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Toothache, I think?

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Unread 04-06-2014, 03:50 PM   #1
Fsansi6
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Default Toothache, I think?

Hi I just joined and I've been noticing how knowledgable Bryanna is. Hopefully you can help me. In the past few years I've had 3 root canals and 3 caps in my last 3 upper right molars. I had so much pain in my last molar about 6 months after cap and root canal I had to have it extracted. So I now have the last 2 molars with caps and root canals and now I'm having excruciating pain in the area. It's been a week already and no relief. The dentist took an x-ray and it's normal. She did say that the sinus cavity runs very low and wanted me to see an ENT doctor. Well I first went to my primary. He said sinuses look good. Did a quick blood test to check for infection and said that looked ok but he would give me a script for 250 mg's of amoxicillin. It's day 3 and no relieve. Advil, aleve and Tylenol do nothing! My doctor sent me for a sinus xray and that was also normal. Tomorrow off the the ENT. ITS JUST MAKING ME CRAZY! The pain is giving me a headache. I get pain between the 2 teeth when anything hits it, food, water, hot, cold room temperature. It's so odd. The other problem is I've been getting shots for osteoporosis for the past year called Prolia. I keep wondering if that has anything to do with it. My dentist is very knowledgable and up to date with everything. But can't seem to locate the problem . I do have very sensitive teeth and cleanings kill me but I just don't know what to do! Any thoughts? I know it takes time and she doesn't want to rush into anything unnecessary but my mouth hurts so bad.
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Unread 04-09-2014, 08:56 PM   #2
justjane37
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Have you had pain off and on in this same area for a long time? Have you ever heard of Trigeminal Neuralgia? You may want to look it up at least. It can present itself as tooth pain and people have teeth root canalled and extracted only to end up with more pain. Your story just sounds similar to what others with Trigeminal Neuralgia go through.

Quote:
Originally Posted by Fsansi6 View Post
Hi I just joined and I've been noticing how knowledgable Bryanna is. Hopefully you can help me. In the past few years I've had 3 root canals and 3 caps in my last 3 upper right molars. I had so much pain in my last molar about 6 months after cap and root canal I had to have it extracted. So I now have the last 2 molars with caps and root canals and now I'm having excruciating pain in the area. It's been a week already and no relief. The dentist took an x-ray and it's normal. She did say that the sinus cavity runs very low and wanted me to see an ENT doctor. Well I first went to my primary. He said sinuses look good. Did a quick blood test to check for infection and said that looked ok but he would give me a script for 250 mg's of amoxicillin. It's day 3 and no relieve. Advil, aleve and Tylenol do nothing! My doctor sent me for a sinus xray and that was also normal. Tomorrow off the the ENT. ITS JUST MAKING ME CRAZY! The pain is giving me a headache. I get pain between the 2 teeth when anything hits it, food, water, hot, cold room temperature. It's so odd. The other problem is I've been getting shots for osteoporosis for the past year called Prolia. I keep wondering if that has anything to do with it. My dentist is very knowledgable and up to date with everything. But can't seem to locate the problem . I do have very sensitive teeth and cleanings kill me but I just don't know what to do! Any thoughts? I know it takes time and she doesn't want to rush into anything unnecessary but my mouth hurts so bad.
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Unread 04-09-2014, 09:23 PM   #3
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Hi justjane,

I cannot say for certain but I would not be surprised if the main reason people continue to have TN <like> pain after an infected and/or root canaled tooth is removed is due to the chronic infection that has diseased and damaged the bone and beyond. The entire area that surrounds an infected tooth can be severely inflamed and very sick. The surgery to remove these teeth and bone has to be very extensive which could result in permanent or temporary nerve damage. It can also be very difficult to eradicate all of the diseased bone because bacteria hides in the nooks and crannies of the bone.

With that said, I cannot help but think that keeping an infected teeth and/or root canaled tooth while treating the TN pain would be counter productive. I think it is unfortunate that all too often people get caught between a rock and a hard place because at that point no matter what they decide to do they may continue to be in pain for the rest of their lives.

