Gum Pain around one tooth - filling faulty?
 

Hi Bryanna, and hi everyone :-)
I have posted on here before and am an active reader of this forum, and would love your valuable input on my most current situation:
I just went to see a new dentist (who lives closer to me than my regular one) and explained to her that I am experiencing a very sore gum around tooth Nr 4 (next to an extraction side, but it is painful on both sides of the tooth, not just next to the extraction area). Basically, I have had issues with soreness of the gum off and on for a good year or more now, but it would always clear up after a week or so. Now, I can feel the soreness all the time. It feels as if one had a popcorn skin or something stuck between both sides of that tooth and the adjacent gum, and it feels very irritated and sore :-(. I don't eat popcorn and even the dentist said, nothing stuck there. It just feels like it.
Anyways, the new dentist is convinced I need to get the filling on that tooth re-done (the filling is on the side of where Nr 5 would be).
I decided to drive the extra hour to my long-time regular dentist to get a second opinion. She said, she could not see anything wrong with the filling at all! Also poked around my gums in the area, which was painful, but she said no visible swelling, infection, and no blood, so she is not sure why I would experience this pain! I am oil pulling, putting Neem oil on it, do salt-water rinses, take very good supplements every day, don't smoke, drink or eat processed foods... I am at a loss and would appreciate if you could take a look and tell me if you can see anything on the X-rays. Also, I should add that there is some material still stuck to that Nr4 as I had a Carlson Bridge for a few months which then got taken out as it was too tight and caused pain. So, you may see some extra material on the x-ray that is from the bonding or something.
Thank you so much, I really appreciate any input as I am not sure what to do next! Just replace the filling as per the first dentist? But would that make my gum on BOTH sides of my tooth feel better, I wonder - second dentist says, no, it would not most likely. ??? What now ???
Meera :confused:

... I just wanted to add that, when I press (not too hard, of course ;)) with my finger around the area, it really only feels sore around the triangle between tooth 4 and 3, maybe a bit sore on the triangle between 4 and the extraction site but really mainly between 4 and 3, but the rest of the gum around tooth 4 feels normal. Pressing onto the triangle between 4 and 3 gives me relief, actually. It really feels like stuck popcorn but I know there is no food in there - just the feeling of constant irritation, soreness, kind of tight...

Hi Meera Dasi,

Did either dentist take a periapical xray? That would give a picture of the tooth in it's entirety as the problem could be at the apex which is not seen on the bitewings. The bitewing xrays only show in between the teeth and how the teeth relate to those they are chewing against.

In the first xray it shows a widening of the periodontal ligament on #4 on the mesial side, closest to #5 space. This can indicate inflammation which may be the result of how this tooth is being used for chewing. Only the distal portion of this tooth is hitting against the lower tooth #30 putting unnatural pressure on tooth #4. This affects the ligament on the mesial side as the tooth is shifting from it's original position in the bone. It affects the distal side, closest to #5, as it's being over used for chewing. So both sides would tend to be sore on and off.

In the second xray, it is questionable as to if the filling on the mesial side of #4 is open or there is decay at the top of the filling towards the gum line. It is also apparent in this xray that #4 has elevated gum tissue exposing some of the root surface which could cause temperature sensitivity and/or soreness at the gum line.

I do see something that looks like material or something present in the gum tissue in the #5 space closest to #4. It is more evident in the second xray as it appears as a white shadowy spot shaped like a horseshoe. If this is something embedded in the tissue, that could be causing or contributing to your symptoms which sound to be inflammation related.

So what is your plan to replace #5 since you had the carlson bridge removed?

Bryanna

Hi Bryanna,

Thank you so much for the detailed reply, that does indeed help a lot and give an idea as to what to do next!

Well, the first dentist's plan was, to re-do the filling. That sounds like it might be a good idea from what your findings according to the x ray are as well, or am I mistaken here? If I do get it replaced, I was wondering as to if composite would be the best choice or if there is anything more durable out there (not amalgam, obviously - which my dentist won't use, since he is holistic). What about porcelain, etc? Any more durable options apart from composite?I don't like how they seem to have to be replaced every few years, and then, in the end, you loose the tooth if, like me, you don't want root canals in your mouth :-(.

Also, I wonder what the horse shoe shaped material could be... and, what to do about it? It's not like they can just dig it out, or can they? Could it be related to the extraction, like a bone spur or something?

