Your pain location & description seems similar to mine (see recent thread "Pain! Failed root canal?"). Only, I've had it for 6 months and about 10 days in worse form. What was your pain like in terms of frequency and intensity (1-10)? Probably not intense as you've tolerated it for 7+ years?

BTW what's with bottom horizontal wisdom teeth? That can't be good, you have pockets there and if you don't clean them, adjacent teeth will get deep cavities. I've had to have my wisdom teeth extracted and they were far more vertical...

<<What was your pain like in terms of frequency and intensity (1-10)? Probably not intense as you've tolerated it for 7+ years?>>
The frequency was 24/7. The intensity would vary from say a 5 to a 9. Tolerate is a very generous word here. It took a tremendous toll on my life, causing me to feel incredibly depressed at times and just frustrated at the fact that I could be living with this for the rest of my life. In my opinion, having a 7 rating pain for almost a decade is equally devastating.


<<BTW what's with bottom horizontal wisdom teeth?>>
No idea, they don't bother me at all and I'm not touching it if there are no problems. The oral surgeon said it would be risky to remove those anyway since they're close to the nerves and such.

Ok, so I went to the oral surgeon's office today.

I told him my story and his diagnosis was that the pain could be due to the tooth infection or it might not be. But he agreed the tooth was infected. He offered an apicoectomy or an extraction as two possible options. I listened while he explained both options. It seemed to me that extraction offered a higher success rate than the apicoectomy. If I did the apicoectomy, there's a chance the tooth could fail and I would end up extracting it anyway.

I opted for the extraction because I wanted more certainty and besides with the implant, I'll still have a "tooth" there eventually.

I went the general anesthesia route and it was amazingly fast. I don't remember drifting off or waking up, compared to previous surgeries I had. It was literally like someone hit pause and then play again. One moment they were sticking the needle into my arm, and the next minute I see him stitching me up. Amazing job, no pain at all other than the normal swollen feeling.

The oral surgeon said he removed everything including the ligament and cleaned up everything. Prior to the operation, he did a cone beam scan and said he didn't see anything noteworthy with the sinus, just maybe a thickening of the mucus as a reaction to the tooth infection. He said it was possible one of the roots was draining into the sinus maybe that's why my condition was stable for so long. Otherwise normally, you would develop gum fistulas.

After the operation, he said he didn't have to deal with the sinus at all as there was still a bone socket there. From the film, there was about 7mm of bone left in that area.

He did do some bone grafting in preparation for a future implant. I'm suppose to go back in four months to get the implant. He said he might have to do a sinus lift then also but we'll see in four months. But it looks like it'll take a full 8 months before I get the actual tooth as you need to wait an additional four months after they put the implant in.

Anyway, it looks like I just need to sit back and wait for things to subside and hopefully, that original pain will fade.

Special thanks to Bryanna for your advice and comments. I really hope this was all worth it, but even if it doesn't, it was worth a shot anyway, especially considering all the other things I tried.

Peter,

You crack me up with the question to pdne about the "horizontal wisdom teeth"!! How observant of you You are correct about them compromising the second molars. But it could be risky to remove them at this time.

Great eye Watson!!
Bryanna

Hi pdne,

Ok so you had that bad tooth removed today... wow.... kudos to you!! I am so glad to hear that this OS was thorough in his surgery and did not try to talk you into the apico!!!!! What a nightmare that would have been :/

I tend to agree with him on the possibility of the one root draining into the sinus as it does appear that way on the panorex and it would coincide with the fact that you had not developed a fistula. Remember I said the infection may be draining and that's why the tooth didn't hurt?? So I'm glad he mentioned it.

It is imperative for you to follow his post op instructions to the "T" and refrain from anything other than a soft nutritious diet for at least a few days because you do not want pain on the other side from over chewing there.
I would expect you to have some discomfort in that area and possibly still in the cheek area for several days due to the inflammation ..... hopefully you won't but you may. Did he put you on an antibiotic? When do you see him again?

Regarding the placement of a dental implant in that area.... this is not something that should be rushed into as this site is going to take months to heal. If the healing goes uneventfully, then it would be wise to have an xray done of this area in 4 months and then again in 6 months. If the implant is placed too soon, it could reignite pain in that same area because it needs time to calm down and become healthy again. Allow your body to grown new bone into the bone graft for several months so that there is no question about the solidity. This also gives adequate time for the sinus to heal and hopefully be free of inflammation. It is ideal to place the implant within one year of the extraction and graft as any longer than that might result in a questionable outcome as the sinus membrane will begin to descend down.

I am so impressed with your rapid decision to deal with this as you have. I am hopeful that you will be pain free sooner than later.

Keep in touch as we want to know how you are doing in the next few days!

