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Dentistry/Percussion sensitivity in vital tooth with normal temperature response


QUESTION: Dr. Buckland,

Due to problems on the left side of my mouth that were subsequently addressed with a filling, I had been favoring the right side for a few weeks when eating.  I then started feeling relatively constant, dull ache around tooth # 3, which previously had a deep filling put in seven years ago and often some gum irritation because the filling goes up to the gumline.    The ache is not bad unless I chew a lot on the tooth, and then a couple minutes later it gradually gets worse, until it gradually improves when I avoid using the tooth.  The tooth reacts normally to hot and cold.  A few spots on the gum near the gumline on one side of the tooth seem a little tender to the touch whenever the tooth acts up and pressing on them seems to subsequently increase the pain (gradually); in contrast, massaging the gumline with a toothbrush and doing salt water rinses seems to encourage the pain to subside.  My dentist noted that an x-ray didn't show any abscess, and he thinks it's an inflamed periodontal ligament.

He made a slight adjustment to the bite a couple days ago, which did feel more natural, but I still have the pain, particularly after chewing or other manipulation (again, it doesn't start right after, but a little while after and gets worse very gradually).  I was wondering, if things don't get better after the adjustment to the bite, if one would begin to suspect an endodontic problem?  Is it true that the tooth has to be necrotic before it can  abscess?  How much time with continuing pain after the bite adjustment (but without temperature sensitivity) and/or what additional symptoms might suggest that this is an endodontic problem?


ANSWER: Hi Johnathan,

I'm sorry you have all tis going on. The fact that the tooth responds normally to hot and cold tells me that you do not have an abscess. An abscess can only form after the pulp(nerve) dies and if that were the case, you would be unable to feel cold in the tooth. So we can rule that out.

At this point you also don't have an inflamed pulp because your tooth is not sensitive to temperature. As a result, at least at this point, I don't think a root canal would solve your problem.

So what is going on? It's really hard for me to diagnosis without examining you, but my best guess from what you have told me is that you have a cracked tooth. That's why the bite adjustment helped, but didn't solve the problem. One was you can test for this is to get a pencil with an erasure. Put the erasure on the points(cusps) of the tooth one at a time. Bite firmly together and then release QUICKLY. Do that on each cusp. If you have any pain when you release, you have a crack. The treatment for that is a full crown. We usually suggest placing a well fitting temporary crown for 2-3 months to make sure the tooth settles down. If it does, then just cement the permanent crown. If it doesn't you may need to reevaluate needing a root canal to get you comfortable.

Hope this all helps.

Gary Backlund DMD, MSD

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

QUESTION: Dr. Buckland,

Thanks so much for the quick, thoughtful and sympathetic response!  I should have clarified that my dentist checked for a cracked tooth by doing what you described with a small stick that had cotton at the end of it, but there wasn't any immediate pain.  My pain on chewing (or other manipulation) seems to gradually increase starting at only several minutes after the tooth is handled.  It also seems to be more dull than sharp. That and a little swelling near the gumline (with no sign of an abscess) was why he thought it might just be irritation to the PDL from the high bite.

I also had a follow up question.  I think that a few years ago you answered another question I asked by saying that where it's unclear if the pulp is irreversibly inflamed, it's usually better to take a wait-and-see approach if the patient can tolerate the pain in the meantime.  Is calcification during this time a major risk, or can most expert endodontists successfully treat teeth that were affected by calcification?

Many thanks again!


Hi again Jonathan,

Calcification is a VERY slow process, so in the time it takes to make decisions about whether to do a root canal or not, there would not be any significant calcification occurring. Also, as you point out, unless the calcification is severe, teeth can still be treated successfully.

Gary Backlund DMD, MSD


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Gary Backlund, DMD, MSD


I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.


25 years practicing as a specialist

American Association of Endodonists, Past President Washington State Association of Endodontists.

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