Expert: Mark Bornfeld DDS - 7/30/2007

Question
QUESTION: I had a root canal done on #29 6 months ago, after having several fillings done in Sept. 2005.  Starting having issues with #29 right after the filling was placed.  Went back to the same dentist 4 times to try to remedy.  Switched dentist, he did the root canal on #29, still had the same pressure type feeling, like something was stuck between my teeth.  He referred me to an endontist, whom I saw last week.  He found an issue with #31, a small crack ,and severe pain when biting down, and issue with hot/cold sensitivity.  He started root canal on that tooth, after numbing wore off, I had severe pain up by #29 again, so severe I could not sleep.  Went to my local dentist, and had him pull #29 Friday(7-27).  It is two days later, and I am still feeling that "pressure" feeling by #28 now.  There are no fillings in that tooth, and no visible issues.
Can you give me any ideas?  I go back to my local dentist on Wed. to have the stitches removed from my extraction, and don't go back to my endontist until Aug. 15th.  I've had two LONG years of pain/discomfort and REALLY want to get this taken care of to go back to a normal, painless life.
Thank you

ANSWER: Dear Mr. Linden,

I don't know about you, but I would suspect the problem is with that #31 tooth. Keep in mind that the symptoms in the area persisted despite root canal on #29, and despite extraction of #29. Also, the pain that you insist was coming from #29 was exacerbated immediately after starting the root canal therapy on #31.

The ability to distinguish the location of the source of pain in the mouth is quite poor. Despite the fact that you feel the pain coming from #29, it is not possible for most patients to perceive pain location that accurately. In fact, pain from a top tooth sometimes feels like it's from the bottom, and vice versa; pain from the sinus often feels like pain in an upper tooth, and vice versa; and pain from the ear often feels like pain from a lower molar, and vice versa. Pain discrimination is even less reliable when trying to distinguish sensation coming from neighboring teeth.

While I don't wish to believe that tooth #29 was extracted in vain, the fact that symptoms persist suggest that your symptoms were unrelated to that tooth. I would advise caution before implementing any additional aggressive treatment until your dentist(s) are relatively assured that it will help. When you return to your dentist on Wednesday, you might wish to ask him to apply a variety of stimuli to #31 to see if he can elicit any suggestive symptoms; this may clarify just what may be going on.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

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

QUESTION: Thank you for your answer.  Yes, 29 might not have needed to be pulled, the pain was pretty unbearable for me, and I've gone through 2 babies with no labor meds.  So it was pretty difficult to get through the tooth issues.
I have had the stimuli done on #31 that is how we determined the issue, and the root canal was started on that tooth.  However, I have no pain in #31 any longer, but still have the "pressure" feeling by #28, and what once was #29. I also forgot to mention I have a filling in #30, that the endontist says is a 'moderate' filling, and does not react to stimuli, not heat/cold sensitive and doesn't hurt when tapped on.  My fear is that they will not be able to determine what tooth is causing the issues, and I will be having numerous dental procedures and with my insurance amount almost up, hence, running into more $$ than I have available.

Answer
Dear Ms. Linden,

I don't wish to push this issue too strongly, but your perception of the location of pain cannot be relied upon. Regardless of where you perceive the pain to be located, the location of its true source may be different. And if tooth #31 were already subjected to diagnostic scrutiny before, it does not mean that it would necessarily respond now the way it did previously; it doesn't hurt to double check the tooth in light of the elimination of #29 as a culprit.

There is a fairly routine diagnostic protocol that should be implemented by your dentists. Not only should the various dental possibilities be explored (pulpitis, periodontitis, occlusal trauma, and cracked tooth), but the failure to determine a dental cause for the symptoms may suggest that the search should be expanded to non-dental disorders, such as neuropathic pain. This may merit a consultation with a neurologist.

Hope this helps...

Mark Bornfeld DDS