100, a further £135 for the referral assessment and £400 for the sedation in addition to the expected root canal costs. I just hope it all has a happy ending.

In the meantime, the positive that I can take from this is that the drilling for a root canal is nowhere near as bad or as lengthy as I'd worried about, and once inside the root canals, there isn't the feeling of drilling deep into the jaw that I'd feared. The cost has escalated far beyond that which I'd expected, however.

I will post an update following the sedation and hope this will be a positive experience.

 

[Judythecat]

Oh my gosh, this sounds awful. I thought the rubber dental dam was used to prevent this exact scenario! I really hope the treatment at the other surgery goes well for you.

 

[Karenw]

I thought the rubber dam would be used too and had been bracing myself for it. I suggested it after the two files were dropped but the dentist said I was likely to find it too gaggy for a tooth right at the back of my jaw.

I was very disappointed to emerge with a very sore tooth, large bill and another 3 weeks before the first stage of treating my abscess (which flared up at Christmas).

 

[Judythecat]

I thought the rubber dam would be used too and had been bracing myself for it. I suggested it after the two files were dropped but the dentist said I was likely to find it too gaggy for a tooth right at the back of my jaw.

I was very disappointed to emerge with a very sore tooth, large bill and another 3 weeks before the first stage of treating my abscess (which flared up at Christmas).

Honestly, I would have walked out if no dam was used. As well as stopping falling files, or you swallowing chemicals, my understanding is that it keeps the open tooth sterile from saliva etc, and is really important. I was so nervous about having it for a root canal on the matching upper tooth to yours, but the endodontist said there was no way he would do the work without it, and he would send me back to my own dentist for an extraction. In reality, it actually made me feel like that tooth was not really “part of me”, so it was a lot easier than expected. From memory (it was last year) I think the frame it’s attached to helps keep your mouth open too.

It sounds like you might have had a lucky escape, in a horrible roundabout way. I hope your wait goes by quickly, and the treatment works well.

 

[Karenw]

I thought he would at least try the dam particularly as I'd suggested it myself after the two files were dropped and wanted to try but he ended the appointment and referred me on instead.

Today I received the bill for the 20 minutes - a whopping £213.50 which is more than half the cost of the full 1-hour appointment had it continued. I felt this was excessive, and said so, but there was no scope for any negotiation. I assumed I would be charged for the time pro-rata. Very disappointed - it might have worked with the dam.

 

[Cj626]

Yikes! I'm so sorry, sounds horrible and I would dispute the bill! I love the dental dam. Never have had a gag reflux from it and puts me completly at ease. He should have not even attempted a root canal without one! If you can afford it, go to an endodontist, I am AMAZED at how quickly they perform root canals. I had a molar root canal done by an endodontist and it took from start to finish 30 minutes and zero pain during or after. Root canals should not be painful or stressful if done correctly, best wishes to you and please update !

 

[Karenw]

I was very unhappy with the appointment and felt I hadn't been given a chance in trying the dam. This has also been a huge knock to my confidence and I now also have a new fear of dental instruments in my throat. A small step forward but a larger step backwards.

The referral is to a specialist centre offering sedation and the dentist I am seeing is not only a dentist but also a qualified doctor and surgeon specialising in maxillofacial surgery. I asked if he would be using a dam and he said he always does. I am uncertain whether he is an endodontist but he, and the practice, are very experienced in doing root canals and are the referral centre used by 80 local practices which is encouraging.

There is a specialist endodontist practice near the referral centre (both are 2h from home) but this doesn't offer sedation. I don't know whether I need sedation or not - I was coping with the aborted appointment - just. Now, after the earlier bill, I can't afford any further failed appointments so, on balance, it's probably better to try with sedation to give myself the best chance. If I don't handle it then I'll have to call it a day with the tooth and have it extracted while under sedation.

D-day is 19/3. I will update afterwards, once I've recovered.

 

[letsconnect]

Root canal treatment without a rubber dam is a big no-no - obviously because of the issue of accidentally dropping files, but also because of the bacteria in the saliva recontaminating the tooth.

Anyone would have panicked under the circumstances you've described (no rubber dam being used and files being dropped repeatedly). There was a widely-reported accident a couple of years ago where a file was dropped down a woman's throat and piercing her stomach, so one would have thought that by now, all dentists would use a rubber dam for root canal procedures, but sadly (as your experience shows) this is still not the case.

