Dentistry/What can be the reason of pain?
QUESTION: Hello Jeff. I hope you could help me to find out my tooth problem or give and advice.
One year ago i got a filling for a tooth – after that the tooth was ok for 1 year.
Recently, after i put an implant on another side of my mouth, i started to use my opposite jaw for chewing more often. And the tooth im talking about is right on the opposite jaw. This tooth started to have pain again (like it did 1 year ago). The pain is small and constant and gets worse when pressure applied. It seems to come out from the inside of the tooth.
I consulted 2 independent doctors in 2 different countries. Each of them said the the tooth seems absolutely ok after looking at the x-ray and the tooth itself. But it's not ok, as there is still pain which sometimes gets worse. But none of the dentists found the reason. One of them just advised to use a toothpaste for sensitive teeth and that's it.
Im currently living in a country which is poorly developed and the dentistry here is quite bad. So i cannot find a good dentist here. I can only do simple things like put a filling or a crown here. I wouldn't do endodontics or implants here. I won't be able to go in a country with a high level of dentistry for the next year. That's why i decided to consult you and i really hope that the reason of the pain can be found in such a way.
Help me to find out the reason of the pain. What actions can be taken to find out the reason?
Another small detail –the tooth with the problem is a little bit lower than it should be because the tooth under it was extracted and replaced with an implant only 1 year after. So during this year the upper tooth got a little lower than it should be.
Please have a look at the X-ray of the tooth - the link is here. http://www.youpic.ru/view.php?id=2013/07/13/8788867295.jpg
The tooth I'm talking about is number 6, the second one from the left side, the biggest one.
ANSWER: from what you describe, one possibility could be what we call cracked tooth syndrome or incomplete tooth fracture. there could be a cracked corner (but it sets in there intact). when you hit it in the right place it can cause sharp pain. it generally will not hurt by itself. it can hurt with cold. does this sound about right? if so, the treatment is a crown. the crack is usually not deep and does not require root canal. occasionally the crack can extend deeper and then there is a risk of needing a root canal.
the way to test for this is for the dentist to use a bite stick and test each cusp of each tooth.
i do not think the supereruption is the issue here...it has not moved that much yet.
root canal symptoms are usually heat sensitivity, spontaneous pain, referred pain down below, etc.
see if this information helps. good luck.
jeff dalin, dds
---------- FOLLOW-UP ----------
QUESTION: Thanks a lot, Jeff.
You know, the pain sometimes get worse after i have something cold or hot, but not significantly. It doesn't get worse too much. Hot drinks or food only never were the reason of this pain.
The pain is mainly in the corner of the tooth which is closer to my right side. Left side has non or little pain. So i think this really can be the cracked corner you wrote about.
Am i right to understand that before putting a crown i have to cut down the tooth?
when a crown is done, the tooth has to be prepared so that the crown can be placed. preparation involves reducing the tooth around 1.5-2mm in all dimensions. so the answer is yes, the tooth is cut down. this is done to make room for the crown. good luck
jeff dalin, dds