Severe tooth pain

[Finegold]

Hi.
Approximately 5 days ago I woke up with tooth pain focused on one side of my teeth. I assumed this would only last a few hours, so I ignored it. Eventually, this led to severe tooth pain, a headache, and pain in my ear. It was hard to localize this pain exactly but I think it came from a upper tooth in the right back side of my mouth.

I went to the doctor three times. The first two times they couldn't diagnose the issue even after many x-ray images. On the third visit, they removed 3 fillings, did freeze tests, and sedated me to attempt to diagnose it. After this, they still couldn't diagnose it. They then put temporary fillings on my teeth and let me go home.

I went home that day without treatment but was sedated in my teeth. After the sedation went away it didn't hurt the same way. I felt that the pain from the upper tooth had gone away (they had removed the filling on it). But now there is a pain in the backmost bottom tooth whenever I bite down on it (they also removed the filling on this), however, this pain is much more bearable (except when biting really hard).

Even after this, I still get a lot of pain in my right tooth (which hurts just as badly as before, but this is rare). I am not sure exactly where it's coming from or why, but it just starts hurting severely. I don't know what is going on, and I don't think the dentists know what is going on either. This is why I'm asking around hopefully to learn and to the pain.

Currently, I have a scheduled root canal treatment on the bottom backmost tooth and normal fillings on the other two teeth. But I am afraid that if I fill that tooth then the pain will remain or come back even more severely.

I will include a link to the x-ray images taken:

https://imgur.com/a/q3iF7xP

I have colored 3 teeth on the left of the panoramic image (which is the right side of my mouth). All the 3 colors are where the filling was removed. The red is where the pain is now when I bite down. The blue is where the pain was coming from before (I think, it was a bit hard to localize).

These are my symptoms:
Severe pain in my right teeth (hard to localize)
Pain on one tooth when biting down (and severe pain if I bite down hard).
Hard to sleep, waking up multiple times at night.
Pain coming and going in random intervals

I appreciate any comment and can clarify anything if needed.
Thank you

 

[MattKW]

Other tests should be explored besides simple Xrays: percussion, perio probing, ethyl chloride or CO2 (cold), electronic pulp test, palpation, FracFinder, and transillumination.

• Pain in the ear is usually referred from a lower tooth.
• Pain on biting usually indicates a fracture, hence a FracFinder and transillumination.
• if I only had the Xrays to guide me, I would select the red tooth as most likely. It is the largest filling on that side of your mouth, and has a suspicious dark area underneath.
• As an absolute last resort, I would give a long-lasting anaesthetic (bupivacaine) for either the upper or lower teeth on the affected side, and tell the patient to try and set off the pain again. It's the least reliable method but sometimes helps.
• I attach a file that I give to my students.
  

Once you start having fillings replaced willy-nilly, it only "muddies the water" because now you have disturbed 3 teeth and maybe set off other symptoms. Temporary fillings should ideally be ZnO/eugenol-based e.g. Kalzinol or IRM, (not simply Cavit); the eugenol will help settle pain. My money's on the lower molar. Let us know how you get on.

 

[Finegold]

Other tests should be explored besides simple Xrays: percussion, perio probing, ethyl chloride or CO2 (cold), electronic pulp test, palpation, FracFinder, and transillumination.

• Pain in the ear is usually referred from a lower tooth.
• Pain on biting usually indicates a fracture, hence a FracFinder and transillumination.
• if I only had the Xrays to guide me, I would select the red tooth as most likely. It is the largest filling on that side of your mouth, and has a suspicious dark area underneath.
• As an absolute last resort, I would give a long-lasting anaesthetic (bupivacaine) for either the upper or lower teeth on the affected side, and tell the patient to try and set off the pain again. It's the least reliable method but sometimes helps.
• I attach a file that I give to my students.

Once you start having fillings replaced willy-nilly, it only "muddies the water" because now you have disturbed 3 teeth and maybe set off other symptoms. Temporary fillings should ideally be ZnO/eugenol-based e.g. Kalzinol or IRM, (not simply Cavit); the eugenol will help settle pain. My money's on the lower molar. Let us know how you get on.

Hey, first of all, thanks a lot for the extensive answer and for the sheet provided.

From looking at it now, before, I felt like I was getting spontaneous pain, which suggests irreversible pulpitis. But after a while, I felt like the pain was only coming when I drank water, or breathed in cold air, but would still stay for 10-30 minutes. Note that I am under painkillers: 1 etoricoxib (90 mg every 24 hours) and 2 panadol (500 mg every 6 hours). So, while that might be skewing the pain results, this would suggest reversible pulpitis, since it's only triggered.
To note: the pain was tremendous, it would give me jaw and ear pain, and it would give me a headache as well. But essentially my guess is that it was some kind of pulpitis.

Yesterday I went to the dentist, and they filled in two teeth in the upper teeth (whose fillings were removed the week before that because I thought the pain was coming from there). During these fillings, it hurt a lot in my bottom rightmost tooth (which has temporary fillings) when they had to apply water or applied cold. The dentist even applied cold to the bottom rightmost tooth, and it would hurt a lot depending on which side the water was applied from, and I heard the dentist say "pulpitis". But they didn't have time to further investigate it, so they left it and told me they would transfer me to a specialist.

Today I woke up and the water does not seem to affect my tooth anymore, all the pain just seems to have gone away and I am not sure why. My last 2 panadol were 17 hours ago and 1 etoricoxib was 24 hours ago, so my guess is that it isn't the painkillers doing their job. I'm a bit afraid that I now have pulp necrosis, if it was pulpitis that I had (which has lasted 2-3 weeks), but I am not sure if it's supposed to hurt or not, because it does not seem to. Is necrosis supposed to hurt? Should I just ignore my previous pain if it truly has gone away? How can I check if I have tooth necrosis now?

Thank you


Some notes (that may or may not be relevant):
- The right backmost tooth still feels weird when I tab it compared to the other teeth. It's not as bad as before when it would hurt, now its just a different feeling.
- The dentists haven't done anything directly to by bottom rightmost tooth, like RCT or something like that, they only took a bunch of x-ray images, removed 3 fillings, filled 2 fillings, and checked a couple of times with freeze and water where the pain was coming from.
- I have now gone to the dentist four times. The first time I told them I had pain in my right backmost tooth. The second time I told them it was an upper tooth that was the source of the pain. The third time upper tooth again, and they were trying to investigate it. The fourth time I felt like the pain was coming from my right backmost tooth (which I think is where the pain truly comes from now). Essentially I feel like I have had some sort of referred pain, but I have always answered truthfully when they would ask me questions. This might have been annoying for them to deal with. But the first time I went to them was with pain in my right backmost tooth, which they even gave me chlorhexidine to treat with.
- I have a slight feeling that the 2 bottom wisdom teeth are coming, because I feel ripples in the skin in the bottom left and right of my mouth.
- My lips on the right side feel a bit weird (like they are scarred, when compared to my lips on the left side)

 

[MattKW]

Well, let's wait and see a bit longer. Good luck.