I've done a great deal of searching on the web about my issues, and I've come up fairly dry, so I'm hoping you guys and gals will be able to help me out a bit.

Some background about me:

32 years old, type 2 diabetic with fairly severe sleep apnea (being treated with CPAP). My wisdom teeth were extracted in 2001. I potentially have TMJ, but it's not been confirmed. I've had one real humdinger of a sinus infection in Nov/Dec, which was treated with Avelox (antibiotic), Prednisone (steroid), and Diflucan (antifungal), though the sinus infection may have returned recently (though not as bad as originally).

It all started in late October, while eating dinner, I noticed that molar #3 (upper right) had lost the filling that I'd had done almost 20 years earlier. The next day, I went to my dentist (whom I hadn't seen in 2 years, I know, I know...) and he said, after x-rays and an examination, that there was definitely some deep decay, and that the tooth *might* need a root canal. He also found several other cavities including a rather large one on the back of molar #2 (right behind the molar with the lost filling).

He filled #3, crowned #2, and also put fillings on the bottom two molars (#31 and #30), same side, because there were interstitial cavities.

I need to state at this point that before I went in to see the dentist, I had no pain in any of my teeth at all. Zip, zero, nada.


Since then, I've experienced pain between molars #2 & #3, and the same pain frequently (but not always) between molars #31 & #30. I've been told that it's likely referred pain for the bottom molars, but I'm questioning that now. Also, I experienced some cold sensitivity on the two uppers, but no pain or pressure sensitivity on the bottom two.

Three weeks ago, I had a root canal on #3, and a few days later I got the temp crown put in. I was still having the same pain between #2 and #3, and still frequently (but not always) having pain between the bottom two molars. The pain always feels like it's between both sets of molars, and not directly in one of them.

On Monday of this week (two days ago), I had #2 root canaled. Thankfully, the crown wasn't cracked, and so she did the permanent filling at the end of the procedure. While neither of the root canaled teeth are cold sensitive anymore, I'm still having the same strange pain between the top two (now canaled) molars, and occasionally between the bottom two.

I realize that it's only been a few days since the second root canal, and that some pain is to be expected, but the fact that the pain is essentially the same as it's been for over a month (minus the cold sensitivity, which is now completely gone), is really starting to worry me. If the root canals were supposed to fix the issues I was having, I would expect the pain to be gone, or different at least - not the same odd pain between the teeth & headache.

I also need to point out that none of the x-rays done - of which I've had at least ten including two of those "full facial" ones with the x-ray machine that circles your head - have shown any signs of infection or abscess, and when the endo did the procedures she said that there was no sign of infection at all - just deep decay between the filling & the pulp in #3, and that the crown on #2 was aggravating the pulp.

So, that said, I'm sorry for the long story I've posted so far, but I wanted to be complete so as to get good answers. Here's my questions:

1. Is this kind of pain - seemingly between two teeth and causing a headache - considered "normal" or within the range of what one might feel after two adjacent root canals? If so, how long should I deal with it until I should get worried and talk to someone?

2. Could all of this pain I'm getting be from the sinus infection(s)? Could sinus infection pain cause referred pain from #2 & #3 to #31 & #30?

3. What else could be going on? Should I go to my doctor and ask about a CT scan, since the x-rays may not be telling the whole story?

Thanks in advance for any help or answers you can offer. I really appreciate it.

One further thing I forgot to mention that might help with answers: Sometimes, when I cough hard, or if I'm walking quickly up & down my stairs at home, I can feel an odd pressure on those two upper molars, as if the impact of my feet is sending a strange pressure through those teeth. Doesn't happen to any of my other teeth - just those upper few.

Hi FlavoredAir,

The sensation that you have in your upper molars in association with your walking, etc..... is not odd at all. It clearly indicates that you have inflammation and probably infection in those teeth and/or the sinus. These are typical symptoms of that connection and every dentist has seen this many times.

Any chance you can have the dental office email you the xrays and post them here?

