Hi pdne,
I will answer you in bold ... easier to follow
<<<1) First, I have no pain in the tooth itself. Now, I suppose this is due to the fact that the nerve was removed during the first root canal. So what you're saying is that there is bacteria hidden in the microscopic root canals and this is somehow leaking toward the sinus region, which is causing this dull, gnawing, aching sensation?>>>
PAIN IN THE TOOTH IS IRRELEVANT BECAUSE IT DOES NOT INDICATED THE EXTENT OF THE PROBLEM. ANOTHER EXAMPLE OF THIS WOULD BE... SOMEONE MAY HAVE SLIGHT DISCOMFORT IN THEIR CHEST AND/OR LONG TERM SYMPTOMS OF INDIGESTION. TURNS OUT TO BE HEART DISEASE. DIFFERENT LOCATION OF THE BODY, SAME SCENARIO.
THE ONLY NERVES THAR WERE REMOVED DURING THE RC TREATMENT WERE THOSE THAT WERE VISIBLE.
WHAT I AM TELLING YOU IS THAT THE TINY CANALS STILL CONTAIN NERVE MATERIAL... NECROTIC, INFECTED NERVE MATERIAL. THE BACTERIA STAYS WITHIN THE TOOTH AS IT SPREADS BEYOND THE TOOTH INTO TH PERIODONTAL LIGAMENT, INTO THE JAWBONE. THE SYMPTOMS THAT YOU HAVE ARE A RESULT OF THE AREA BECOMING OVERWHELMED WITH BACTERIA AND INFLAMMATION. SOME PEOPLE WOULD EXPERIENCE SYMPTOMS IN THEIR TOOTH... YOU ARE EXPERIENCING THEM BEYOND THE TOOTH. SAME PRINCIPAL, SAME SOURCE OF INFECTION.
<<<2) I've been dealing with this pain for many years and have been led down many dead-ends. For example, an ENT doctor I saw years back thought it was due to a deviated septum. He recommended a septoplasty, which I did, but it didn't help with anything. I just don't want to get an extraction if it's not the true cause of this pain>>>
MOST PEOPLE REPORT THE SAME LACK OF DIAGNOSIS AS YOU UNTIL THE TOOTH IS REMOVED AND THE ENTIRE TOOTH AS WELL AS THE SURGICAL SITE IS VISIBLE DURING THE SURGERY. THAT IS WHEN THE DENTIST ADMITS THE TOOTH WAS UNHEALTHY. ENT PHYSICIANS TEND TO BE CAREFUL AS TO ATTRIBUTING A SINUS PROBLEM WITH A ROOT CANALED TOOTH. ONE REASON IS BECAUSE THEY PRETTY MUCH ASSUME THAT DIAGNOSIS WILL FALL ON DEAF EARS AS MANY DENTISTS DO NOT MAKE THE CORRELATION. ENT PHYSICIANS RELY ON REFERRALS AS THE MAIN SOURCE OF THEIR INCOME. SO THEY TRY TO KEEP THEIR PEERS HAPPY. THOSE THAT COULD CARE LESS ABOUT THEIR PEERS TEND TO BE MORE APT TO TELL THEIR PATIENT ABOUT THE TEETH AND SINUS CONNECTION. I KNOW... THIS SOUNDS SO BAD... UNFORTUNATELY IT IS SO TRUE :/
<<<What other symptoms should I have to be positive that this pain I have is due to the tooth?>>>
MAYBE NONE. THERE IS NO "SHOULD" HAVE PAIN LIST TO DETERMINE THE CAUSE OF THE PROBLEM. EVERYONE HAS DIFFERENT EXPERIENCES WITH PAIN AND FOR DIFFERENT REASONS. SOME SYMPTOMS ARE MORE DIRECT WHILE OTHERS ARE NOT. WHAT ELSE DO YOU THINK COULD BE CAUSING THIS LONG TERM PAIN? HAVE YOU HAD AN MRI OF YOUR SKULL TO RULE OUT A TUMOR? WHEN YOU HAD THE DEVIATED SEPTUM DONE, DID YOU HAVE A SCAN DONE THEN? YOU SAID YOU HAD PAIN AND THEN THE RC DONE. COULD HAVE BEEN THAT THIS TOOTH WAS INFECTED AND THE ONLY SYMPTOM YOU HAD WAS PAIN UNDER YOUR CHEEK. WHY DID HE DO THE RC AT THAT TIME?
<<< Again, I have no pain inside the mouth at all. The ONLY pain I have is in this area right below the left cheekbone. It's not on the surface but it feels like it's several inches inside the face. I have no pain in the gums, which somehow makes me feel like the tooth is not the cause of the pain.>>>
YOU DON'T HAVE TO HAVE PAIN IN THE TOOTH OR IN THE GUMS TO HAVE AN INFECTED TOOTH. I HAVE HAD COUNTLESS PATIENTS WHO CAME IN FOR ROUTINE EXAM AND XRAYS WITH NO DENTAL COMPLAINTS.... ONLY TO FIND AN ABSCESSED TOOTH. GO FIGURE!
<<<<I mean it is possible this root canal infection and the pain are two separate things.>>>
COULD BE TWO THINGS OR MORE GOING ON AT THIS POINT. ACCORDING TO WHAT YOU WROTE... IT HAS ALREADY BEEN RADIOGRAPHICALLY CONFIRMED THAT YOU HAVE AN INFECTED TOOTH AND THE BACTERIA HAS SPREAD BEYOND THE TOOTH.
<<< Does it surprise you that I can have pain in the area I mentioned earlier without having pain in the gums/tooth etc..?>>>
NO, NOT AT ALL. IF THE INFECTION IS DRAINING INTO AN OPEN SINUS CAVITY, CHANCES ARE THE SINUS WILL FEEL SWOLLEN AND ACHY AND THE TOOTH MAY NOT HURT AT ALL.
I know this is not at all what you want to hear. The bottom line is this... based on the radio-graph it has already been confirmed that your tooth and the area above it has infection. Your choices of retaining an infected tooth are to leave it or re treat it with another rc or apico. Any one of those choices will not cure the infection or alter the prognosis other than the bacteria will continue to multiply and spread further. I'm sorry that seems so cut and dry... but that is the reality of the situation. I wish there was a way to cure an infected tooth... but it's just not physically possible.
Bryanna