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FAQ:  Pain - Gum and Mouth



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Gum Pain Ask The Dentist Corinne Scalzitti Question:
Toothache and lower jaw pain: Three weeks ago my dentist preped my #2 tooth for a crown.

The tooth was fractured, but had not been hurting me. It was discovered during a routine visit. Since that time I have had a toothache in tooth #2 and on the lower back teeth area on the same side of my mouth.

The permanent crown was attached a week later, at which time the #2 had to be deadened, but I still had pain during the procedure. Last week, my dentist adjusted my bite, which he felt was the reason for the consistent pain.

It hasn't helped as I am still having pain in both areas. He has prescribed Hydroco / Apap and I have also been taking Tylenol and Advil. It's worst at night. The crown is very sensitive to cold / hot.

Am I too impatient? .... Visitor from OK

Answer:
I am sorry to hear of your tooth pain. My guess is that the crown is too high.

Because #2 is the last tooth back, it is at the hinge of the TMJ (temporomandibular joint) and receives the most pressure in your bite. I believe that your TMJ is affected and will not calm down until a few things happen.

The dentist needs to adjust the crown. I like to have the patient chew gum on the opposite side while I measure on the problem side. This mimics all of your jaw movements.

Adjusting a few times may not be enough because the muscles of the jaw will relax and your TJM will seat differently and the tooth will be high again. So, this may be an ongoing process.

Also, I suspect that you are grinding at night as a subconscious attempt to have your teeth bite correctly. I would put you in a nightguard to have the bite forces distributed among all of your teeth instead of only #2.

I would also prescribe a muscle relaxant at night. My favoride is valium, 2 mg. at night for 14 days. This will allow the muscles to relax and help you to find relief.

Another idea is that the nerve of this tooth may be dying and it could need a root canal, but my gut feel is that the bite is high. You might also seek a second opinion.

Corinne Scalzitti, DMD, MAGD

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