As to replacing my missing teeth (I have 4 missing, one on each side, two were root canals, two cracked possibly due to my jaw being out of place for a very long time and me grinding my teeth - I have a temporary gel cushion now for nighttime and will get a custom guard once replacement teeth are in). I am thinking about implants, or removable partial denture. I have an appt. with my oral surgeon tomorrow to determine how extraction sites looked. I had bone grafts done in all of them, and only one of them (which was an old root canal) had some infection. I know of the possible risks of implants... on the other hand, I know that jaw bone will reabsorb and if I do need to get rid of more teeth in the future, I don't know what would happen if I lost more and more jaw bone... hence, I am really thinking about implants as well. Bridge, I do not want anymore. Did not like mine at all, and it just does not seem very durable (I would only ever want a Carlson bridge).

Let me quickly add: I just called my oral surgeon's office, whom I will be seeing tomorrow anyways for post-op check-up, and the receptionist was super helpful and told me to forward them my x-rays and the surgeon would have a look in regards to the horse-shoe shaped object/material.
I wanted to ask you if it would be okay for me to copy-paste your first response to me to them (without your name, of course), as the receptionist did say it would be helpful to include any findings of other specialists and you are the only one who has really commented on that issue, or even seen it in the first place (which I am so grateful for, by the way, as I just KNEW something must be there, otherwise, why would I be in so much discomfort?). Would that be okay? Also, I just spoke to my dentist's receptionist, who was super nice as well and asked if I could send her an email with what your findings/ suggestions are, as well (obviously, I don't mention your name to anyone, I just talk about "another specialist of the dental profession"). She said she thinks it is a good idea to have my dentist look at the x-rays again, combined with reading your response to me as well.

I also retrieved one more x-ray from my dentist, which shows the roots... not sure if it is clear enough though for you to see the root at Nr4. BTW, the left side (left when you look at it on your computer screen) is my right side jaw, so Nr 4 is located on the left side of the picture, not right :-).

Meera Dasi ... edited version of my post you can share
 

Meera Dasi,
I edited part of one sentence ... I changed a tooth number to reflect a correction in my original post to you.
Yes, feel free to share my notes with your dentists.
Bryanna


Hi Meera Dasi,

Did either dentist take a periapical xray? That would give a picture of the tooth in it's entirety as the problem could be at the apex which is not seen on the bitewings. The bitewing xrays only show in between the teeth and how the teeth relate to those they are chewing against.

In the first xray it shows a widening of the periodontal ligament on #4 on the mesial side, closest to #5 space. This can indicate inflammation which may be the result of how this tooth is being used for chewing. Only the distal portion of this tooth is hitting against the lower tooth #30 putting unnatural pressure on tooth #4. This affects the ligament on the mesial side as the tooth is shifting from it's original position in the bone. It also affects the distal side, closest to #3, as it's being over used for chewing. So both sides would tend to be sore on and off.

In the second xray, it is questionable as to if the filling on the mesial side of #4 is open or there is decay at the top of the filling towards the gum line. It is also apparent in this xray that #4 has elevated gum tissue exposing some of the root surface which could cause temperature sensitivity and/or soreness at the gum line.

I do see something that looks like material or something present in the gum tissue in the #5 space closest to #4. It is more evident in the second xray as it appears as a white shadowy spot shaped like a horseshoe. If this is something embedded in the tissue, that could be causing or contributing to your symptoms which sound to be inflammation related.

So what is your plan to replace #5 since you had the carlson bridge removed?

Bryanna

Meera Dasi,

Thanks for posting the pan.

The adjacent teeth next to all of your extraction sites have moved a bit towards the opening. This could make the restoration portion of a dental implant complicated as there needs to be adequate space between the teeth to place the implant crown that fits onto the dental implant. The areas would have to be measured carefully prior to any proceedings with implants. Sometimes orthodontia is suggested to help widen the spaces allowing the final restorations to be better functioning, easier to clean and esthetic-ally pleasing.

Pertaining to the jaw bone... it looks like you have maintained a good level and solidity of bone on your left side in both areas of the extracted teeth. On the right side in the area of tooth #5, the height of the ridge is a bit higher compared to that on the left and it has not healed as smooth as those on the right. Given your symptoms with that area and tooth #4, I think site #5 should be looked at more closely to rule out if there is anything lingering in that site at the ridge.

Pertaining to the jaw bone on your lower right in tooth #29 site. When was that tooth extracted? If it was more than several months ago, then it needs further evaluation as it appears "on the pan" to still contain the periodontal ligament or remnants of it. You can see that by the clearly defined outline of the tooth that was removed. That bone should look solid without any hint of a tooth ever being there. Placing a dental implant in the jaw bone where the perio ligament from an extracted tooth is still intact and where the bone has not healed properly can be problematic. Perhaps a periapical xray would be helpful. But ideally a 3D scan may be necessary if you want to proceed with an implant in that area.

Bryanna

Hi Bryanna,

Thank you for the detailed explanations.
I saw my oral surgeon today, and he took half an hour (originally I only had a 10 minute follow-up to see how extraction site 29 was healing, which had only been extracted 3 and a half weeks ago) to talk to me about my symptoms, and also about how to proceed for possible implants.

