Unexplained pain in gums
 

I was having discomfort in a front tooth that had been root-canalled over 20 years ago, it also is one of the anchor teeth to a 3 tooth bridge spanning across my front teeth. The x-ray showed that it had a dark shadow and some slight bone loss. The strange thing was that from time to time accompanying the discomfort from this tooth, I experienced pain and discomfort across my gum line, rather like a soreness as opposed to toothache, over the top of a gum area on the same side as the problem front tooth, but not next to it, but two or three teeth away from this front tooth going back on the same side. The dentist has examined the gums, teeth and taken x-rays on this area, but cannot find any reason why I should be having any pain or discomfort in my gums above these teeth. I am wondering if this is nerve related pain due to the bone loss and problem with the front tooth. I have now had the front tooth re root-canalled in order to try and save the bridge, but is early days as this was only done a week ago and has not been finished off yet, so is a little uncomfortable at the moment but no major pain. Yet I still have this tenderness and soreness above the non-related gum area. Any advise on what this could be really would be appreciated because my dentist has drawn a complete blank here. Thank you

Hi Paddywhite,

I realize you are concerned about this three unit bridge especially since it is in the front of your mouth. But the truth of the matter is that nfection from a tooth does not go away until the tooth is removed because the chronic source of infection is the tooth. Root canals, apicoectomies do not remove all of the necrotic tissue from inside of the tooth. Rendering the tooth chronically infected. The longer the tooth is present, the more proliferate the infection can become.

Infection in the jawbone may not show up radiographically until it is severe. As a good example is your root canaled tooth.....20 yrs later (although it was probably sooner but undiagnosed or being monitored) the infection shows up on the x-ray. This has been an ongoing infection since the tooth first became infected. Some people will develop swelling, others feel pain or discomfort. If the pressure from the bacteria has found a path of release through a periodontal pocket or a fistula above the tooth, then it is likely not to swell and be uncomfortable or painful. Maybe that is what occurred in your case. The actual amount of bone loss being referred to a slight may or may not be more than slight. It is typical to see bone loss around root canaled teeth. So sometimes it's just "typical" to see it and not thought of as a problem. When in fact any time an infected tooth has caused bone loss, it indicates a problem.

In periodontal disease when there is bone loss in any amount, it is immediately thought to be a bacterial problem and some intervention is usually suggested. It could be as simple as more frequent dental cleanings and a change in oral health habits or something more technically involved. But with infected teeth that have been root canaled, dentists often do not diagnose this same bone loss as a bacterial problem. Go figure.......

Anytime you have chronic inflammation and/or infection in your jawbone, you will most likely have referred pain or soreness along that same ridge. It can often also be felt in other areas of your mouth, head, ear, neck..... etc.

This three tooth bridge.... is it replacing a missing tooth or are the three teeth splinted together due to mobility of the teeth and/or periodontal disease?

Bryanna

More detail for Bryanna
 

Thank you for responding Bryanna. I have read with great interest the concern with root canals in general. I will give you details of the situation. I had a root canal done on a front tooth about 20 years ago. After the tooth died it discoloured and I had two veneers on it and the neighbouring front tooth. Approximately 15 years later a new dentist suggested the veneers be replaced and in so doing drilled through a sound front tooth, splitting it in two, so it had to be removed there and then. To recover the situation they did a bridge spanning the already root canalled front tooth and then used the tooth next to the removed tooth to anchor the bridge on the other side, doing a root canal and a post to support it. So you can see from this why I am quite keen to retain the bridge I have, which took almost 3 months to get right and why I am particularly frightened about procedures on my front teeth.
I must admit however that I did have some peridontal inflammation over the tooth in question, not severe, but a little puffy and red for quite some time. I have never had any gum abcess, or nodes or lumps or discharge of any description at any time in the last 20 years and never suffered any pain until recently. The actual pain started in the gum and to one side of the bridged tooth, but to me felt more like inflammation than severe infection. It was at this point that the xray was taken to see a slight darkening at the end of the root, but this had not been evident in an xray of some 12 months earlier. The root canal itself still appeared to be clean and intact - but I was told the only answer to get to the shadow, ie the infection, was through a re-root canal. I have heard of referred pain, and it does seem to be of a nerve type, as the gum and teeth are all sound, but the dentist has not connected the two - which is why I am so confused. I look forward to hearing from you with your thoughts. Thank you.

Hi Paddywhite,

You are very welcome and thanks for explaining in more detail. So you have two root canaled teeth and one missing tooth, correct?

I can understand your reluctance to have dental work done in the front of your mouth especially since you have had so much done already. I know you want to "save" this bridge and that is understandable given the (mis)information that you have been given by your dentists over the past 20 years. I say that because both of those root canaled teeth harbor necrotic nerve tissue which means the inflammation and bacteria is more widespread than just having one root canaled tooth.

Also, I just want to clarify that all root canaled teeth are dead or non vital. This condition occurs immediately when the nerves that feed from the main blood supply are cut off during the root canal procedure. The microscopic nerves that reside in the tiny canals (called accessory canals or dentin tubules) are not removed because there is no access to them. However, these nerves no longer receive any nutrition from the blood so these tiny canals will always contain dead, infectious bacteria inside of them. That is only a part of what occurs after a root canal procedure. There are other things that occur in the jawbone from the lack of blood supply. I would be surprised to hear that you have ever been told any of that by your dentists.

Dental problems are very odd. There is usually NO pain until the problem has progressed or something is picked up on a x-ray. Keep in mind that for the infection to be seen on the x-ray (irrelevant of how big or small it appears on the film) it has had to be present for quite some time.... sometimes for years. When someone says their root canaled teeth never hurt or they have no obvious symptoms of an infection that does not negate the fact that these teeth are infected or that the surrounding bone is healthy. The example that I use is this.... diabetes, heart disease, blood clots, etc. often have no symptoms until something happens. So we really cannot say that something is okay just because it is not hurting for the minute.

The inflammation over the tooth is indicative of bacteria. This may come and go... it may lighten or darken in color... it may swell... it may spread...... or it may actually find another place to move to. Someone recently posted on here about his root canals in his upper front teeth and how he has swelling on his palate.

Root canaled teeth on x-rays do not show what is going on inside of the tooth unless the bacteria has eaten a hole through the tooth into the bone and even then that does not always show up. The x-ray only shows a 2 dimensional view which leaves many other areas unseen. So dentists will say... the root canal looks good or clean based on the incomplete picture on the film and nothing else. This is why I stress the chronic nature of the infection in the tiny canals.

You wrote....<<<I have heard of referred pain, and it does seem to be of a nerve type, as the gum and teeth are all sound, but the dentist has not connected the two - which is why I am so confused.>>

As I have explained the teeth are not "sound". They have problems. The dentist knows this, but he is not going to inform you of the things that I have unless you question him specifically about the residual bacteria inside of the accessory canals. He may then tell you that the body takes care of that bacteria.... false. Or that an antibiotic will take care of it.... false again.

To give you a clearer idea of what I am saying. Here is an article an clip from Dr Mercola talking about root canals....
http://articles.mercola.com/sites/ar...ot-canals.aspx

I know this is all very hard to read... I totally understand. But it is more than just your front teeth at risk here and you have the right to be properly informed. Whatever you decide to do is your personal choice. But you need the information to make that choice.

Bryanna