This is why I repetitively inform people to think twice about keeping an infected tooth... root canaled or not.
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***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Unread 04-09-2014, 10:30 PM   #4
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Hi Fsansi,

I will offer you information based on my professional experience in the dental field. Not to sound insensitive toward the dental profession but general dentists are educated people <in the field of tooth carpentry>. They are not well educated in the systemic problems that arise from unhealthy teeth. This is why they often seem puzzled or suggest a wait and see approach when the root canaled teeth are having problems without obvious pathology. In other words the "tooth carpentry" has been performed... so what could possibly be wrong?

The first problem I see is the 3 root canaled teeth. One root canaled tooth contains diseased nerve tissue and is chronically inflamed. Times that by 3 and you can imagine the havoc going on in that area of your mouth. To make matters more intense your sinuses are in close proximity to these 3 upper teeth which means they could also be inflamed.

To tell a patient that the dental xray of a root canaled tooth is normal means nothing obvious is showing on the film. However, the bacteria residing inside of the tooth cannot be seen on the xrays until it proliferates from the tooth into the bone. Even then it is not always picked up because dental xrays are only two dimensional and depending on how the film is angled the pathology may or may not show at a different angle.

I'm guessing your primary care doctor checked up your nose and didn't see any pus so he thinks all is good. Yes? The sinus xray again if it wasn't a dental ct scan taken in slices it may not show anything more than the 2 dimensional dental xray. Again not to be insensitive to the medical profession but physicians are not educated in dental health and they are not apt to know how to treat a patient with a dental problem.

The basic blood work to check for infection will only show elevated markers depending on the severity of the infection. Did he do a C-reactive protein, Erythrocyte sedimentation rate, Plasma viscosity, Fibrinogen, Ferritin, or any other tests that could indicate inflammation or bacterial infection?

The osteoporosis drug Prolia is in a class of drugs referred to as Bisphosphonates. Have you read about Prolia and the possible side effects associated with the jaw bone? Infected teeth, root canaled teeth and periodontal disease all have bacteria related problems which can cause the jaw bone to a break down. People who take Bisphosphonate drugs are at a high risk compared to those who do not take them for developing osteonecrosis of the jaw bone which results in further bone loss and often infection. This can be very progressive and painful. An oral surgeon could be helpful in diagnosing this.

I personally think the origin of your bacterial issues have stemmed from your unhealthy root canaled teeth and quite possibly the Prolia. But at this point I doubt that you have Trigeminal neuralgia... not that it can't progress to that. I just don't think that is what it is now.

What did the ENT dr say?
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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Unread 04-09-2014, 10:30 PM   #5
Fsansi6
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Default Toothache, I think?

Quote:
Originally Posted by justjane37 View Post
Have you had pain off and on in this same area for a long time? Have you ever heard of Trigeminal Neuralgia? You may want to look it up at least. It can present itself as tooth pain and people have teeth root canalled and extracted only to end up with more pain. Your story just sounds similar to what others with Trigeminal Neuralgia go through.
Yes I've had problems in that area on and off. No I've never end heard of TN. ENT doctor said everything looks fine but I will be getting a cat scan to rule out any sinus issues. Dentist increased amoxicillin to 550 mg's and it eased pain quite a bit. Dentist suspects maybe a fracture in tooth root, but wants to see results of cat scan first. Going crazy!
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Unread 04-09-2014, 10:54 PM   #6
Fsansi6
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Quote:
Originally Posted by Bryanna View Post
Hi Fsansi,

I will offer you information based on my professional experience in the dental field. Not to sound insensitive toward the dental profession but general dentists are educated people <in the field of tooth carpentry>. They are not well educated in the systemic problems that arise from unhealthy teeth. This is why they often seem puzzled or suggest a wait and see approach when the root canaled teeth are having problems without obvious pathology. In other words the "tooth carpentry" has been performed... so what could possibly be wrong?

The first problem I see is the 3 root canaled teeth. One root canaled tooth contains diseased nerve tissue and is chronically inflamed. Times that by 3 and you can imagine the havoc going on in that area of your mouth. To make matters more intense your sinuses are in close proximity to these 3 upper teeth which means they could also be inflamed.

