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Dentistry/Irreversible pulpitis or neuralgia

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QUESTION: I started having pain in tooth#10 along w/ nausea. Dental X-rays looked good but 3d X-ray showed abscess at tip in bone. Tooth had root canal 32 years prior. I had tooth extracted but pain continued shooting up towards my nose. Endodontist thought tooth #12 could be the problem as it had a dark spot in the bone beyond the tip as well. It had a root canal 16 years prior. Extraction was uneventful but I got really sick and my primary care Dr put me on antibiotics for months.While on antibiotics no pain. Now I feel pain in tooth#9. I chipped bottom of it over forty years ago.It has had crowns replaced on it twice and it shows quite a bit of calcification and the nerve has shrunk up. My endodontist thinks I have neuralgia. I have no facial triggers, just a burning ache in this tooth that radiates upwards. I have had an MRI and CT scan that ruled out MS, stroke, sinus issues, etc. A neurologist and a pain specialist do not think I have trigeminal neuralgia. No one wants to treat or remove this tooth yet I am in constant pain and can't take much more. Do you know of a good oral surgeon I could consult in the pacific northwest?
If it is neuralgia I don't want to have an unnecessary treatment but I don't want to continue suffering either. There is a dark space between the cap and my gum, like the tooth or gum has moved. It isn't sensitive to percussion but if I touch it to my bottom tooth the pressure makes it burn. Also if I press on my cheek between my lip and eye there is a slight popping noise on the same side as the painful tooth. I need implants and I'm not sure who to go to for those either. Thank you for any advice you can give me. My oral surgeon retired years ago, I asked him for references in our city and he had none. Which is kind of sad. He was an MD and I trusted him very much.

ANSWER: Rebecca - I wish I could just read the paragraph you wrote and come up with a simple answer, but by now, I am sure that you are aware that the reason for your pain appears not to be a simple one.  I agree with you that you need an oral and maxillofacial surgeon to evaluate you.  

The one question I have is where you live.  I ask that because there are quite a few surgeons who I know of, but I'd like to find a board certified oral and maxillofacial surgeon near for you.  I see that it says on this question that you are Colorado, but you ask for a surgeon in the Pacific Northwest.  That is not a problem, but I wanted to make sure.  So if you could, get back to me and let me know an area you would be interested in seeing a doctor.

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QUESTION: Dear Dr. Teig,
I sent you a private message as to where I live. I hope you get the information ok.
The pain in that tooth gets worse as the day progresses. Laying down on my back and resting seems to help. Doing pushups makes it worse. I asked my dentist if there could be decay under the crown. It is 20 years old, porcelain bonded to metal. Some vibration was noted when I close my teeth but he said after all these years it shouldn't be a problem. My top and bottom teeth meet end to end. Not a great bite really.
The pain feels like a burning and some throbbing. No "electric" shocks like people with TN experience. It feels similar to the pain I had in the root canaled tooth with the bone abscess at the root tip. This tooth tests vital as I can feel cold. So the question is, can a dying tooth act this way? How long can this go on before the tooth dies? Does the fact that it is calcified and that it had trauma 44 years ago concern you.
I look forward to your response.
Thank you in advance for your time and thoughts on this matter.
Rebecca

Answer
Rebecca - I have sent you the name of the doctor I suggest you see.  Your description of the pain does not sound neurological in origin.  If it is an infectious process, the bone surrounding the root of the tooth is made up of chambers of bone.  The main problem with antibiotics is that the blood vessels taking the antibiotics to the infection are often not as capable of transporting antibiotics to fight and infection.  The best way to establish drainage of some type to allow drainage and reduce the infection and relieve the internal pressure pain.

I don't know what the doctors have suggested in the past, but I think that you should immediately begin warm salt water rinses (teaspoon salt in glass of warm water) and rinse for a minimum of 5-7 minutes in the area of the pain, at least 4-5 times a day.  This may or may not help, but if the problem is due to a trapped infection where antibiotics cannot get to, then is should improve the situation.  The warm salt water helps to provide drainage.  This will not happen overnight, but usually, if it will help, it will take at least a week.\

I really wish you well and hope this will help to calm the area, but I suggest that you have the doctor I suggested examine you.

Rebecca - the doctor is Dr. Bradley Turner
         (206) 787-5322

this number is for the residency program he is chairman of.  Call the number and ask to be seen by him and not a resident.  I hope he can help you.

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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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