Hello, me again with my never ending dental pain. I just got an evaluation from an endodontist about my upper back molar #15. It had off and on issues for years, but always resolved. First was a filling replacement 9 years ago which made it very sensitive for about a month (that is the large restoration in it, it was a composite that replaced an old amalgam back in 2007-8). The dentist at the time did topical application of desensitzer and told me to give it time which did work. Eventually pain went away for about 5 years. Then I bit on a pit 5 years ago and dentist said I "bruised the ligament". That went away after about a week. Then spontaneous pain about a year later, saw endo who said it was from impacted wisdom tooth next to it. Had wisdom tooth removed, pain went away for about 2 years. Then last year started getting random aches when chewing in that area, saw endo again, he said it was TMJ. Got a bite appliance, seemed to go away. However, last few months it got cold sensitive and bite sensitive. Saw my dentist, he said trauma from occlusion. He took it totally out of the bite, which caused it to get better, cold sensitivity gone now. But I still cannot bite on it. Saw a new endo (I stopped going to the old one for other reasons) who did few tests. The "tooth sleuth" was extremely painful to bite on. He said possible crack or "stressed tooth syndrome" causing symptomatic apical periodontitis and pulpitis. He said that the pulpitis was "probably" irreversable but nothing on xray shows immediate work needs to be done. He said I can wait as long as I want to see if it gets better or I could RCT or extract it. I also have mild pain with biting with the molar next to it, but that might just be referred pain. It was #15 which made me jump when I bit on the tooth sleuth. The pain is not constant, but if I chew anything on it, it aches for many hours afterwards. If I don't chew on it there is very little pain now that the pain to cold is gone.

I have had so many issues this year, I don't understand what is going on with my teeth. I am about to get an implant in 6 weeks on my root canal molar #19 I had extracted in June, and I also have had ongoing issues with tooth #7 as you might remember from earlier threads.

Is there anything you can think of to try to get the pulp to calm down? It is already out of occlusion and I am not chewing on that side. I am wearing a lower acrylic night guard to sleep. My holistic dentist just did an ozone injection above #15 but I have been in MORE pain since the injection, I am hoping this is temporary. He said we can try a weekly series but after this experience I don't think ozone injections are the right thing for this tooth.

The endo said that if I could get the pulp to calm down, I might get a few more years out of the tooth until I had to make any major decisions, and then I could be past my implant and have had time for the other teeth in my mouth to calm down so I can not have multiple areas in my mouth getting worked on at the same time. (I also need two old amalgam fillings replaced as well but have been afraid to do it as they are in my only chewing surface at the moment since I can't chew on my left due to #15 pain and the missing #19.)

I do not want to get another RCT nor another extraction. Do you have any ideas for me about what else I can do to help calm the pulp in the meantime, even if it just gives me another few pain free years?

Here are the xrays from the tooth. One set was from my dentist, the other from the endo because he wanted to take his own. Both say they see no sign of cracks or anything in the xrays. My dentist also looked with a dye and a light but said he sees nothing.

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I hope it is OK that I am bumping this? I am still hoping for a reply from Bryanna. Sometimes posts can slip down the list and get overlooked so I hope it's not bad form to bump it to the top again. Thank you in advance.

Hi nukuspot,

It's okay to bump up a post as sometimes they do get lost in the line up. I am also here as often as I can be and sometimes can only spend a few minutes at a time.

Of course we remember you! I'm sorry to hear that you have another tooth bothering you... but thanks for sharing the xrays.

Has anyone measured the pocket depth behind tooth #15? If so, do you remember what it is? Also, has anyone measured the amount of recession on the distal side? I ask because the bone level is quite high on the distal of that tooth. It may be due to the extracted impacted wisdom tooth which may have been lying up against the distal of #15 causing bone loss to occur.

Sometimes when a tooth has significant bone loss which exposes the root surface of the tooth, it can have on/off again symptoms to temperature sensitivity and to chewing. This occurs because the exposed root area is vulnerable to these things and when it feels beat up, it acts up. This does not mean that you are doing anything specific to beat it up... just everyday usage of your teeth can trigger it to flare up. This tooth also has a large restoration in it that does not appear to be too close to the pulp but it is large enough that in chewing on it a fracture could develop in an area of the tooth that is not restored. Tooth fillings, especially large, can make the attached tooth structure a bit fragile and it's not uncommon for those areas to have hairline fractures or worse. A fracture in a tooth is not often able to be seen clinically or radio-graphically unless it is large or displaced. Your symptoms are typical of a fracture, so that is possible.