To tell a patient that the dental xray of a root canaled tooth is normal means nothing obvious is showing on the film. However, the bacteria residing inside of the tooth cannot be seen on the xrays until it proliferates from the tooth into the bone. Even then it is not always picked up because dental xrays are only two dimensional and depending on how the film is angled the pathology may or may not show at a different angle.

I'm guessing your primary care doctor checked up your nose and didn't see any pus so he thinks all is good. Yes? The sinus xray again if it wasn't a dental ct scan taken in slices it may not show anything more than the 2 dimensional dental xray. Again not to be insensitive to the medical profession but physicians are not educated in dental health and they are not apt to know how to treat a patient with a dental problem.

The basic blood work to check for infection will only show elevated markers depending on the severity of the infection. Did he do a C-reactive protein, Erythrocyte sedimentation rate, Plasma viscosity, Fibrinogen, Ferritin, or any other tests that could indicate inflammation or bacterial infection?

The osteoporosis drug Prolia is in a class of drugs referred to as Bisphosphonates. Have you read about Prolia and the possible side effects associated with the jaw bone? Infected teeth, root canaled teeth and periodontal disease all have bacteria related problems which can cause the jaw bone to a break down. People who take Bisphosphonate drugs are at a high risk compared to those who do not take them for developing osteonecrosis of the jaw bone which results in further bone loss and often infection. This can be very progressive and painful. An oral surgeon could be helpful in diagnosing this.

I personally think the origin of your bacterial issues have stemmed from your unhealthy root canaled teeth and quite possibly the Prolia. But at this point I doubt that you have Trigeminal neuralgia... not that it can't progress to that. I just don't think that is what it is now.

What did the ENT dr say?
Hi thanks for the input. ENT doctor didn't see any sinus problems and is sending me for a Cat scan of the sinuses, to rule out any problems. The blood work was just a finger prick so I doubt all those tests were done. Yes I know about all the side effects of Prolia and it took me a long time to make the decision on getting this shot. The jaw issues were my main concern. I discussed this with my dentist and she said I have no signs of osteonecrosis. She suspects maybe a fracture in the tip of tooth. She increased amoxicillin to 500 mg's which is helping a bit with the sensitivity.The Ent doctor said he never saw such a healthy looking mouth! Too bad it doesn't feel as good as it looks! Just so baffled. I wish it could all show up on an ex ray. Dentist said if it's fractured the next step is extraction. But what will happen to other root canalled teeth? I also keep hearing about referred pain. All so confusing. I'm very impressed with your knowledge.
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Unread 04-09-2014, 11:11 PM   #7
Fsansi6
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Default Toothache, I think?

Quote:
Originally Posted by Bryanna View Post
Hi Fsansi,

I will offer you information based on my professional experience in the dental field. Not to sound insensitive toward the dental profession but general dentists are educated people <in the field of tooth carpentry>. They are not well educated in the systemic problems that arise from unhealthy teeth. This is why they often seem puzzled or suggest a wait and see approach when the root canaled teeth are having problems without obvious pathology. In other words the "tooth carpentry" has been performed... so what could possibly be wrong?

The first problem I see is the 3 root canaled teeth. One root canaled tooth contains diseased nerve tissue and is chronically inflamed. Times that by 3 and you can imagine the havoc going on in that area of your mouth. To make matters more intense your sinuses are in close proximity to these 3 upper teeth which means they could also be inflamed.

To tell a patient that the dental xray of a root canaled tooth is normal means nothing obvious is showing on the film. However, the bacteria residing inside of the tooth cannot be seen on the xrays until it proliferates from the tooth into the bone. Even then it is not always picked up because dental xrays are only two dimensional and depending on how the film is angled the pathology may or may not show at a different angle.

I'm guessing your primary care doctor checked up your nose and didn't see any pus so he thinks all is good. Yes? The sinus xray again if it wasn't a dental ct scan taken in slices it may not show anything more than the 2 dimensional dental xray. Again not to be insensitive to the medical profession but physicians are not educated in dental health and they are not apt to know how to treat a patient with a dental problem.

The basic blood work to check for infection will only show elevated markers depending on the severity of the infection. Did he do a C-reactive protein, Erythrocyte sedimentation rate, Plasma viscosity, Fibrinogen, Ferritin, or any other tests that could indicate inflammation or bacterial infection?