He has a 3D Scan from a month ago and looked at that thoroughly as well as at the newest x rays (the ones I sent you), and said, extraction site 5 looks good to him, gum looks perfect, feels perfect... his only concern was, that I may be hitting the area hard or clench due to 29 now missing. He though that maybe clenching due to the recent extraction of 29 could have caused Nr4 to bruise.He suggested I see an orthodontist, to get some further evaluation of tooth nr 4. He gave me a referral, and I was able to see the orthodontist today, as well. She took some very thorough tests of nr 4 plus the teeth around the area, with cold test and also some electric current testing, she said, x rays looked clear, gums as well, tooth responded to all testing - also, bite test and knocking the tooth did not really give much of a reaction from the tooth. I say, not much, since it did feel a tad more tender when banged with the metal hammer than the surrounding teeth, but not painful really, just kind of bruised maybe?
She did not recommend a root canal at this point, as all her testing did not reveal the need for one at this point, and she wants me to see her again for a (free of charge) follow-up in a month (unless pain worsens).

I also got an email reply from my general dentist, and he again said, he does not see anything wrong with the tooth or the filling apart from the filling being very deep :-(. Which makes me wonder - he suggested, maybe it was "dying slowly".

In regards to the implants, my surgeon did say that I should speak to the dentist who will be making the crowns to see whether he would suggest any othodontia. He did agree that my lower spaces especially, are smaller and the crown would have to be made a bit smaller than my original teeth in those spaces. He also said that sometimes, it is still very well possible to do it and it might only be an aesthetic issue. So, will have to speak to the dentist about that.
He further said that they do this thing (sorry, I don't know the professional term) some weeks before the implant surgery, where they do a computer generated surgery first and this will be sent in to certain specialists, who then will determine the best way to do the surgery (to prevent accidental nerve-damage etc). He said it was not absolutely necessary in my case, but he said if financially it was not too much of an extra burden, he would suggest me to include this step.

He also suggested to do the implants in about 2 months from now, but hold off on tooth nr 5 until it is figured out what is going on with 4 (and in case I will have to remove 4 as well - since I will not opt for root canals anymore, ever).

You know what, I just rememberd that tooth nr 4 was the tooth that the Carlson bridge was attached to for 9 months - and it had always caused me a great deal of pain and discomfort, it had moved my jaw and teeth out of alignment and I remember when I had it, the gum around 4 would feel irritated on and off all the time! I never knew that 4 had such a big filling in it, because I would have asked my dentist whether he really thought it was a good idea to attach a bridge to an already compromised tooth :(.

Anyways, I am not really sure at this point what to do next... just wait it out and take some ibuprofen (I don't tolerate anything stronger very well)? I kind of just wish something WAS wrong with the tooth so I could get it pulled and be done with this pain. I am also scared due to the fact that it has such a big filling already - does that not mean it is headed for a root canal sooner or later, which for me would mean extraction?

I am so grateful for your advice, Bryanna, I really feel you "know your stuff" and you seem so genuine, open and honest. It is so good to be able to openly talk about these things! :hug:

I want to add that my pain has not gotten better, if anything, it seems to be slowly getting worse, and I really wonder if maybe the tooth is just dying on me due to being compromised from a big filling and also having been stressed for almost a year being an anchor post to my Carlson bridge. I did get recurring gum pain and redness on that tooth 4 and always felt the bridge was pulling it out of it's natural position... anyways, if it is indeed dying, I will get it pulled next week. No root canal.
The pain seems to be mostly present on my upper palate in the area where I suppose the tooth root would be. It does not seem to come from the extraction site but seems localized around number 4.
One thing I am scared about is, what if it is something more serious like Osteomyelitis or -necrosis? I know it is rare, but still worried ... I have no swelling and no redness and the extraction site from number 5 feels fine to me. If the surgeon ends up taking 4 out too, would he be able to see if the bone was infected? They did take a CT scan and he said all extraction sites look fine, except #29 needing more time to heal (which was removed only 4 weeks ago).

Well, to be honest, if the tooth did not have a deep filling and was compromised already, I would be very sad and worried at the prospect of losing it, but I know the next step according to both my dentist and the endodontist I saw last week, would be a root canal, and I do not want that. And both my dentist (who agrees with me, he had all his RC pulled years ago) and my oral surgeon (who think's it's a pity a young, beautiful woman like me would rather have her teeth pulled than root canalled - but, still says he is here to help me either way I chose, and he will respect whatever decision I take for my health) know that I don't do root canals anymore. So, I don't feel I need to "convince" them or explain to them my choice.

:-)