Dentistry/Post Root-Canal Pain
I have asked you a question before. I have had several issues going on since then to which I have been trying to determine if it is a dental issue, a nerve issue, or both.
Here is my history on the one tooth which I asked you about before.
1. Starting in March I noticed I was having sweet sensitivity in a tooth on left side, now I now it was tooth #20.
2. On May 7 filling on tooth #20 fell off.
3. Had filling replaced twice on #20 which each time only increased pain, to where it went from only when biting to all the time and sensitivity to hot/cold.
4. All x-rays seemed fine.
5. Went to endodontist on 6/13, he did x-rays and didn't see anything wrong, but tested all the teeth and said pulp on #20 was so inflamed I needed root canal, I asked about possible crack/fx in that tooth and said he would see it on microscope during root canal.
6. Had dull pain the whole time still after root canal that never really went away.
7. Was getting pain in top teeth for unknown reason--now I think my trigeminal nerve was irritated from root canal and then subsequent temp crown placement(6/26) as this has happened before after getting several fillings done in a short time span, went to MD about this and a month of Neurontin seems to help. Also had bad headaches/jaw pain/ear pain.
8. Before getting temp crown done dentist took x-ray and saw shadow under #18 and nothing wrong with #20 or top teeth. Saw endodontist about #18 and everything else, said #18 needed filling, everything else looked fine.Saw MD next day for Neurontin due to extreme unknown tooth pain/jaw pain/headaches and earache.
9. Got filling on #18 on 7/7
8. Been chewing almost completely on right side for 3 months so feel like headaches/jaw pain was due to this as well--has since mostly resolved with occasional pains but MD still wants me to now see ENT- go on 7/14.
9. Slowly started to eat on left side, pain has been more frequent since that, I notice I have pain more-so after I am done chewing. If I put direct pressure on #20 with my finger the pain seems to shoot once I release pressure. I also have pain if I press on gums further below where tooth meets gum line. Also notice pain with talking at times when there are words that create more vibration.
10. Since Neurontin has seemed to take care of most of the other pains I have been having I think that was all nerve related, hopefully just irritation of trigeminal nerver and not the start of Trigeminal Neuralgia, but that is more of an MD issue that I know you can't really help with.
11. Starting to wonder if I have a cracked root on #20 that just cannot be seen since I am still having pain a month past root canal and that the temp crown seems to be fit fine. Plus the symptoms I have been having pre and post root canal.
12. I have not gotten perm crown on yet due to the fact of the pain and my dentist doesn't seem to think its tooth related. I have already paid in full for the crown but I know if I have a deep root crack I will still have pain regardless and would need extraction.
13. Is there anyway to tell if my root is cracked other than actually extracting it, if ENT did CT of my head and neck would it show, even if he were looking for other issues?
14. If I called you as my endodontist with these symptoms would you future investigate this as a possible cracked root?
15. Do you have any idea as far of since I already paid for crown but I did not have it put on and it was found out I need extraction, am I out of luck for any type of refund?
Sorry for such a long post but these last 3 months have been very frustrating and I am really sick of instant breakfast, yogurt, soup and applesauce. I was originally scheduled for perm crown on 7/21 but I rescheduled for 8/5, I have been delaying due to pain and was scared that getting perm crown put on would only cause more pain and I have a trip scheduled on 7/29-8/3 and didn't want to be stuck in bad pain during it.
I have a panoramic x-ray that was done before getting root canal by oral surgeon that I went to for the jaw pain/headaches. But it's not the best quality and it's prior to root canal as well.
I'm sorry to hear all this is still going on. No wonder you're frustrated and looking for answers. It seems that your questions are really can we diagnosis a fracture without extracting the tooth and would you be able to get a refund? As far as diagnosing the cause of all this, without examining you, I really can't help there. A cracked tooth is always a possibility in situations like this where pain remains when you should be feeling fine. You obviously have a complicated problem. As you also said, the panorex x-ray you have is really not much help at this point and they are not useful to exam any problems at the end of roots...they are rally designed to get a good look at anatomy and overall status of your mouth. So, let me answer your questions....
Fractures can sometimes be diagnosed by using an MRI machine. Some dentists have them but they are pretty scare still as they are quite expensive. Endodontists and some high tech general dentists might have an MRI, but you would need to call around in your area to find one. They are not 100%, but much better than a regular x-ray.
As for a refund, that would strictly be between you and your dentist. Your dentist has spent time working with you and has paid the lab bill for your crown. What he/she can negotiate is the profit built into the fee, but even there, he/she has paid staff salaries, and all the other costs of keeping an office open, so it becomes a matter of negotiation.....there are no "rules" in cases like this.
I hope this helps. Good luck!
Gary Backlund DMD, MSD