Regarding the pulpitis... not occluding too hard on the tooth will help but chances are the symptoms will continue to wax and wane. As far as I know the best things to do to try to calm it down are through nutrition as this just helps the body to function healthier. Whole fresh foods as well as green juicing are packed with dense nutrients whereas processed foods, sugar, fast foods are negative on the nutrient scale. Supplements that help with inflamed nerves are B complex vitamin c, and omega 3's.

Hope this helps....
Bryanna



QUOTE=nukuspot;1183356]Hello, me again with my never ending dental pain. I just got an evaluation from an endodontist about my upper back molar #15. It had off and on issues for years, but always resolved. First was a filling replacement 9 years ago which made it very sensitive for about a month (that is the large restoration in it, it was a composite that replaced an old amalgam back in 2007-8). The dentist at the time did topical application of desensitzer and told me to give it time which did work. Eventually pain went away for about 5 years. Then I bit on a pit 5 years ago and dentist said I "bruised the ligament". That went away after about a week. Then spontaneous pain about a year later, saw endo who said it was from impacted wisdom tooth next to it. Had wisdom tooth removed, pain went away for about 2 years. Then last year started getting random aches when chewing in that area, saw endo again, he said it was TMJ. Got a bite appliance, seemed to go away. However, last few months it got cold sensitive and bite sensitive. Saw my dentist, he said trauma from occlusion. He took it totally out of the bite, which caused it to get better, cold sensitivity gone now. But I still cannot bite on it. Saw a new endo (I stopped going to the old one for other reasons) who did few tests. The "tooth sleuth" was extremely painful to bite on. He said possible crack or "stressed tooth syndrome" causing symptomatic apical periodontitis and pulpitis. He said that the pulpitis was "probably" irreversable but nothing on xray shows immediate work needs to be done. He said I can wait as long as I want to see if it gets better or I could RCT or extract it. I also have mild pain with biting with the molar next to it, but that might just be referred pain. It was #15 which made me jump when I bit on the tooth sleuth. The pain is not constant, but if I chew anything on it, it aches for many hours afterwards. If I don't chew on it there is very little pain now that the pain to cold is gone.

I have had so many issues this year, I don't understand what is going on with my teeth. I am about to get an implant in 6 weeks on my root canal molar #19 I had extracted in June, and I also have had ongoing issues with tooth #7 as you might remember from earlier threads.

Is there anything you can think of to try to get the pulp to calm down? It is already out of occlusion and I am not chewing on that side. I am wearing a lower acrylic night guard to sleep. My holistic dentist just did an ozone injection above #15 but I have been in MORE pain since the injection, I am hoping this is temporary. He said we can try a weekly series but after this experience I don't think ozone injections are the right thing for this tooth.

The endo said that if I could get the pulp to calm down, I might get a few more years out of the tooth until I had to make any major decisions, and then I could be past my implant and have had time for the other teeth in my mouth to calm down so I can not have multiple areas in my mouth getting worked on at the same time. (I also need two old amalgam fillings replaced as well but have been afraid to do it as they are in my only chewing surface at the moment since I can't chew on my left due to #15 pain and the missing #19.)

I do not want to get another RCT nor another extraction. Do you have any ideas for me about what else I can do to help calm the pulp in the meantime, even if it just gives me another few pain free years?

Here are the xrays from the tooth. One set was from my dentist, the other from the endo because he wanted to take his own. Both say they see no sign of cracks or anything in the xrays. My dentist also looked with a dye and a light but said he sees nothing.[/QUOTE]

Thank you for your quick response! I guess I am doing all that I can to help it if it is pulpitis, then, based on what you said. I eat a 100% organic diet, very low in sugar. I drink green drinks daily and take an omega 3 supplement and a B complex among others. My dentist took the tooth totally out of occlusion earlier this month, which helped get rid of the cold pain but unfortunately did not change the pain to chewing. When I chew on it, especially hard food, it is very painful, and then it aches for 1-12 hours afterwards, sometimes all through the night. Soft food does not hurt to chew, but still causes that same prolonged aching pain afterwards. So I almost completely chew on the other side. I try to stay off of that tooth completely because chewing=pain for hours. I also wear a night guard on the lower teeth, which has been recently adjusted last month to not touch #15.

I imagine that perhaps if it is a crack, that will never heal, correct? What is the standard treatment for a crack? Do they always suggest RCT or EXT or can they ever treat the tooth when it is still alive? The endo said the tooth is vital but he doesn't think it will recover.