It's really sad that this experience has knocked your confidence - it sounds like you've been doing really well up until the point where he kept dropping the files. Maybe you could reconsider the endodontist option, even if they don't offer sedation? The results (especially for molars) tend to be more predictable and successful when done by an endodontist who has access to an operating microscope, so if you can afford this option, it may be worth reconsidering. If the endodntist practice has an email, you could try getting in touch with the dentist there to get a feel for what they're like.

Wishing you all the best regardless of which option you go with

 

[Karenw]

Good advice re trying an endodontist. However, with the cost of yet another assessment (£150-200) plus the cost of each appointment (£700-£1k), if it didn't work without sedation, I wouldn't be able to raise any further funds so would be stuck. Already, the tooth is costing at least £1375 (excluding crown) due to the sedation referral. The original cost was £750 so it's almost doubled and, because I'm not working at present (frail elderly parents need help) this is being funded via the mortgage.

I'm just hoping the sedation works and I can cope with the procedure without gagging (LR7 - the back double-molar). This has become my biggest fear now.

 

[Judythecat]

The costs you have been quoted sound quite high, and I would second the advice about seeing an endodontist. I was referred for an upper molar - the cost was £50 for the consultation, and then two appointments which totalled about £800, but if it had taken ten appointments the cost would have been the same. I had the crown done by my own NHS dentist, which was £85 (I’m in Scotland, so different charging system). The guy I saw did the majority of the work using a microscope, teaches at the local hospital, and made me feel so comfortable. I was also 100% confident in him, although I was really nervous about seeing a new person. I think the sedation really bumps the cost up?

 

[Karenw]

Yes, the sedation starts at £200 and a consultation is £150-£200. Because I couldn't handle the fingers with files so deep in the back of my mouth, my worry is if I took the endodontist route (which is much more expensive) and I had the same problem with him without sedation, then I have no further options other than living with the abscessed tooth for another year or so until I can make another claim on the mortgage. I've already had the sore tooth since Christmas (plus years of pain flare-ups before the abscess, shown on 2009 and 2013 x-rays was diagnosed): it's tender to touch with my tongue, obviously can't chew on it, sore to talk, jars when walking and I really want it to be treated now because the worry over it all is wearing me down. I've already come to the conclusion that if I can't handle the treatment via sedation then there are no other routes to take (at least none I can think of) other than extraction while already sedated as a last resort.

There is no NHS dentistry at all here so it all has to be paid for privately. I've already paid two dentists now which has doubled the cost due to the aborted appointment costing £213.50, so I can't really afford bring a third into the equation.

You are so lucky to have access to NHS dentistry - as well as living in stunning Scotland!

 

[Judythecat]

I had sedation when I was about 17 - all I remember is coming to and the dentist was playing a CD I had in my bag. Apparently I had told him his music (classical) was rubbish! My dad was with me and completely mortified...!

I am really, really lucky to have a great NHS dentist. My surgery is mainly private, but because I was previously registered as an NHS patient before it changed hands, I remained an NHS patient.

I sympathise about the cost. I spent thousands last year between that root canal and a retreatment, both done privately, plus a load of other work. Mine was all linked to clenching my teeth, which essentially smashed up my molars. The clenching was due to stress, because my partner had been made redundant and it was all on me to carry the household. The financial worry did not help! (He is working again now, thank goodness.)

 

[Karenw]

My husband would empathise with your teeth clenching and grinding. He ground all his teeth down to short stumps and they had be crowned or rebuilt at a cost of... wait for it... £14k. Luckily he was in a well-paid job at the time.

I've had sedation once before too - for some fillings back in 2013 but I was far beyond any conversation and felt I'd had too much (8mg?).

https://www.dentalfearcentral.org/forum/threads/my-iv-sedation-experience-for-4-fillings.5361/

 

[Judythecat]

My friend had it around the same time as me - this is about 20 years ago - and didn’t get collected. She went straight to a cheesemonger and bought £30 worth of different cheeses! We were students, so that was an actual fortune. And a lot of cheese.

I am a nervous patient, but my fear is really needles rather than dental treatment, so I have never had it again since. One of the nurses has to hold my hand when I get local, which I should be embarrassed about, but I no longer have any shame!