Dear all,

Going to try to keep this short and simple - Hopefully someone could help get me to think right especially with all this pain.


About myself:
- Mid 20s.
- Non smoker
- Occasional drinker
- Floss, brush daily.
- Accidentally skipped a few days of my night flossing during early November due to jetlag and fatigue.


Sequence of Events:
1. Started having toothaches whenever I eat on the upper right side of my teeth during the mid of Nov.
2. 16-Nov-2015. Went to the dentist, had an x-ray and found out the first and second molars to my right have deep cavities.
3. Dentist did a pulpotomy treatment on the first molar, as she would like to avoid doing RCT if the tooth may survive this.
4. Pain intensified, sensitivity heightened after the pulpotomy treatment.
5. 20-Nov-2015 - Went to the dentist a second time, this time a different one. Found my second molar was actually dead with no response to cold (not sure why the first dentist did not notice this). Asked for extraction after discussion with this dentist for the following combined reasons:

• Time taken for RCT - Currently working at a foreign country with tight deadlines - Unfortunately my job takes quite a priority in life.
• Excruciating pain - Wanted something to stop the pain immediately. Painkillers did little for me then.
• A wisdom tooth is growing at the back - Confirmed with the dentist that this looks to be growing out straight. The wisdom tooth may take place of the second molar (and with extra room to grow - It appeared that there wasn't much space left on my jaw).
• Cost - I could always have my employer pay in my stead, which is reasonable seeing that I am in Geneva, though I am aware they will be conscious of the cost. *sigh*

6. Extraction tooth place and I was a happy man. First molar was still very sensitive to cold water, but I took that as the tooth needing time to recover. Started using interdental brush, toothpaste to reduce sensitivity, PlakOut gel. All good for about 10 days. Food did get into the extraction site occasionally but that was dealt with a quick rinse of my mouth.
7. 2-Dec-2015 - A dull ache started on my extraction site, or on my first molar (hoping it is just referred pain). I could not exactly pinpoint the source of the pain. Over the days it grow into ache + pain, bad enough to make me want to knock myself to sleep. No swelling on gum nor face, no fever.
8. There isn't a consistency to this pain, i.e. not related to my meals. It could hurt at one moment and not at all on another, with due aches in between. What is consistent is the response to cold water, where the tooth/extraction site would feel really sensitive for a couple seconds then subside. Still fine with hot drinks.



I am prepped to return to the dentist next Monday if the pain still continues to be this excruciating. Currently I am on ibuprofen to reduce the pain, already took 4 over the past 24 hours.

Could someone share with me what could possibly be happening to me, possibly a dry socket (10 days after extraction?), or the gum on my first molar receded a bit due to the extraction of my second molar causing pain + sensitivity? Or my first molar is just boinkers now and I should go ahead with RCT immediately?

Many thanks in advance, any replies would be really comforting for me.

Hi tre,

Your symptoms could be due to the nerves dying in the first molar and/or to a possible dry socket or infection in the extraction site.

The first molar..... The cold sensitivity on a tooth that has deep decay indicates exposed nerve chambers or tubules (of which there are many hundreds in every tooth) which react unfavorably to cold temps. A pulpotomy does not necessarily remove the decay in the tooth at the time of that procedure, it just removes a portion of the infected pulp chamber. So the tooth still has nerves that are very much alive and inflamed. The cold temp sensitivity may change to hot temp sensitivity as the nerves becomes more inflamed. Sometimes the exposed nerves die off to the point where there is no pain but then this is usually followed by swelling and further infection.

The only choices you have with the first molar are root canal or extraction. A root canal does not remove the dead and infected nerve tissue from the dentin tubules therefore rendering the tooth chronically infected. The extraction of the tooth is a permanent solution as the source of the infection, which is the tooth, is removed. However, you may want to know what your options are about replacing that tooth.

The second molar extraction site.... due to the extensive decay in that tooth, the infection from the decay may have spread beyond the tooth. If that infection and the periodontal ligament was not scraped out during the extraction procedure, then the site could still be infected. Not performing the debridement can lead to a dry socket and/or a bone infection. It is imperative that a tooth socket be thoroughly debrided after a tooth is extracted to avoid post operative infection and complications. Unfortunately not all dentists are thorough with the debridement. Not that a patient would know to request this on their own, I always recommend that patients tell their dentist or oral surgeon to be sure to thoroughly debride the socket of all tooth remnants, diseased tissue, ligament and bone.

The best you can do at this point is to keep the area clean and the rest of your mouth clean. Rinse well with a cup of warm salt water 5-6 times a day. Do not use mouthwash as the chemicals are irritating to the oral tissue and can prolong the healing time. Avoid eating on that area of your mouth and it would be best to get in to see the dentist on Monday for sure.

I am attaching a diagram of the anatomy of a tooth which clearly shows the many hundreds of microscopic dentin tubules throughout the tooth that contain nerve tissue and are not accessible during a root canal procedure. Each brown line represents a single tubule.

Hope this information helps and I hope your pain calms down over the weekend. Please let us know how you do at the dentist on Monday.

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