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FAQ:  Pain: Teeth - Molars


Wisdom Molar Pain Relief
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Question:
I take really good care of my teeth and gums, but about 7 years ago, as a result of a bicycling accident, I broke a molar on the lower left side of my jaw and had to have a root canal. I was given a temporary crown at the time, as a precaution foreseeing complications which did in fact arise. After a year and half or so, when my dentist felt that the risk had passed, I was given a permanent crown. The tooth and crown have been fantastic. However, very suddenly over the last two days I have experienced an unbelievable pain associated with that tooth. It doesn't not seem to be an abscess-there is no swelling, no fever, no tenderness at all around the tooth or in my lower jaw under the tooth. It seems to radiate at times around the back of my neck and up under my eye, yet maintains a very clear 'center' at the root of that tooth. The pain is so intense, over the counter pain relievers in recommended dose do not have much impact on it (2 Motrin every 4-6 hours not exceeding 6 in 24 hours!). The pain is not throbbing, but steady and it seems to be very clearly emanating from the old tooth itself as though the nerve had come to life again. Is this possible? Is there likely a tiny bit of nerve left down deep in the root of my tooth? And if this is the case, what does one do about it? Does this mean I will have to not only go through the root canal process all over again and then what of the lovely and expensive crown that I have enjoyed for the last 7 years? Will that have to be made anew as well? Is there any health risk if the nerve, as suddenly as it became agitated, suddenly becomes dormant again? Is this something that I can then 'ignore' unless it keeps recurring? ...Nicholas in CA

Answer:
Nicholas: It is very unlikely to have a root canal treated tooth have a nerve "come back to life" especially after feeling good for so long. I would certainly go in for an exam and a new x-ray of the area and some testing.

You said you are taking good care of your teeth and gums so I am assuming you have been going in for regular exams, cleanings, and x-rays. If correct, they should have a current x-ray of the area. I would still get an updated film and have some testing done.

What could explain this?
1. You could have had a crack in the tooth at some time during the root canal or crown process and it may have finally started giving symptoms. Usually a crack in a tooth will be painful to biting pressure or lateral pressures. You also can develope periodontal pockets around a cracked tooth. The latter must be checked by a dentist. I hope this is not the case as a cracked tooth with a root canal usually means tooth extraction.

2. You could have developed a problem in another tooth in the area or even on the upper arch. Teeth can often give all of us a rough time finding which one is causing a problem. You can have pain referral from a totally unrelated tooth. Again, this will have to be tested. This is more likely the problem.

3. You could have an inflammation in your jaw joint or some aberrant firing of your facial nerves in the area. My recommendation to you is to go in and get the area checked with updated x-rays and pulp testing. A periodontal exam measuring the pockets around the tooth in question can also be helpful. For the weekend, you can safely up the dose of your over the counter Motrin to 800mg (4 tablets) every 4-6 hours with something in your stomach.

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