Expert: Steven C. Scherr, D.D.S. - 10/8/2005

Question
I have been suffering for years with tooth pain in my 2 upper back teeth. (Not my molars, they have been removed) The ones next to where
my molars were. I think one or two were root canalled. I can have no pain for a week or two and then it comes back. The pain can last for
3 or 4 days. It  can be mild to very bad. It can be on one side or both. It can move back and forth, from side to side. It can come and go many times in a day. It can start any time of the day. The other important thing is that the tooth pain is always accompanied by headaches  in my temples only.  I'm 58 years old. In my 20's I was diagnosed as having TMJ and treated.  But that pain was different. I was told by one dentist that there was nothing wrong in the x-rays. Another said I have TMJ again and made me a night guard. I do not believe I have TMJ or grind my teeth anymore. My jaws are not sore nor do they pop, click, etc.  Over the counter medications do nothing for the pain. I have even taken 2 Vicodins with little if any relief!

I recently read about a procedure on a dentists website called an Apicoectomy. It was described as follows:

Occasionally, a root canal procedure will not be sufficient to heal a tooth and surgery is recommend. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection. An apicoectomyc procedure can be used to locate fractures or hidden canals that do not appear on xrays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure.  An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

Do you think this might be my problem?  

Answer
Vincent,

There are a number of possible causes of the discomfort and headaches described.  The teeth are unlikely to be the primary source since the pain alternates between the left and right sides.  An apicoectomy is only appropriate for the treatment of tooth related pain caused by a failed root canal.  Unless there are problems in multiple teeth, this is not likely to be the solution.

TMJ related pain is a legitimate possibility.  The pain can occur on either side of the face.  There does not have to be joint sounds.  In fact, 90% of TMJ pain originates in the jaw muscles.  The other 10% originates in the joints themselves.

Neurovascular pain is another possibility.  This is migraine-like pain that can feel just like a toothache.  However, treatment of the tooth provides little or merely temporary relief.  The pain can occur in clusters with periods of remission in between.  This type of pain is treated with medication.  I suggest you seek a good neurologist.  Do not have any dental work done on these teeth until you have done so.  Many people have gone so far as having multiple teeth removed unnecessarily due to misdiagnosis of neurovascular pain as a dental problem.

Vincent, I wish you well.

Steve