Bryanna

<<I am so glad to hear that this OS was thorough in his surgery and did not try to talk you into the apico>>

Well, that was actually his initial suggestion and I was the one who actually suggested the extraction first. Then we casually discussed both options. He was a very good professional and did not try to force anything. Though at one point he mentioned that he could even start the apico and once he goes inside, if it looks like it's not going to work, he'll extract the tooth. But I didn't want to take any risk at all and told him to just extract and be done with it.

<<Remember I said the infection may be draining and that's why the tooth didn't hurt??>>

Well, this was a root-canaled tooth so it was dead. I wouldn't have felt anything in the tooth anyway right? But I suppose the draining was why I didn't have pain in the gums. Though after I saw the endodontist this past Saturday and she was poking around the gum area, the next day I woke up with a lot of pain in the "affected area". Maybe she somehow irritated the infected area.

<<It is imperative for you to follow his post op instructions to the "T" and refrain from anything other than a soft nutritious diet for at least a few days because you do not want pain on the other side from over chewing there.
I would expect you to have some discomfort in that area and possibly still in the cheek area for several days due to the inflammation ..... hopefully you won't but you may. Did he put you on an antibiotic? When do you see him again?>>

I actually feel quite fine right now but I suppose maybe the anesthesia hasn't worn off completely yet. And I took some Motrin as well. I'm on Amoxicillin now. Well, I suppose I can just see in 4 months when I'm ready for the implant. I don't see much benefit in going in for a follow-up unless I develop complications over the next few days. But he told me to come in anytime over the next month if there are any issues.


<<Regarding the placement of a dental implant in that area.... this is not something that should be rushed into as this site is going to take months to heal. If the healing goes uneventfully, then it would be wise to have an xray done of this area in 4 months and then again in 6 months. If the implant is placed too soon, it could reignite pain in that same area because it needs time to calm down and become healthy again. Allow your body to grown new bone into the bone graft for several months so that there is no question about the solidity. This also gives adequate time for the sinus to heal and hopefully be free of inflammation. It is ideal to place the implant within one year of the extraction and graft as any longer than that might result in a questionable outcome as the sinus membrane will begin to descend down.>>

Yes the plan is to see him in 4 months to check things and possibly put the implant in then. Then, the implant would be remain there for about 4 months and then finally the tooth can be put on. We discussed the possibility of a sinus lift and he also suggested he might be able to do a sinus bump? where he just taps the sinus up or something. Not really sure on the specifics but this is something we'll investigate in 4 months.

<<I am so impressed with your rapid decision to deal with this as you have. I am hopeful that you will be pain free sooner than later.>>

After all these years, the sheer thought of potentially discovering the source of the pain was too much for me to sit on. I had to act fast. I was practically up all of Sunday night just thinking about this extraction! I really hope the pain goes away and I will definitely post updates here. I hope no one else has to go through what I suffered through for nearly 8 years.

pdne,

Glad you're doing well!

Regarding a root canaled tooth being painful.... although they are considered non vital and many dentists will argue that they cannot possibly cause pain ... the tooth still has those untreated tiny canals that contain nerve tissue which is not alive it is necrotic and inflamed which causes pressure inside of the tooth. The root of the tooth is encased in a live ligament which sits in live bone.... so yes, a root canaled tooth can hurt. When the bacteria finds an outlet to drain to, as long as that outlet stays open, the tooth will not hurt because the pressure is being relieved via the outlet. If the outlet closes off from inflammation, the tooth will hurt. Not all root canaled teeth find an outlet and that's when a large swelling occurs.

Just thought you and others reading this might be interested in knowing that

Hope all continues to go well!!
Bryanna

So it's been a few days since the tooth extraction...

To recap, I had the tooth extracted last Monday afternoon. When I got home, I actually felt better for the rest of the night and Tuesday. However, the pain resurfaced by Wednesday and by the weekend, it seem like it's pretty much back at its original state. It seems like there's pressure there and just this gnawing aching sensation.

1) Could it be that my temporary relief from pain was just the anesthesia?

2) If the tooth was the source of the infection and I'm still feeling pain, could it be that the infection did spread to other areas and that's what I'm feeling now? But then I would think the antibiotics I'm on (amoxicillin) would take care of these problematic areas, especially since these areas aren't "dead" zones like the tooth was.

3) Any advice on next steps here? I'm thinking about going to an ENT again and getting some kind of cat-scan or MRI done here.

Frankly, just a little disappointed the symptoms returned so soon. But after all these years, I'm not surprised. I do think I'm on the right track though. There was definitely something going on with the tooth.

pdne, Same thing happened to me when I had #14 extracted. After a week, it was still painful in areas and throbbing at times. It took close to two weeks to feel better. The OS said, it was an extraction after all, you can expect pain!

I hope the same happens for you and that you feel better soon. Keep doing warm salt water rinses, they helped me.
Gretchen

I hope you're right in that there's room for improvement. For me, I feel like the area has more or less stabilized by now, so I'm not sure if this pain will somehow go away in a few more days. Having this pain for so many years, I recognize it all too well and it seems like it's the same sensation rather than post-op extraction pain but let's see..