Bryanna

FlavorAir,

I am in the dental field and can offer you some information here. Thanks for the detailed descriptions. Your dental problem is fairly typical as in common and perhaps your dentist should been more informative with you. If she told you that you did not have an infection, she misspoke because ALL tooth decay is infection and the longer it is present the more proliferated the infection becomes. For another she should have discussed your sinus issues as being a possible connection to the infection inside of your teeth. I will re-post your questions and answer them in bold.

<<<1. Is this kind of pain - seemingly between two teeth and causing a headache - considered "normal" or within the range of what one might feel after two adjacent root canals? If so, how long should I deal with it until I should get worried and talk to someone?>>

DO NOT LET ANYONE CONVINCE YOU THAT THIS IS "NORMAL" PAIN AS IN "WAIT IT OUT" AND SEE WHAT HAPPENS. EVEN IF THIS PAIN SUBSIDES, IT DOES NOT MEAN THAT THE PROBLEM HAS BEEN CURED.

THIS PAIN IS "TYPICAL" WHEN THERE IS INFLAMMATION AND INFECTION PRESENT. YOU MAY HAVE WHAT IS REFERRED TO AS a PERIO/ENDO INFECTION. THIS MEANS THAT YOUR TEETH AND YOUR GUM/BONE ARE CONNECTED. THIS TYPE OF INFECTION OCCURS WHEN A TOOTH HAS HAD A DEEP CAVITY FOR A LONG PERIOD OF TIME AND THE BACTERIA THAT CAUSED THE DECAY SPREAD BEYOND THE TOOTH INTO THE TISSUE/BONE SURROUNDING THE TEETH. IT CAUSES A DEEP POCKET AND/OR BONE LOSS TO FORM INTER-PROXIMALLY (IN BETWEEN THE TEETH) AND IT HAS ALSO INVADED THE PULP CHAMBER CAUSING THE NERVES TO BECOME INFECTED. IN YOUR CASE, BASED ON YOUR HEALTH HISTORY CONCERNING YOUR SINUSES... THE BACTERIA MAY HAVE ALSO SPREAD TO THE SINUS AREA PRIOR THE ROOT CANAL THERAPY THUS THE PREVIOUS SINUS INFECTIONS.


<<2. Could all of this pain I'm getting be from the sinus infection(s)? Could sinus infection pain cause referred pain from #2 & #3 to #31 & #30?>>

THE SINUS AND THE UPPER MOLARS ARE OFTEN DIRECTLY IN DIRECT CONTACT OR WITHIN CLOSE PROXIMITY WITH EACH OTHER. AN INFECTED TOOTH CAN INFECT THE SINUS AND VICE VERSA... BUT IT'S USUALLY THE TOOTH TO SINUS MORE SO THAN THE OTHER WAY AROUND.
A SINUS INFECTION CAN CAUSE TOOTH PAIN EVEN IN TEETH THAT ARE HEALTHY. BUT IN YOUR CASE, I WOULD VENTURE TO SAY THAT TEETH #2 AND 3 HAVE A CORRELATION WITH YOUR SINUS INFECTION. TEETH #30 AND 31 MAY BE HURTING FROM REFERRED PAIN OR THEY MAY ALSO HAVE INFECTED NERVES FROM THE TOOTH DECAY.

<<3. What else could be going on? Should I go to my doctor and ask about a CT scan, since the x-rays may not be telling the whole story?<<

UNFORTUNATELY IF THE TWO UPPER TEETH ARE TO BLAME FOR THE SINUS INFECTION, WHICH IS HIGHLY PROBABLE, THE ONLY WAY TO BEGIN TO HEAL THE INFECTION IS TO REMOVE THE TWO UPPER TEETH BECAUSE THE BACTERIA IN THOSE TEETH WILL PREVENT THE SINUS INFECTION FROM CLEARING. IT IS ALSO IMPORTANT THAT YOU KNOW THAT NEITHER OF THESE TEETH WILL NEVER BE HEALTHY AGAIN AS ROOT CANAL THERAPY CANNOT MAKE A TOOTH HEALTHY AGAIN. THE RC PROCEDURE IS DONE TO ATTEMPT TO "RETAIN" A TOOTH FOR AN UNDETERMINED AMOUNT OF TIME, NOT "CURE" IT.