For your questions--All my measurements for my gums have been 1-3s, so while I don't know the exact number, it was not anything abnormal for that pocket. There is recession on the distal side. My kids' dentist had early on recommended using MI Paste or ozonated olive oil on it (when I asked him while I was there for my daughter, he looked at it) to see if that would help. But it did not and when I saw my dentist he said that he didn't think the recession could cause my symptoms. The wisdom tooth was laying against it, you are right. That was removed about 3 years ago, because I was having pain in #15! Looking back, I think #15 has been having issues for awhile. When the pain went away after the wisdom was out, I assumed the pain was the wisdom, but based on what is going on now, it was probably whatever is going on with #15.

Is there anything else you can recommend I do as far as trying to get a diagnosis or treatment to calm it other than just watch and wait? It's not ideal to chew just on one side, but I will do that indefinitely if I have to.

Nukuspot,

The wisdom tooth, #16, was what caused the recession on #15 if it was laying up against it. The bone loss occurred not because there was a problem with #15 but because #16 left no room for bone to grown in between it and #15.

The loss of bone means that the distal area of the tooth is no longer protected as it would have been if bone were there covering it. The recession that occurs from the bone loss exposes a good portion of the root surface. So even if this were a virgin tooth, it would still be vulnerable to problems more so than if there were no bone loss. In addition to the recession, the tooth has a large filling which weakens an already vulnerable tooth.

If a tooth is fractured in the crown portion (this is the part of the tooth that visibly sticks out of the gum tissue) sometimes a crown can be done to help protect the tooth. But if the fracture is below the gum line or is vertical from the crown area down the root, then there is no effective way to restore that tooth. Root canaling a fractured tooth does not repair the fractured area but it does render the tooth chronically unhealthy due to the inability to debride the nerve tissue from the dentin tubules.

It can be very difficult if not impossible to find a fracture in a tooth and generally a fracture does not heal and repair itself. The best you can do is eat healthfully, take supportive supplements, seek help if you have a grinding habit (like meditation or other calming therapies), avoid chewing hard or chewy food on that tooth, and keep it clean.

Bryanna

Thank you Bryanna.

Unfortunately, I don't think I can live indefinitely with the pain. Well, it's not PAIN like how my other dental issues this year were. It's more like a boring, deep ache which worsens after any pressure is applied to the tooth.

So right now I am not rushing into anything, but eventually I imagine if it does not get any better pain wise or especially if it gets worse, I will have to make a decision. Do you know why my dentist has not offered to crown the tooth? At this point, after taking it out of occlusion and doing the ozone injections, he says the only options are to live with it, RCT with ozone (which I know you are not a fan of, but I am telling you my options) then a crown, or extract and do an implant.

Do you think there is any chance to work on the tooth while it is still vital? Like if he did a crown now without RCT? Or, my idea, remove the large composite fillling that is there now, check for cracks, then replace it with a medicated filling to try to calm the nerve? At first he seemed open to that idea, but then emailed me later saying that he thinks that would push it over the edge and he doesn't think it's worth trying.

I just am hoping for just one more step I can try at this point....Before making a life changing permanent decision on the tooth. Or living with chronic toothache!

Nukuspot,

The tooth is inflamed. So anything you do to it that involves drilling could put it over the edge. In order to remove the filling he has to drill it out which even if he didn't actually touch the tooth too much, just the vibration of the drilling could result in irreversible pulpitis. I think he wants to see if it will calm down on it's own and if it does then remove the filling as you said or do a crown on it. In the meantime, you are overusing the other side to chew with and dealing with an achey tooth!

I wish I had a wise remedy for you!

Bryanna

Thanks, I wish you had a magic remedy too!

He said basically either:

it will calm down by itself (though that is very unlikely given how long it's been going on) and that it may stay calm or flare back up again.

I can get a root canal with ozone (he agrees RCTs are not ideal but it is an option that he offers through a local endodontist. It is what I did with my front tooth #7 that was horribly painful this summer which was not a good candidate for implant in that space. Again, I know it was not ideal, but it was the best of few poor options I had which you remember my story, I am sure, and that pain was unbelievable.)

I can get it extracted and an implant. But that is not without risk either as the root is very close to the sinus back there and the bone level on the side where my wisdom tooth was is low.

So I don't think he is offering a crown on the vital tooth (unless a crack did appear then I am sure he would do one) or the filling replacement at all. I agree the filling replacement might put it over the edge but being these are my choices....I still wish he would reconsider it.

Thank you for all your help! So far I am trying to wait it out and see if anything will change, better or worse.