The osteoporosis drug Prolia is in a class of drugs referred to as Bisphosphonates. Have you read about Prolia and the possible side effects associated with the jaw bone? Infected teeth, root canaled teeth and periodontal disease all have bacteria related problems which can cause the jaw bone to a break down. People who take Bisphosphonate drugs are at a high risk compared to those who do not take them for developing osteonecrosis of the jaw bone which results in further bone loss and often infection. This can be very progressive and painful. An oral surgeon could be helpful in diagnosing this.

I personally think the origin of your bacterial issues have stemmed from your unhealthy root canaled teeth and quite possibly the Prolia. But at this point I doubt that you have Trigeminal neuralgia... not that it can't progress to that. I just don't think that is what it is now.

What did the ENT dr say?
Just a quick question do you think the endodontist would be able to better diagnose this? Also my dentist does do oral surgery. But is not considered an oral surgeon. It's hard because I don't have insurance and I keep paying for root canals and caps and the had one pulled! But I guess there's no guarantee in life! Thanks again , any input I would love to hear .
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Unread 04-10-2014, 01:07 PM   #8
justjane37
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Hi Bryanna,

I agree with your entire basis for the problems regarding root canals. I also agree with your statement below about lasting pain due to a chronic infection. This is precisely why it is such a grey area when it comes to TN. I personally would never have had a root canal had I known then what I know now.

Type 2 Trigeminal Neuralgia when presenting itself in the mandibular branch mimics tooth pain. It does not matter if the person does nothing, has a filling, root canal or an extraction. The pain will remain and most likely worsen.

There are two different things happening. So, when presented with this type of pain and there is no physical evidence of an infection I think that it is important to at least consider a problem with the nerve itself, separate from the teeth.

Many people that have TN have had one or more unnecessary root canal or extraction. Knowledge of this rare disease in the dental and medical fields is lacking.

You do important work on this website and I do not mean to undermine that in any way. I simply need to bring it into the conversation if I see red flags going up. You are aware of TN and how and when it can present itself in the dental chair. Maybe in these situations you can present it as well so that at least the patient is aware of it?

After all this is a website about Neurology. The trigeminal nerve serves a person's entire face. When presented with nerve pain Trigeminal Neuralgia or Neuropathy should at least be in the conversation. It takes some people many years to receive a proper diagnosis. If more people at least knew about its existence that would not be the case.

Here is some more info:

http://www.livingwithtn.org/page/info-6

http://www.mayoclinic.org/medical-pr...nal-nerve-pain

http://trigeminalneuralgia-ronaldbri...al-Issues.html

http://www.bbc.com/news/health-24932880


Thanks,
Jane


Quote:
Originally Posted by Bryanna View Post
Hi justjane,

I cannot say for certain but I would not be surprised if the main reason people continue to have TN <like> pain after an infected and/or root canaled tooth is removed is due to the chronic infection that has diseased and damaged the bone and beyond. The entire area that surrounds an infected tooth can be severely inflamed and very sick. The surgery to remove these teeth and bone has to be very extensive which could result in permanent or temporary nerve damage. It can also be very difficult to eradicate all of the diseased bone because bacteria hides in the nooks and crannies of the bone.

With that said, I cannot help but think that keeping an infected teeth and/or root canaled tooth while treating the TN pain would be counter productive. I think it is unfortunate that all too often people get caught between a rock and a hard place because at that point no matter what they decide to do they may continue to be in pain for the rest of their lives.

