Expert: Mark Bornfeld DDS - 4/11/2009

Question
Dear Dr.
 I have a toothache that is a lot like the pain I have had in the past and ended up with root canal.  I don't have the normal hot/cold reactions and when I saw the dentist he took an xray.  I am a new patient for him and without comparisons he felt the exray showed it to be one of my front teeth.  BUT when he tapped on them the one that hurt most is not the one he thought so he did nothing.  Well actually he did file down the front teeth thinking it could be my bite.......how long can a tooth take to die....I am at a point now (2wks later) wishing for a full blown abcess so I would know which tooth it is.  Also, isn't there a better way to determine which tooth it is?  Thank you for any advice you can give,

Answer
Dear Patricia,

Actually, the most accurate way of determining which tooth is responsible for a patient's specific complain is to sequentially apply the offending stimulus to each tooth, one tooth at at time. For example, if a patient complains of sensitivity to cold beverages, the dentist applies a cold stimulus one tooth at at time; if a patient complains of sensitivity to biting pressure, the dentist taps on each tooth, etc. This may seem primitive, but it is the most direct way of determining the tooth responsible for the patient's complaint. The use of x-rays may be misleading, because of the possibility of co-existing dental disease that is unconnected to the complaint. After all, the first priority is to get the patient out of pain.

The difficulty in your case is that sensitivity to percussion is a non-specific sign that can reflect a variety of different maladies-- a pulp infection, a periodontal inflammation, injury from excessive force ("occlusal injury"), or a fractured tooth root. These problems all call for different treatments, and you risk implementing the wrong treatment if you randomly treat the tooth before the problem has been conclusively identified. Adjusting the bite of the tooth is a rational first step, because it is a conservative measure that does not eliminate the later possibility of other treatment modalities should it fail to eliminate the pain. In fact, this is probably the same thing I would have done if you presented at my office.

However, it is true that if you have not experienced any relief a full two weeks after the bite adjustment, it's probably not going to happen. In situations like this, if I am unable to identify the problem, I send my patients to an endodontist (root canal specialist) for more diagnostic testing, and that is what I would recommend for you. Assuming your general dentist has reached the limit of his diagnostic rope, you would not be out of line asking him to provide you with a referral to an endodontist.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY