[VMarieM]

Hello, I am new here. I am a generally healthy 46-year-old female, but recently I have not been so healthy, and I am trying to figure out how everything that has been happening to me is or is not inter-related. Please forgive the long, detailed post, but it is hard to know which details are important and which aren't!

More than a year ago, my dentist told me I had a cracked tooth. This was diagnosed by the fact the floss would not go down between that tooth and the one in front of it plus the dentist poking his tools into the area. I had NO pain from the tooth, but it had a large, old amalgam filling and xrays showed possible decay starting around the area of the suspected crack, so the dentist told me it needed to be crowned. I had never had a crown and didn't like the idea of removing most of the tooth besides not being in a good financial position to pay for a crown, so I put it off. Fast forward to this July at my regular check-up--still no symptoms from the tooth and the floss goes down now, but the dentist says xrays show more decay in there so the crown must be done soon or a root canal would be needed. I had a trip to Ireland planned at the beginning of August, so I scheduled crown prep after my return. I don't know tooth numbers, but the tooth in question is on the bottom right. It is a molar between two other molars.

Meanwhile, I developed a stubborn sty on my right eyelid which would not completely heal despite lots of hot compresses. I went on my trip, but a few days after returning, I woke up with a pain in my hinge area of my right jaw which made it painful to open my mouth wide or chew normally. It was worse the next day and I realized I was running a fever of 100.3. I thought maybe the eyelid infection had spread (no pain from the tooth at this point so I made no connection to that). My GP dismissed the eyelid problem as allergy irritation (on just one eye?!) and diagnosed a sinus infection since the pain had now settled behind my right cheekbone. She gave me a round of Amoxicillin which I took. I have had sinus infections before, but this did not seem like a right diagnosis since I could breath through my nose fine and had no unusual sinus drainage. However, I took the Amox and the pain subsided (though it did not go completely away) and the fever too.

I had postponed my crown prep because of this, and I was concerned that I still felt a little pain in front of my ear after finishing the Amox but figured I'd better get the tooth taken care of before it needed a root canal. As soon as the anesthesia wore off, I had a terrible tooth ache! I did not chew on the temp crown at all, and I waited and hoped the nerve would calm down. After a week, I could no longer stand the pain. I noticed the pain in front of my ear was also worse and began to wonder if there was a connection, plus my temp was creeping up again to 99.5. My dentist said I needed a root canal and referred me to an endodontist who did the procedure the same day. I had never had one before and knew little about them and had no time to research. I asked if I needed an antibiotic afterwards but the endo said no because the root did not appear infected to him (pulpitis, I guess?)

A week after the root canal, most of the tooth pain had resolved but I still had pain in front of my ear and fever of 99.3-99.8 plus less energy than usual. I had done some research by that time and found out there is a nerve center right where my pain was and that tooth pain could refer to that spot. I began to think the pain there had been from my tooth all along, that maybe it HAD been infected even before the crown prep, and the continuing symptoms made me wonder in the endo had missed a canal. But I called them, and they said the symptoms didn't sound related to the root canal. I asked to come in for a check but they couldn't get me in for two weeks.

Meanwhile, I went back to my GP because I also still had this sty on my eye. She said she would refer me to an opthamologist and arrange a CT scan of the area where the pain was. Her office was supposed to get back to me within a few days. They never got back to me at all, and by this time I was pretty disgusted with them (especially after the nurse told me she had no record of my being prescribed Amox in August!). So, I made my own appointment with an opthamologist and went in for my endodontist check. The endo tapped the tooth, felt the gum, applied cold, but could not get any abnormal reaction so he concluded the tooth was fine. So, I had the permanent crown installed and waited to see the opthamologist who couldn't get me in until early Nov.

During October the pain in front of my ear subsided and my temp lowered to 99-99.5 or so. I felt a bit more energetic and thought maybe whatever the issue was was resolving on it's own. However, by the end of October things were getting worse again. The pain returned, and the day I saw the opthamologist they recorded my temp as 100.1 after taking it three times. The opth did not think the temp and pain were related to my eye problem, but he did put me on Doxycycline for chronic problems with the oil glands in my eyelids causing infection. After a week on 100mg/day of Doxy, I felt better! The pain went away and my temp was actually normal! Then, I went on a 50mg/day dose for longterm treatment and things gradually started to get worse again.

