- Joined
- Dec 26, 2023
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- 136
How long does it take maximally for a radiolucency indicating a periapical lesion to develop from pulpitis?
My dentist mentioned 2-3 months, literature says 2-10 months.
See: Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Development of periapical lesions. Swed Dent J 1993;17:85-93.
Reason for asking: tooth 41 became symptomatic in March and peaked in intensity in early May. Two CBCT scans in early May and late July showed no periapical abnormalities and pulp was normal. The paradox is that tooth 41 was/is sensitive to my own horizontal percussion which points to the opposite.
The endodontist interpreted the condition in tooth 21 related to trauma from bruxism and advised monitoring.
The pain in tooth 41 disappeared over the summer and returned a bit weaker in the fall. It is not constant but only present when I move around (and sometimes not even then). In the summer, I was on daily 800 mg Carbamazepine for another condition. If Carbamazepine caused that temporary relief, it must have taken 70 days to become effective....and then ineffective again as the pain returned while I still was on this med.
The condition is not so much an ache but more like a pushing (like in the early stage of a pulpitis) and has not changed in intensity since its reappearance (it is not your classic sharp alpha fibre pain).
I wonder whether, 8 months after tooth 41 became symptomatic, this could still be a developing endodontic condition or whether this is a neuropathic pain.
This issue followed the extraction of first molar tooth 46 last December and endodontic treatment of tooth 21 in February.
To add another complicating factor: after obturation in June, the periapical abscess around tooth 21 has never healed and is still constantly painful. This tooth may have to be extracted.
BUT: the pains in teeth 21 and 41 flip all the time...either one OR the other is symptomatic, but never both simultaneously.
A neurologist thinks at least tooth 41 constitutes a neuropathic condition and prescribed low-dose amitriptyline.
Complicated? Yep! Oh, I forgot that tooth 36 became symptomatic in March and failed an endo ice pulp test in April (pain lingered for a few minutes). When re-examined in July, pulp was normal again but the crown was observed to be cracked and extraction was recommended as long-term prognosis was poor. Tooth 36 was extracted in September.
So much for diagnosing "irreversible pulpitis." Endo ice is not reliable.
BUT, with all the gaps and sensitivies, the occlusion is obviously affected negatively and that poor tooth 41 may have to work harder than before, which could explain its condition.
My dentist mentioned 2-3 months, literature says 2-10 months.
See: Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Development of periapical lesions. Swed Dent J 1993;17:85-93.
Reason for asking: tooth 41 became symptomatic in March and peaked in intensity in early May. Two CBCT scans in early May and late July showed no periapical abnormalities and pulp was normal. The paradox is that tooth 41 was/is sensitive to my own horizontal percussion which points to the opposite.
The endodontist interpreted the condition in tooth 21 related to trauma from bruxism and advised monitoring.
The pain in tooth 41 disappeared over the summer and returned a bit weaker in the fall. It is not constant but only present when I move around (and sometimes not even then). In the summer, I was on daily 800 mg Carbamazepine for another condition. If Carbamazepine caused that temporary relief, it must have taken 70 days to become effective....and then ineffective again as the pain returned while I still was on this med.
The condition is not so much an ache but more like a pushing (like in the early stage of a pulpitis) and has not changed in intensity since its reappearance (it is not your classic sharp alpha fibre pain).
I wonder whether, 8 months after tooth 41 became symptomatic, this could still be a developing endodontic condition or whether this is a neuropathic pain.
This issue followed the extraction of first molar tooth 46 last December and endodontic treatment of tooth 21 in February.
To add another complicating factor: after obturation in June, the periapical abscess around tooth 21 has never healed and is still constantly painful. This tooth may have to be extracted.
BUT: the pains in teeth 21 and 41 flip all the time...either one OR the other is symptomatic, but never both simultaneously.
A neurologist thinks at least tooth 41 constitutes a neuropathic condition and prescribed low-dose amitriptyline.
Complicated? Yep! Oh, I forgot that tooth 36 became symptomatic in March and failed an endo ice pulp test in April (pain lingered for a few minutes). When re-examined in July, pulp was normal again but the crown was observed to be cracked and extraction was recommended as long-term prognosis was poor. Tooth 36 was extracted in September.
So much for diagnosing "irreversible pulpitis." Endo ice is not reliable.
BUT, with all the gaps and sensitivies, the occlusion is obviously affected negatively and that poor tooth 41 may have to work harder than before, which could explain its condition.
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