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QUESTION: I had a root canal on #19 molar three weeks ago and was in pain a few days afterwards.  Since then I have had no pain until last night when I mistakenly bit down on something.  Now I feel like I have nerve/toothache like pain, but the nerves are dead.  I'm starting to panic because of the holidays.  Why am I having pain?  Does this mean I may need an apico?

thank you.

ANSWER: Sharon - I cannot tell you exactly, but when a pain begins with a bite down there a few of different causes.

1) there is a possibility that a crack in the tooth occurred, though that would give you pain, especially when you bite down.

2) the ligament that holds the tooth to the bone that surrounds it might be swollen.  If this is the case, when you bite down the area is often sore.

3) there is a chance that the root canal within the tooth is still inflamed and at the end of the root there is significant inflammation or a small infection developing.  Then an apicoectomy might be necessary.

4) the final possible cause is simply that your bite is off.  

I, of course, cannot tell you which one is happening, but I can tell you that it is important to get back to the doctor who did the root canal treatment as soon as possible to diagnose a potential problem.

I wish you well and hope this all blows over and goes away on its own, but most likely you might need some treatment.  If you have additional questions, feel free to contact me again.

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QUESTION: Dear Dr. Teig,

Thank you for your prompt response and all the possibilities that might be happening.

I went back to my dentist yesterday.  I explained everything to him.  He took  another x-ray and he said it looked perfect.  He said there was no crack in the tooth.  He said gums look good.  He checked the bite and it was also good.

There is no pain when I bite down on the tooth.  He put a piece of cotton in between top and bottom.

He did say your #3 answer is a possibility and gave me amoxicillin in case there is a start of an infection.  He said an apico is a possibility, but not so soon.

You have me a little worried when you said "most likely I might need some treatment."  Are you talking about the apico?  What other treatment can I have?

By the way, I was diagnosed in 1982 with atypical trigeminal neuralgia and if I have a problem that is the first thing the dentist will say to me.  "Maybe it is your neuralgia."  I don't know the answer to that, but usually my facial neuralgia pain is upper face, not lower...and my neurologist is baffled when I have facial pain after simple or complex dental work.

I'm not sure if you can help me anymore than you have, but I would appreciate any more answers you might have.

Thank you so much for volunteering your time and helping me and other patients.

ANSWER: Sharon - The treatment I remarked about could simply be the antibiotic now and have the dentist evaluate the area again.  Sometimes something as simple as the antibiotic will cure the problem, but it is important that you repeatedly see the dentist until all the pain is gone.

I hope the area gets better and nothing needs to be done, but it is important that you have your dentist evaluate the area until all symptoms are gone.  

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

QUESTION: Dr. Teig,

I am back in the same pain again.

I was prescribed amoxicillin and it took my root canal #19 pain away while I was on it (it took a few days) and continued to feel OK a few days after the antibiotics.  The pain is now back.  It started a few days after the antibiotics were stopped.

I called my dentist and he said he wanted me to try another round of antibiotics, this time Clindamycin, and get back to him in a week.

Does this mean there is an infection there?  Do I go spend another $1500 and have it redone by someone else? Or have an apico?  I am completely lost.  There is no pain when I push down on the tooth.  The gums are fine too.  If it's ligaments, how does one get rid of that problem?  I'm once again desperate.

Thanks,
Sharon

Answer
Sharon - I wish I could give you an answer that would definitely produce a resolution of your pain.  The fact that the antibiotic treatment helped means that there is some type of infection brewing.  Is that infection within the tooth, in the surrounding tissues or in the bone? I just cannot answer that.  If your dentist does not come up with a solution to arrest the bacterial induced problem, seeing a specialist is probably you best solution.  So if the dentist does not give you an answer or the pain returns and he tries the same antibiotic treatment again, make an appointment with an endodontist (root canal specialist)to evaluate the problem.

I hope the pain resolves on its own.  If you have additional questions, I am always available.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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