Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 12/5/2009

Question
QUESTION: I had a sports injury in Sept.  Several weeks following the injury, I began to feel a burning sensation in the gums in front of and behind teeth #7 and #8, in addition to sensitivity when biting down.  In October, I had a root canal performed on #8.  The endo suspected #7 might need one, too.  Seven weeks later, #8 feels terribly sensitive to the slightest pressure and, worse, the burning sensation has expanded to gums surrounding not only #7 and #8, but also #9 and #10, as well as my top lip.  After a few weeks of persistent pain, my first endo referred me to an oral surgeon for an apicoectomy.  Went to the oral surgeon who told me to hold off as sometimes pain resolves on its own.

Now, am seeing another endodontist (highely credentialed) who sees that there is an overfill of #8.  She also suspects that #7 needs a root canal.  She took a new x-ray of #8 and sees no obvious problem other than overfill. She has suggested that the combination of trauma (3 months ago) and root canal (performed 7 weeks ago) caused (temporary) damage to connective tissue and that this, plus the overfill, plus the problem w/root #7, are all factors contributing to pain.  

What is most unbearable is not tooth sensitivity or pain but is the burning sensation in the gums surrounding #7, #8, and more recently, #9 and #10.    

QUESTIONS:  1) Of the 3 factors discussed above (trauma, overfill, an adjacent tooth in need of an RC), what would most likely be the cause of intense and worsening burning feeling in the gums (a feeling that preceded the initial root canal but was less intense than at present). 2) When a tooth needs a root canal, is one of the symptoms a burning sensation in the gums?
3) If so, could such gum pain refer or spread to gums surrounding adjacent teeth?

ANSWER: Julie -  Gum pain is rarely associated with the need for root canal.  Let me better define what I mean as the gums.  It is only the tissue that surrounds the crowns of the teeth.  It does not extend up higher, on the upper jaw, past the crowns.  Burning is also not a common symptom when root canal treatment is needed.  The most common symptom of the treatments you have been rendered would actually be sensitivity or pain when touching the teeth.  If there is swelling high up on the soft tissue above the crowns of the teeth, then it could be do to the root canal treatment excessive fill.  

I don't know.  It just seems like your symptoms are not completely from the teeth.  I think you should get back to the oral surgeon.  You need to see a doctor not focused on the root canal treatment to more objectively examine the area.

I wish I could give you a more definite cause and answer, but without an exam it is a little difficult.  So get back to the surgeon.  I wish you well and hope they can find the cause.

---------- FOLLOW-UP ----------

QUESTION: My endodontist is ALSO an oral surgeon who performs curettage and apicoectomies.  As mentioned, she thinks the RC is overfilled.  The burning started after the trauma but has intensified and spread to additional areas post-rc.  My gums look fine.  Are you suggesting I should see a neurologist?

Answer
Julie -  I am a little confused.  An endodontist, although they attempt apicoectomies and other minor surgeries are not board certified oral and maxillofacial surgeons.  As such, I'm not sure the knowledge of your doctor.  She may well be a board certified oral and maxillofacial surgeon. If not then see a board certified oral and maxillofacial surgeon or do see a neurologist.  Seeing an endodontist for this type of problem is most likely beyond their knowledge.