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Oral Surgery/pain after intervention

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QUESTION: I had a root canal two years ago in tooth 26 which was incomplete. A dentist in Greece, instead of completing the root canal, extracted the tooth. He then drilled the two adjacent teeth to prepare for a bridge. That is when the pain started in tooth 27, top left - as a result of his drilling. He then pulled the nerve out of tooth 27 and sent me to someone else to have a root canal in that tooth. The root canalist saw me for several sessions over several weeks to do the root canal but the pain did not abate. It hurts also to talk.

I have had a number of diagnoses following that but they all disagree with one another. Some say I should have the root canal done again because there is inflammation there; others say that having the root canal repeated would exacerbate the situation; others that the muscle was damaged; others say that the muscle is fine and the pain in that area is reflected from the tooth; others say that maybe there is a abscess behind the tooth and an operation will solve the problem; others say that if I remove the tooth the pain will go. The X rays and CAT scans don't appear to show anything. Some suggested the nerve was damaged but the others  disagreed with that.

My inclination is either to have the root canal done again or to have the tooth removed but I am desperate not to make another mistake

If you could possibly offer me guidance I would be so really grateful. Thankyou

ANSWER: Polly - I would love to assist you in making a decision, but I would need additional information. If you could get a copy of the xray, you can attach it to a question here and I will look at it.  That might give me additional information.

The main problem for me is that I just need more information.  Does the pain increase or decrease with hot or cold?  Does the pain get better or worse if you bite down?  Is the tooth affected by sweets?  I am trying to find out more, but if you could get back an tell me when the pain gets worse and better that may help.

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QUESTION: Thank you very much for your reply. The X-rays which have been examined by a few dentists/endodontists show nothing untoward. The pain is unaffected by hot or cold, nor by sweet things, however,the pain is much worse when biting down and I can't eat on it at all because of this. Ocassionally also I get a sort of tingling in the tooth, a bit like the feeling when metal is scraped against metal. The pain is worse when I talk as well or if Isleep on that side and put pressure on it.

I really hope that this information is helpful to you in being able to formulate some idea as to what is the problem but more importantly what I can do to resolve it as I have days when I feel really desperate.  Thank you so much again

ANSWER: Polly - The type of pain you describe is often not due to the tooth itself, but from inflammation of the ligament that holds the tooth to the bone or it could actually be with the bone surrounding the tooth.  The other possibility is a nerve inflammation, but it does not seem to be neurological.

What can be done to help?  That is the difficult question to answer.  If I was the dentist I would start very slowly and take the tooth out of occlusion so it does not strike the tooth on the opposite jaw when you bite down.  I would let this sit for a couple of weeks.  During that time, I would have you begin warm salt water rinses 4-5 times a day for about 5 minutes.  This greatly helps in reducing inflammation.  

I really don't know what else to suggest.  Starting slowly is key and add a new test if there is failure in the initial approach, but the doctor needs to be patient and so do you.

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QUESTION: Thank you very much for your e mail.
I really appreciate your kindness and time.
I did have a splint made one and a half years ago (six months after the pain started with the dentist's drilling) but it did not help at all. I subsequently and eventually had the bridge removed in the hope this would relieve the pain (which it didn't) and so now there is no need for the splint because the drilled tooth is too short to touch the bottom tooth anyway.

At the time I also gargled quite a lot but to no avail. I will however start again, as you advise, 4-5 times a day.

If this does not work after a few weeks what can I do? All the dentists I have seen disagree with each other! If I have the root canal done again might it help or make things worse? If I removed the tooth do you think that might be a solution to this nightmare.
All I know is that it started with the drilling (or maybe the injections -anesthetic before the drilling-  which the dentist gave me, which were very roughly and forcefully done)  but I don't know what actually happened to cause this intense pain over the last two years.
I realise that you cannot answer with any guarantee however I do value your opinion
Again, thank you very much indeed

Answer
Polly - there is one additional possibility.  It may not be the root canal, but the tooth may have a crack.  If that crack extends to the root or even just below the gum, out of site, that can produce intense pain.
 
So if it does not get better the tooth needs to be checked for a crack.  I wish I could give you other possibilities, but from description alone it is difficult.  I wish you well and hope there is a reduction of pain.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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