Now, the pain in front of my ear is back PLUS it sometimes feels like it also hurts very briefly in the root area of the crowned tooth. The pain there is vague, unpredictable, and intermittent. I cannot cause the pain to happen by chewing or temperature application, but I do notice it happens more often when I am lying down. I still think the tooth may be the cause of my continuing issues, but my question is HOW do I get a dentist or endodontist to believe me? Will an xray show any problem that may be there? Do I need a CT scan? Is there any other possible explanation? If it is the tooth, is extraction the only option? If so, how can I find a dental pro to help when they are all so gungho on saving the teeth?

[rose8]

Hi VMarieM,

Very sorry to hear you're going through such an ordeal.
I'm also new on this forum, but I thought I'd add my thoughts.

In my opinion your dentist damaged your tooth pulp during the crown procedure. I'd say he wouldn't be to blame, as you said there was already a massive filling in there - it sounds like unavoidable. My guess would be that the tooth infection, if present, was not that deep, since the tooth was not hurting you before.

So my guess would be that the eye stye and ear pain are connected, and they further affected the now damaged tooth. You've probably already seen online that both the eye and the ear are connected to a thing called "preauricular lymph node" - so, in my non-expert opinion, perhaps you should ask your GP for treatment for that (I read they give antihistamin + anti-inflammatory).

My dentists (yes, plural) have told me that some random mild pain is normal for months after a root canal, so perhaps wait that one out?

[VMarieM]

Thank you for your reply, Rose8. I also thought initially that the eye problem might be causing the pain in front of my ear, because I read that eye infections can cause swelling in the lymph glands near the ear. However, my GP said those lymph glands were not swollen on me. She also said that if infection had spread that far there would be visible facial swelling and a higher fever. Since then, I have realized that the pain has a lot of the characteristics of nerve pain. I have suffered from sciatica nerve pain and from ulnar nerve pain in the past, due to separate injuries, so I know how that can feel and how it can seem that the pain is coming from one place when the source is really an entirely different place. There is definitely a connection between my constant lowgrade fever and this pain as they started at the same time and one always gets worse or better when the other does. My research indicates that a constant lowgrade fever usually indicates a bacterial infection somewhere in the body. If there is an infection in my tooth, that would explain why the fever and pain have gotten better both times that I went on antibiotics. The antibiotic gets the infection under control but cannot eradicate it until the tooth is properly cleaned out or removed. So as soon as I go off the antibiotic (or lower the dose too far) the infection symptoms return.

As I have searched online for answers, I have seen more than one endodontist's website where they give info to their rootcanal patients saying that if you are running a temp of 99.5 or higher after your root canal, you probably have an infection in the tooth and should contact their office about it. Having seen that, I am puzzled why, when I called my endodontist's office a week after my root canal and told them I was registering a temp that high all the time, they told me, " That can't be from your root canal. That is not a symptom we see in patients after root canal." Other endodontists don't seem to agree?

The pain seems to be settling more and more into my jaw and the area of the crowned tooth, and it us more constant now in that area. I fear it will soon be an all-out toothache if this continues. Then maybe the endodontist will take it seriously! Unfortunately, I live in a small enough town, that I don't have a choice of endodontists unless I drive an hour or more.

[nukuspot]

I had a very similar ear/jaw/same tooth as you describe pain last year for almost 8 months. They first thought it was TMJ and being that your pain is right in front of the ear, that makes me think that about you as well. Mine was inside the ear, though, like an earache.

My tooth in question was a tooth that had been root canaled for 19 years. Eventually I did get it extracted and I can say that the ear pain did eventually go away. I still am not totally convinced what the connection was, neither do the dentists. But I wonder if it could have irritated the trigeminal nerve.

As someone who has had multiple dental issues that no one could figure out, I can say that most likely, no one will ever give you a diagnosis unless something shows up on xray. Otherwise they just tell you to either live with it or extract it. It's unfortunate, but dentistry is just not very advanced.

