Question:
My wife experience chronic tooth pain in one of her teeth. After various
diagnostic procedures & attempts to remedy the problem, the dentist decided
to do a root canal. After the procedure the pain was still there.
My wife has also seen a endodontist, who, after conferring with her primary
dentist, performed an apiectomy. This still did not eliminate the pain.
Both the dentist & specialist admit to being bewildered at this stage over
what the problem might be. This problem has now existed for over several
years. It has been quite some time (over ayear), since her last procedure,
so we can rule out any residual pain created by the procedures themselves.
Is it possible this is referred pain, and that the problem is actually
caused by a different tooth? My wife says when she taps the tooth, it
hurts (and she does not feel main when she taps other teeth).
Does anyone have any other suggestions or ideas?
Answer:
I have, in the past, seen the occasional patient with complaints such as
this who were clenching their teeth so hard at night, that this pain was the
result. You might choose to try an occlusal appliance. See if your dentist
will fabricate an NTI device. Just a suggestion, discuss it in person with
someone who has actually examined her.
First and foremost root canal
therapy is not 100% successful.
There is a small percentage of
teeth (less than 10%) that do not
respond to conventional therapy.
Certainly after a year there
should be significant relief. Many
factors could be involved in this
discomfort including: root fracture,
night clenching and grinding,
clinical crown fracture, referred pain
from another tooth, non tooth related
pain, inadequate root canal therapy, etc.
Some suggestions:
1.Go back to the endodontist and make
him aware of the present situation.
2. Consider a NTI or Hawley Nightguard
3. Take endodontic tooth out of occlusion
(bite) in all excursion movements
4. Retest all teeth in the area including
opposite arch ruling out referred pain.
5. Have the endodontist redo the root canal
under microscope, checking for possible root fractures or inadequate fills
6. Consider crowning tooth if it is not
already been done
7. Finally if all else fails consider extraction
with or without intentional reimplatation
Although these steps are numbered, this is
not to imply one should proceed another.
Only the treating dentist can decide
which options should come first.
This case reminds me of the occasional patient I see who has had RCT on #19
or #30 done 2-3 times, apicoectomy, then crown, then RCT the tooth in front
of it, then RCT the tooth behind, then, RCT the tooth above it, then extract
the original tooth, and the pain is still there. In each of these cases, I
have eliminated the pain with a full arch splint carefully adjusted over a
3-6 week period. Now, I do the same thing in days with and NTI.
I agree that some RCT teeth fail, and mostly to fractured roots. However, I
see enough cases like this to always need to rule out clenching and occlusal
trauma before doing irreversible treatment. I suspect you see a number of
the same sort of cases?
Since none of these "dentists" has bothered to ask, I'm curious, which tooth
is it?
Second question: when she had the "tooth" worked on, was novocaine
administered and did it work? Did she require additional injections during
the proceedure or was one enough? Depending on the tooth and it's location,
we all may be barking up the wrong tree here.
She should seek the help of an alt. dentist... he can mix some eye of newt,
dragon scale, and pixie dust together to create a composite mixture similar
to that which Jan's alt. dentist uses. Then he'll dance around a fire with
a little doll of the tooth chanting magical incantations, putting pins in
the tooth-doll to alleviate her pain. It really works!