I have seen this situation countless times and I think it is possible that your x-rays may be telling a different story. If you can obtain the x-rays and are comfortable sharing them here... please feel free to do so. Just make sure that your name is not visible.

Bryanna

Thanks for the replies. I'm not going to lie, you've definitely scared the bejeezus out of me.

I've got an appointment with my regular doctor on Thursday afternoon, and I'm going to bring all of this to my doctor's attention.

I'll try to get the x-rays from my dentist, and I'll let you know what my doctor says as well.

Thanks all.

FlavoredAir,

I am not trying to scare you, I am trying to provide you with information that your dentist should have already provided you with. I'm sure this information comes as a shock and yes, it is alarming to read when you have been mislead into thinking that your problems were solved by doing the root canals.

Every person has the right to be properly informed prior to accepting any dental or medical treatment. If the dentist had told you that your sinus problems may be linked to your upper teeth and that all root canaled teeth remain unhealthy and can cause further infection elsewhere in the mouth or body, you most likely would have wanted to discuss your other option. Once you were informed about all of this, you are then better equipped to make the choice of treatment that you feel is best for you.

Before you see your physician... to help you understand the whole picture and to be able to speak with your physician in better detail, I would suggest that you google Dr Mercola/root canals and download his detailed information. Yes, the facts you will read are a bit alarming but it is better to deal with this now than after it has become a more extensive health problem.

Please check back with us.
Bryanna

I've got the x-rays from after the first root canal, and after the second root canal on Monday. Here they are:

Update: Just came back from my primary doctor, and he's fairly certain that what I'm experiencing is a fairly unpleasant TMJ flare up.

He looked over the x-rays I provided him and performed several tests - including one in which he felt my face around the jaw and nearby muscles and triggered some pretty spectacular pain on my right side jaw muscle - and is fairly confident that between the sinus infection I had in November, and all of the dental work I've had done in the last few months, I've aggravated my jaw something fierce.

This makes a lot of sense to me, as my bite has been out of whack since all of this began, and that I have a tendency to chew on straws and other stuff - specifically on my right side (though usually I grind things between my canines, but it's always on the right side). I've also had crackling and popping when eating.

He also said the fact that I've lost 40lbs in the last eight months and haven't had my CPAP therapy re-evaluated leads him to believe I'm definitely either bruxing or grinding my teeth at night, which is another indicator of TMJ.

So, for now, he put my on Clindamycin to clear up what might be left of the sinus infection, and Vicodin for the evenings for the pain, and instructed me to setup a new appointment with the dentist to discuss my TMJ treatment options.

I'll post back here after I have that appointment.

Thanks again for all of the information & advice.

FlavoredAir,

Thanks for posting the x-rays. It is clear that your two upper molars are in close contact with your sinuses. The roots may actually be into the sinus area but since the film is only 2 dimensional that is not conclusive. There appears to be pathology indicative of inflammation, possibly infection in the sinus area at the tips of the roots with both of these teeth.

Your physician sounds like a pleasant and caring person but did he tell you that he has no training in reading dental x-rays? It is quite possible that you have a TMJ problem but that is not the cause of your tooth problem.

When we have pain in our teeth or in our sinus area, we tend to clench our teeth together as a way of soothing the pain. The clenching can cause a TMJ flare up and you would feel tender in the masseter and other facial muscles. So it is not a surprise for your physician to diagnose that at this time. It would also make sense for these muscles to be over stimulated after having a lot of dental work in a short period of time.

If the sinus infection is related to these teeth.... then antibiotics may temporarily subside the symptoms but they will not "cure" that infection.

I just want you to be aware of the facts that you may not be told by your physician or your dentist.

Bryanna

Hi Bryanna,

My doctor actually *specifically* mentioned that he's not entirely qualified to read dental x-rays, and clearly stated that I should go back to my dentist next week to consult with him about the TMJ, and to get a new set of x-rays performed (they do have a 3D x-ray machine - the ProMax, I believe) to re-evaluate everything. That's about the best I can hope for at the moment.

Cheers,

Scott