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I am 22 year old male. Recently, after my semi-annual cleaning 3 weeks ago I have been experiencing minor discomfort in my upper right far back molar area.

In terms of history in that area, in February 2005 after my idiodic 2 year stint away from dental checkups due to anxiety, I went into my current dentist (changed Dentist) complaining about pain in the far back upper right molar (#2?). It was due to deep decay which was exposed and my dentist did an indirect pulp cap and filled with a long-term temporary filling. Currently we are in a "wait and see" pattern until further treatment is warranted.

No symptoms were present from Feb 2005 until May 2006. Had regular exams in meantine. Radiograph at cleaning in late May 2006 showed nothing abnormal that he could see with the tooth and the filling looked fine.

Forgive me for this being complicated. In terms of current discomfort, it tends to be localized in the general vicinity of the treated tooth. It will sometimes be at the treated tooth, but it will migrate to other areas such as in front of, in back of and upwards parallel to the ear and up to the right the side of the head. Coughing and sneezing also causes a very brief response in the area.

The discomfort does appear randomly and lingers for unspecified periods of time. It does not seem to be stimulated by eating or drinking cold or hot food/drink. Feeling the tooth or applying light pressure does not seem to illicit much of a response. Bending over and other actions that change the orientation of the head sometimes causes a brief reaction. The gum line has receded on the molar in front of the treated tooth due to previous improper brushing which the technique has been corrected through education by my current hygienist. That area is periodically sensitive.

I  have a long  history of sinus infections and allergies but have never had issues such as this previously. Sinus problems I am currently having (severe allergies) seem to be more pronounced on my right than left side of my head. My wisdom teeth have not been removed and they are seen on my standard radiographs but there was no mention of them being impacted.

I guess my question is that are the symptoms consistent of a dying nerve or is this another issue such as wisdom teeth, sinuses or something psychological?  How should I proceed for diagnosis and treatment?

Forgive me for not being brief and concise, as this discomfort is complicated. I am concerned about under treating or over treating the problem. I understand itís hard to understand without personal consultation, examination and radiographs.

One last note: I now visit the dentist regularly. My previous anxiety was due to bad childhood experiences when having my teeth cleaned and have been alleviated due to my positive relationship with my current dentist and hygienist.

Thank you for your time.

-Jesse


Answer
Hi Jesse,
Sorry to hear about your discomfort.  I'll try to help you figure this out as best as I can.

There's no classic presentation of a dying nerve--it literally could range from excruciating, obvious pain to fleeting pain/discomfort and eventually nothing till the absess in the bone causes pain.

I can tell you that if you had a carious exposure (the indirect pulp cap) of the nerve chances are it was infected.  The nerve does have the capacity to heal itself, but I would have the tooth evaluated by an endodontist (root canal specialist) to check the status of the tooth.  

I would ask your general dentist to refer you to the endodontist that he/she works with--I understand your anxiety:  past experiences are hard to forget.  The endodontist who your general dentist will serve as an extension of their office, often with the same philosophy:  so you should find the same level of comfort.  Also, endodontists will be able to treat you quickly and efficiently, with adequate anesthesia, so don't be discouraged or scared with all the negative hype that root canals have gotten.

Your history of sinus problems makes diagnosis a bit more complicated.  Sinus pain can refer to the teeth and dental pain can refer to the sinuses.  The best advice I can give is to contact an endodontist or ask your general dentist to refer, so they can help you get to the bottom of it.

All the best,
Ketan Amin, DMD
Austin Center for Endodontics (Root Canal Specialists)
Austin Center for Endodontics

Dentistry

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Ketan Amin, DMD

Expertise

Graduating from Harvard School of Dental Medicine, I received a broad understanding of both medicine and dentistry. I continued my training at New York University, as a dental specialist in endodontics, which concerns root canal therapy, related surgeries, as well as diagnosing and managing various forms of pain occurring in the head and neck

Experience

Dentistry; Specialist in Endodontics (Root Canal Therapy).

Organizations
American Association of Endodontics American Dental Association American Academy of OroFacial Pain

Education/Credentials
Harvard School of Dental Medicine-Doctorate in Dental Medicine (DMD) New York University College of Dentistry-Certificate, Endodontics

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