This is why I repetitively inform people to think twice about keeping an infected tooth... root canaled or not.
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Unread 04-10-2014, 01:28 PM   #9
justjane37
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One more thing--the point is with Trigeminal Neuralgia is that it does not matter whether or not the person has a root canal. The pain is not from the tooth or the infection. It is from the nerve. Trigeminal Neuralgia is caused by a blood vessel or a vein pushing on or wrapped around the base of the Trigeminal Nerve. This causes the nerve to send false "pain" signals to the brain. Other causes of Trigeminal Neuropathy are a tumour or MS and can both be ruled out by an MRI. When Trigeminal Neuralgia affects the third branch, the mandibular branch it presents itself as tooth pain because it is the nerve attached to the teeth.

http://lh6.ggpht.com/_oj6TkG186pI/S0...255B7%255D.png



Quote:
Originally Posted by Bryanna View Post
Hi justjane,

I cannot say for certain but I would not be surprised if the main reason people continue to have TN <like> pain after an infected and/or root canaled tooth is removed is due to the chronic infection that has diseased and damaged the bone and beyond. The entire area that surrounds an infected tooth can be severely inflamed and very sick. The surgery to remove these teeth and bone has to be very extensive which could result in permanent or temporary nerve damage. It can also be very difficult to eradicate all of the diseased bone because bacteria hides in the nooks and crannies of the bone.

With that said, I cannot help but think that keeping an infected teeth and/or root canaled tooth while treating the TN pain would be counter productive. I think it is unfortunate that all too often people get caught between a rock and a hard place because at that point no matter what they decide to do they may continue to be in pain for the rest of their lives.

This is why I repetitively inform people to think twice about keeping an infected tooth... root canaled or not.
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Unread 04-11-2014, 11:24 AM   #10
Bryanna
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Hi Fsansi6,

Okay so the blood work was really not adequate and you truly cannot rely on the results of the finger prick to tell you anything. However, since you have been taking an antibiotic... even further blood testing at this time may come up with skewed results due to the medication. Keep in mind this does not mean there is no chronic or brewing infection or that the antibiotics is killing it off.

The ct scan needs to be done in slices and needs to include dental as well as sinus. Do not assume that this is the test that will be done.... please make it known this is what you need to have done. This is very important or the results will be as irrelevant as the finger prick blood test :/

Without a doubt based on vast research and evidence the root canaled teeth are not healthy. To what degree they are infected would not be known until they are removed and it would be great if they were biopsied and cultured. That is something you <should) could request that your oral surgeon do when he removes them. The results of those tests would not only confirm the teeth are diseased but they would tell what specific antibiotic should be used post operatively. So the bacterial issue residing inside of the teeth <and most likely beyond) is the first problem that needs to be acknowledged. The second issue which would truly only be icing on the cake could very well be that these teeth are fractured. Not an unusual thing for root canaled teeth... especially those that have had a dental post put in them. Thirdly, replacement options need to be discussed with your general dentist and the oral surgeon if you should be a candidate for dental implants. As a side note..... you should give dental implants a second thought if they are offered because again you are at a high risk of complications due to hte nature of the infection and the Prolia. So in summary a plan needs to be put in place so you know what to expect dentally as well as financially.

If your teeth problem has progressed to your sinuses and/or beyond then that needs to be confirmed as best as it can be. However, the extent of the bacteria may not be adequately visible until the oral surgeon removes the teeth and literally gets into those other areas. These issues are a very common occurrence and most often seen in cases regarding infected and/or root canaled teeth. If the sinuses are involved depending on the extent of the involvement the surgeon may or may not deal with that at that time. That is something you need to discuss with him ahead of time. In some extensive cases and ENT will also be present during the surgery and may need to perform additional treatment at that time. Keep in mind that no one is yet sure of the extent of your infection .... hopefully it has not yet spread too far. This is why I urge you to be aware that the teeth are a problem.

You are at an elevated risk for slow healing and post op complications due to the Prolia. Irrelevant of what your general dentist tells you about osteonecrosis, you are in the high risk category and no one can tell you how your jaw is going to heal after any oral surgery procedure. Your overall health, any medications that you take and your nutrition play a huge role in how you will heal.

It is best at this time to not get side tracked on things like referred pain .... TN pain .... post op complications ..... the maybes or what ifs. Focus on the origin of the problem which is the root canaled teeth. This will help you sort through the pages of this journey and keep you feeling more positive about the outcome.

You may have a healthy mouth aside from this quadrant. Or your dentistry may be very esthetic and gives the appearance of a healthy mouth. I'm hoping it's both of those things!!!
__________________
Bryanna

***I have been in the dental profession for over 3 decades. I am an educator, trainer and extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my professional experience and is not meant to be taken as medical advice.***
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