[nukuspot]

has anyone done any folllow up xrays since the root canal?

[VMarieM]

No, no xray has been done since the root canal. When I finally got to see the endodontist about three weeks after the root canal, he said "Since you still have your temp filling and temp crown, there is no point in taking an xray because nothing has changed since the procedure." That is one of the reasons I came on here--to find out if a problem with the tooth is always going to show up on an xray or not. What kind of problems do or don't show on one? I could probably get my dentist to take one (I hope) but if he says nothing shows up, how confident can I be that nothing is wrong? Should I push for a CT scan if an xray looks normal? And how reliable is that? I have learned through unfortunate experience that medical imaging tests are not as foolproof as doctors would like to think. For two years after tearing the labrum in my shoulder, I was in a lot of pain, but an MRI showed nothing wrong--because the labrum does not show up well even on an MRI--which is probably why so many doctors seem unaware of the possibility or symptoms of a labrum tear. When I finally found one that was, he just knew that was my problem without needing a test to prove it. He went in surgically and repaired it and gave me my life back. I suppose I am not very trusting of doctors after that experience because if they don't see the explanation for your pain, they tend to jump to the conclusion that it's mostly your imagination and start asking you if you are depressed or under a lot of stress. "Yes, but if you would make this pain go away I wouldn't be!"

[VMarieM]

In regards to TMJ, I have considered that as well. The first time I woke up with this pain back in August before the root canal, my first thought was that I either slept funny on my jaw and put it out of alignment and/or I was clenching/grinding in my sleep. Years ago during the stress of pregnancy and being a new Mom, I had some issues with clenching and grinding during sleep causing my two upper rear molars to hurt. This was diagnosed by my dentist at the time. Since then, I have learned to sleep with my teeth apart and my jaw relaxed. I haven't had any symptoms of grinding for years, and I never had pain in my jaw joint. I have been paying special attention lately, but there is no pain in the teeth that used to hurt when I was clenching and no tension in my jaw muscles when I wake. Furthermore, I wore the temp crown for over a month, and I think sugns of grinding would have showed on that. Instead my dentist noted how the crown showed little wear because I tried not to chew on that side for so long. Then, there is the lowgrade fever. I have never heard of that happening with TMJ. Am I wrong?

[nukuspot]

I think that low grade fever can happen with any chronic inflammation---though have been dealing with chronic dental pain/inflammation for over a year (in a very similar story to your own) and do not run a fever....

As far as xrays go, they cannot show infection in early stages, they are also bad at seeing cracks in teeth. I have so many xrays where they found nothing wrong, but I had awful pain in that tooth. Have another situation right now as we speak. It's so disheartening and it's not in my head or your head.

Just an idea---Can you see if your dentist can make you a splint you wear at night? Just to rule out any bruxism during your sleep causing or exacerbating your pain? Just until you get more answers.

[nukuspot]

I had a root canaled tooth extracted in June because it was causing pain that did not show up clinically on any xray. The extraction did solve the issue (no tooth=no pain) BUT it seemed to wreck havoc on the rest of my mouth, causing my bite/TMJ to shift and put pressure on other teeth. As a result, I had extreme pain in other teeth that never bothered me before. I believe that if I had worn a night guard back then, I might have been able to avoid the extraction. Now that is not to say that root canaled teeth are safe and healthy to have in the mouth, but living in chronic dental pain, as I do now, is also not safe and healthy. So I don't know which would have been the lesser evil. I think about my teeth 100% of my life now, and it limits what I can eat or do or sometimes, when the pain is worst, limits my daily function. I might have more root canals or extractions in my future, even with wearing the bite guard.

I can say that having my dentist adjust the occlusion on the teeth that hurt the most did make a big difference from horrible pain to mild pain. And I now only chew in one little area of my mouth in the one place I have no pain.

[Siobhan]

Hi nukuspot,
Apologies for my ignorance, but do you maybe have any residual bone infection after that root canaled tooth was extracted in June?

Also, what does it mean "adjust the occlusion on the teeth that hurt", how did he do that??

Thank you for any help you might offer me!