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Dentistry/Treating chronic periodontal ligament inflammation?


Dr. Finnk,

I hope you might be able to provide some insight about my situation.

About nine months ago, I needed a large silver filling in tooth #14.  I was later told that the filling was done well in the sense that it had good margins, but that it was overcontoured and had both an overhang and high points that have been slowly shaved away in several subsequent dentists' visits.

Within a few weeks, I started feeling some pain that seemed to be related to chewing.  It didn't hurt when I chewed, but if I chewed a lot of tougher foods (like gum or crunchy vegetables), over time, the tooth would feel sore.

I've now seen several dentists for this issue over the last several months.  They've ruled out a crack in the tooth because there wasn't a reaction when chewing on cotton wads and because I don't feel sharp pain immediately on biting (more like a dull pain slowly developing after I put pressure on the tooth).  Further, the tooth responds normally to cold stimuli so they've ruled out a problem with the pulp.  The gum around the tooth is only slightly receded (there is a 4 mm pocket on one side caused by the overhang, which they're hoping will improve now that the overhang was removed), and I was told my overall periodontal health is very good.  However, the periodontal ligament space around tooth #14 looks enlarged on X-rays.  So they've all concluded that I have an inflammed ligament, most likely caused by occlusal trauma.

This should have been goods news for me, but the treatments haven't worked.  The dentists have tried to adjust the bite a few times and fitted me for a dental night guard.  The night guard helps in that normally within 15-20 minutes of my putting it on, I can feel the pain quickly diminishing, and when I wake up in the morning, I have no pain.  But most days, the pain keeps coming back, getting stronger over the course of the day (then disappearing again once I have the nightguard on overnight).  The only possible confounding factor I can think of is that the adjacent tooth (#13) developed a narrow class II cavity down to the gumline due in part to the overhang, but that has now been filled without a corresponding improvement.  The filling on the adjacent tooth (and some more occlusal adjustment on tooth 14) was done about five days ago and the pain hasn't gotten better (except, again when I have my nightguard on at night).

I was wondering if there are any other treatments option for an inflammed periodontal ligament other than what has been done so far?  Would a periodontist have any more expertise in this than the general dentists I've been seeing?

Dear Jonathan,

My guess is that you clench both at night and during the day.  First:  Try wearing the guard 24/7 for several days, taking it out twice a day to clean it and your teeth.  If this solves the problem, have your dentist adjust this tooth out of your bite (so it doesn't hit when the rest of your teeth come together).  This should solve the problem, at least for a while.

Check in with me next week to let me know how it went.


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Howard Finnk, D.D.S., P.A., CEO


I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.


Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center ( On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (, I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

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Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

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