Expert: Mark Bornfeld DDS - 11/20/2006

Question
I recently went to the dentist for a pain in my lower back molar on the left side.  It hurts when I bite down and my jaw hurts to open.  It feels very stiff in the morning.  The dentist put me on antibiotic and has a root canal schedules for a week from today.  My question is more related to my jaw.  My jaw hurts up near my ear.  There is no popping - just pain.  Could it really be the tooth that needs the root canal...or could it be some other issue.  This tooth has a filling and hasn't really given me any problems until this pain just woke me up in the middle of the night.  If my jaw is bumped...it just hurts terribly.  Should I get a second opinion.  I guess I have just never had a tooth cause my jaw so much pain.  Thanks much!

Answer
Dear Karen,

It is difficult to say for certain whether the jaw pain and the tooth are related. Certainly, an infected lower molar could conceivably refer pain to the jaw and the ear; however, your dentist must have used additional diagnostic criteria to determine that the tooth needed root canal therapy. Since you did not communicate your dentist's rationale for prescribing root canal therapy, I cannot judge whether his line of reasoning makes sense.

In order to determine the need for root canal therapy, your dentist should have been able to elicit one or more diagnostic signs-- for example:

1. a deep cavity or filling on the suspect tooth that encroaches on its pulp ("nerve")
2. visual signs of infection on or near the tooth- for example, a "gum boil"
3. x-ray evidence of an infection in the tooth
4. other physical signs of inflammation directly attributable to the tooth, such as sensitivity to percussion or thermal stimulation

In short, there should be specific criteria that implicate the tooth under consideration. Although an infected tooth might well cause jaw pain, there are other possible causes; dysfunction of the temporomandibular joint (TMJ), among others. If your dentist cannot explain his reasons for prescribing root canal therapy to your satisfaction, you have every reason to seek a second opinion.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY