Unknown Pain - Advice Please

[Stephen80]

Hi All,

My first post, and to explain everything that's going on will probably take a while, so please bear with me. I will start from the beginning and try to be as succinct as I can.

I visited the dentist in mid-February as I was having a shooting pain in what I thought was my lower back right molar (no.7 I've been told it's called). The NHS dentist I saw advised that I had a crack in my tooth which didn't surprise me as I've been told that I grind my teeth (and whilst I'm pretty good at wearing my tooth guard, I didn't wear it always). As this was NHS, I had to wait for an appointment - one was booked for the end of March.

On the 5th March I noticed that my pain was getting worse, to the point where I couldn't eat on my right hand side. I made an emergency appointment on the 7th March, at which point the pain was unbearable... coming in waves of pain. The NHS dentist did my filling and it was then I found out that the crack was actually in my no.6 not where I thought the paid was coming from (she also commented that she wouldn't charge me as much as first quoted as the filling didn't need to be that deep - this becomes relevant later). She then took an X-ray as she seemed surprised by the level of pain I was in. From this, she identified that my bottom right wisdom tooth is situated horizontally and is impacted in my no.7 underneath the gum and is rotting it. Due to nerve placement she told me I'd need to get a surgeon to remove the wisdom tooth.

Thankfully I have BUPA through my work and whilst they don't cover dental issues, the do cover operations, and so instead of waiting I managed to get an appointment on the 9th March to see a surgeon... a good job too as the pain was unbearable, I couldn't eat properly and couldn't drink any hot drinks. I met the surgeon and he said he needed to take a Cone Beam X-ray to see what was going on, but this would have to be in the hospital on Monday 12th March.

After a horrendous weekend, I had the Cone Beam and was lucky enough to see the surgeon afterwards (he made a special visit as he knew how much pain I was in - cannot say enough about this guy). He said he didn't feel the wisdom teeth needed to be removed and thought they were a red herring, he did however notice what he thought was decay in my no.6, which is were I had the filling by the NHS dentist. It was at this time that I also found that sipping cold water got rid of the pain for a minute before it came back in waves - each sip would sooth it but the pain would go on for over an hour on each attack, so I was drinking a lot. My surgeon told me that due to these symptoms he felt I had irreversible pulpitis.

I managed to get another appointment at my dentist on 13th March, however, I had lost faith in my NHS dentist so I decided to see the private dentist. I should note that about an hour before my appointment I was getting another attack of the pain in the form of waves, and where water had soothed the pain before, this time it caused it to become more excruciating, and the pain had moved from the lower jaw to the cheekbone. It hurt so bad that I was screaming in agony.

By the time I got to my dentist, I was in tears due to the pain (and stress of the past week). He examined me, took more X-rays and told me that the NHS dentist hadn't gone deep enough on my filling and there was decay underneath. He undertook what he called a deep filling on my no.6 and told me I would be sore for a couple of weeks. He then charged me for the privilege (I was in too much pain to argue, even though if this had been done the first time correctly then perhaps I wouldn't have gone through this level of pain). He also commented that he felt my wisdom tooth was causing a problem and that I would need my no.7 removed, due to the level of decay and impaction from the wisdom tooth - I argued against this following what the surgeon had said, and we decided to see if the filling resolved the problem.

Anyway, here I am today and I'm still experiencing discomfort. Don't get me wrong, the waves of pain have gone, however, I still have an aching pain in my right cheekbone and I have tenderness underneath my lower right teeth. I still can't eat anything that isn't soft, as I get a jabbing pain when I chew, although it's not all the time. For example, I had chicken last night that was relatively soft, and I got a jabbing pain on a couple of bites, but on other bites it was just uncomfortable, not painful. I also get the occasional heartbeat in my no.6 tooth, which I read on forums was the tooth dying, as such, I decided to go back to my dentist today.

He initially told me that he felt all of my issues were now the wisdom tooth and he should pull it. I was reluctant, as the pain is in no.6 and if I end up having no.7 removed and it doesn't solve the pain, then I might end up losing no.6 as well. He then examined me by feeling around my gums and checking my teeth and told me everything seemed fine, and he thought the pain was just my mouth still recovering from the trauma of the deep filling.

So, I have no idea where to go from here. I could leave this a bit longer to see if the pain subsides or should I pay another dentist for a second opinion? My issue is, I have to put so much trust in what I'm told and if I get something done irreversible (such as a tooth removed) and it doesn't solve the problem then I'm not only out of pocket, but also without a tooth (or teeth potentially!).

Sorry for the overlong post - I would be grateful for any advice?

 

[Busybee]

You seem to be getting lots of conflicting information. But I do find that when you have two dentists you can end up with three opinions.

You should request all the dental records from your nhs practice (before and after x rays and the notes). You are entitled to this information by law if you make a request. They are allowed to make a small admin charge if they wish. You should then find a good dentist (or two) and get them to examine you and look at your current situation. Then ask for a second opinion on all the work you've had done vs the x rays and notes. You are not in the same pain as before, so make sure you don't rush into any work without getting some different viewpoints.

At least you haven't yet had to have any teeth extracted and your last dentist has managed to reduce your pain and has tried to help you. You are no longer screaming in agony. It's possible that the filling he did needs to be adjusted down slightly as your bite may be too high. This should be free of charge. If your wisdom tooth is horizontally impacted then that doesn't sound too healthy for the root of the tooth next door.

What you should do is complain about the NHS dentist who it appears gave you a filling in your 7 which you didn't need. You will need your records to do so. Your symptomatic tooth was also made worse. You will need the opinion of another dentist. a report can cost up to £50 but may be less.

By the way I'm not sure what is no. 7 and no. 6 but diagrams show this to be an upper right incisor and canine. You were talking about lower back right molars. These are 30 and 31 on diagrams.

 

[Stephen80]

What you should do is complain about the NHS dentist who it appears gave you a filling in your 7 which you didn't need. You will need your records to do so. Your symptomatic tooth was also made worse. You will need the opinion of another dentist. a report can cost up to £50 but may be less.

Thanks for the advice... just to clarify, the crack was actually in my no.6 (as my dentist calls it) and this is where the NHS dentist placed the small filling... she then said my issue was my wisdom tooth. The surgeon then told me this wasn't the case and when I went to see the private dentist he gave me a deeper filling in my no.6 saying that the NHS dentist (who works for him) hadn't gone deep enough and there was decay underneath... so if she had caught it in time then I might not have gone through a week or unbearable pain. I was charged £73 on my first visit and £109 on my second visit... so, the most I could probably claim back is £73 and it might not be worth it if I have to spend money for reports etc.

By the way I'm not sure what is no. 7 and no. 6 but diagrams show this to be an upper right incisor and canine. You were talking about lower back right molars. These are 30 and 31 on diagrams.

Not sure if this is just the way it is in the UK, but both the dentist and surgeon referred to my bottom right molars as no.6 and no.7 (i.e. the two back teeth) and my impacted wisdom tooth in my back right as my no.8?

 

[Busybee]

I think they count from the middle outwards (starting with the central incisor). In terms of the complaint you should make it so that the NHS are aware of the problem. You may be in a position to claim compensation for your distress and pain. That would be in excess of the cost of the work.

so the private dentist you saw was at the same practice? I'd get a second opinion from another dentist. It's worth the money to have your teeth checked by someone who knows what they are doing. You could end up spending far more in the future if there is an underlying problem that hasn't been addressed.

 

[Stephen80]

so the private dentist you saw was at the same practice? I'd get a second opinion from another dentist. It's worth the money to have your teeth checked by someone who knows what they are doing. You could end up spending far more in the future if there is an underlying problem that hasn't been addressed.

I agree with you, and I've been looking at other practices to go to, but I have no idea if they would be any good. I've found a practice that looks nice and will cost me £20 a month, however, I've lost all faith now and I'm worried I could go there and find they have less experience than the dentists at my current practice

 

[Busybee]

It is worth looking at both NHS choices and the General Dental Council website for a specialist in your area. NHS choices have reviews of NHS Dentists. I'd recommend you google a "minimally invasive" dentist because their focus is on conservative dentistry, preservation of tooth structure and a more careful approach. They might for example take the view that "watchful waiting" is a good approach to your impacted wisdom tooth, where they observe over time whether it's likely to cause a serious problem, etc.

 

[MattKW]

Long and detailed post, wish you had an OPG to show. The way I interpret what you have said and what the dentists have said comes down to:
1. Wisdom tooth (8) prob not decayed, but impacted against 7.
2. This often causes decay in back edge of 7. You may have decay there.
3. You seem to have had deep decay in 6. Depsite treatment, this may not have resolved.
Tooth pain can appear to be coming from nearly any tooth on the same side: front/back/top/bottom. It doesn't cross the midline of your face. Sometimes it can be difficult to locate the exact source of pain if there are a few choices - your perosnal indication is only one of the factors. The dentist also has to look at Xrays, test teeth with tapping, test teeth with cold, listen to your history of the development of the pain and the type of pain, and then make a decision. If you're unlucky, there will be more than one tooth involved.
I'd get the records (politely) including copies of Xrays, and get a second opinion. If you drop the records off to the new dentist a few days before your appointment, it'll give him/her a chance to review before you come in.

 

[Stephen80]

Thank you both for your replies. I'm actually on the way to being sorted now, as I found a local dentist in my area that had 30 positive Google ratings, and upon reading his page, he sounded very experienced so I thought I'd give him a go and booked in for an emergency appointment yesterday.

I took copies of my x-rays that were taken weeks ago (sorry I haven't posted them in on here, I don't have them digitally) and I showed them to my new dentist and he said he new exactly what the problem was as he could see my nerve was all inflamed. I explained my symptoms of the throbbing/heartbeat in the tooth, wobbly feeling, pain to bite on and the tenderness in the gum. I also explained my previous symptoms and how the waves of pain had gone, and he agreed that believed my surgeon had made the correct call with the irreversible pulpitis. I was advised that the reason the waves of pain had stopped was because the tooth had probably died.

Long story short, he drilled out my mouth (there was a disgusting smell in the office which I presume was related to my dead pulp?) and he applied a sedative dressing (which again is what my surgeon had recommended a couple of weeks ago). I have a root canal planned for next Thursday. He also confirmed at the end of the appointment that my tooth was in fact dead and I had an abscess forming (which is presumably why my bite was becoming more painful)

Whilst I still feel a little tender and I still feel a slight pain when I bite something that isn't very soft, I do actually feel so much better than I have done in weeks now. However, I'm very angry at both the NHS dentist and the Private dentist (her boss) that I went to see, as they had so many opportunities to capture this and if they had acted early enough, I probably wouldn't have lost my tooth. In addition, I paid them over £180 for this poor service and now I've had to pay £105 for yesterday's treatment, with the Root Canal being estimated at about £350 next week. So, all in all, it's going to cost me over £600 in total to have what I deem an unpleasent procedure (not that I've ever had a root canal before) when if my initial dentist had spotted the issue in the first place I wouldn't have had to go through any of this pain and suffering and at a fraction of the price.

I just hope the root canal goes okay as some of the horror stories I've read whilst I've been researching this really make worry about this procedure - I feel I've found a good dentist so hopefully it'll be okay.

Anyway, once again, thanks to you both for taking the time to come back to me.

 

[Busybee]

I hope it works out with the new dentist. Good news that you are feeling better. Keep us posted on progress.

 

[Stephen80]

Thank you - I will update after the procedure.

 

[Stephen80]

So, I've just got back from root canal procedure - that's not an experience I want again. Don't get me wrong the new dentist I've found seemed to be very good, but having my jaw open for so long was not fun and the injection was really painful (he had to do it twice because of the shape of my jaw!)

At the end, my dentist took another x-ray and he pointed out that some of the filling has gone through the bottom of where my root was - he showed me on the x-ray and there seemed to be a lump next to the root. He told me that this is inert and won't be a problem - is this correct? I know I should probably just trust what he's said, but after the experiences I've had recently with my previous dentists, I'm now very paranoid.

I also asked if I'd needed a crown (as I've read you normally do) and he's confirmed I will, but he says not to worry about it at the moment and to see how the root canal goes. I hope this isn't because he's expecting problems... in fairness he did say this before he had undertaken the procedure, so I'm sure it was precautionary as opposed to concern that something went wrong afterwards.

Anyway, hopefully everything will be okay. Thanks to the Busybee and Matt for replying on this post - it's nice to have people with experience help.

 

[Busybee]

Stephen was this a specialist endodontist? I'm not sure of different methods, but I did think that you don't leave a tooth uncrowned after the nerve dies. I thought you crowned it to strengthen and protect it. I know that gutta perca sometimes can go a little outside the root but thought your body absorbs that over time. It was the rubber filler than went past the root right?

 

[MattKW]

So some of the GP has gone through the root tip - the body doesn't reabsorb it, but if all is clean, then often the body tolerates it OK. This might be why he wants to wait a little while before crowning, to see if it gives you any issues. The sooner the crown, the less likelihood of fracture; some teeth will fracture before the RCT is finished! Some endodontists put orthodontic bands around the teeth to prevent fractures until crown can be made. Personally, I sometimes shorten the tips of the tooth straight after my RCT preps, or do a temporary crown preparation, and wait a few weeks before commencing crown. It's understandable that patients sometimes can't do crowns straight away because of time or money constraints.

 

[Stephen80]

Hi both,

Thanks again for the responses. Today feels pretty good on the tooth, I had a pasta ready-meal at lunch and I only occasionally felt some pain as I chewed the parts the microwave had made hard... I presume this wasn't from the tooth as the nerve has been removed, and I'm guessing that it's just part of the natural healing process (although please tell me if I shouldn't be getting any pain). I should add, my dentist pointed out that there was an abscess prior to him undertaking the root canal, again, I presume he would have removed this during the procedure? I also have a sore throat and blocked, slightly painful, ear on the right side of my face... again, I presume this is normal at the moment?

As for the filling, as you've both correctly highlighted, this is GP as I remember my dentist telling me that's what it was (I just can't spell it which is why I'm calling it a filling)

I've arranged a new patients visit with this new dentist on the 3rd May, which is the first appointment I could get due to my work commitments and his availability, and whilst we're going to discuss the crown then, I'm guessing I'll need a new appointment to take a mould and then another visit to fit it, as such, I'm probably going to be without a crown for at least two months. Whilst my dentist did advise I'd need one, he didn't express any urgency with it... do you think a couple of months is too long as I'm really not sure how I can get this sorted any quicker?

 

[Busybee]

Hi Stephen, you should really do your best to avoid chewing on the tooth for now. If you had an abcess and are now having symptoms such as a fever or lymph node pain or swelling under your jaw then you should go back and say you need antibiotics. Obviously you should only take antibiotics when you need them but a dental infection doesn't always go away without some help from medication.

You could take some ibuprofen to see if that helps. You might also want to try to have some extra vitamin C as that can promote healing. It's just something I do if I have anything like this and I've found it helps.

The abscess won't be removed by the dentist, rather it should heal on it's own once the nerve of the tooth is removed. When I've had root treatment the Endo always emptied the canal and then sent me away with a temp dressing before filling with gutta perca and sealing a few days later. This he said was to let any residual infection find its way out. He also stuck something in there that smelt like disinfectant (drain cleaner!) and I immediately would have relief from symptoms.

I did look up the shooting past the root tip with filler online just out of curiosity and I have some old x rays of my own rcts. The article I read said that shooting past the root can cause aches and sensitivity and that the filler should end a fraction short of the tip (which is not always easy to see. So that might be why the dentist wants to wait and see how you get on. I think May is a long time to wait for a crown. If you have a problem you may have to go back sooner. It's a shame you didn't go to an endodontist for treatment. They deal with all sorts of complex cases & invest in the most high tech equipment. Although all dentists are trained in this, they don't always do it every day like an endo. Some dentists won't do any root treatment and will automatically refer to a specialist.

 

[Stephen80]

Hi Busybee,

Thanks for the response. Perhaps I've made things sound worse than they are - my dentist did say I have an abscess but my tooth doesn't hurt anymore. My sore throat has now gone and whilst my ears still feel a little blocked, this is nothing new for me and they have certainly eased since the treatment. If I was a betting man, I would guess that given I had my jaw open for an hour, this is what's causing my ear blockage. I do grind my teeth and my ears have always felt blocked to a degree, it's just they were painful initially after the root canal (although only when I tried to equalise them) but as I say, this seems to be getting easier.

The weird thing at the moment is a strange feeling I have just below my lip on the right hand side. It's really hard to explain as it's not painful. It almost feels like there is something stuck in there or that it's slightly numb, but its only occasional and so it could just be psychosomatic.

My big fear at the moment is the overfill of GP - I've also read some horror stories on-line. That being said, I would have thought if it was a problem then I would still be feeling pain?

I know I should have seen an Endo, but I couldn't find an experienced one near where I live. Also, at the point of my initial visit, I wasn't even sure I would need a root canal, I was purely after a second opinion as my previous dentist had told me that I just had to wait until the deep filling had settled down. Whilst I didn't think he was correct, my fear with visiting an Endo was my assumption they would say I needed a root canal even if I didn't, as it's all money for them. Given my past experience, I've become very wary and cynical of dentists now (MattKW excluded from this sweeping statement of course, as he's done nothing but try to help, much like you).

My current plan is to just see what happens. I am eating on both sides now, as my dentist advised I would be fine to eat normally even without a crown, so perhaps it still has a good structure on the outer shell? Of course, he did recommend that I have a crown eventually, so I'll discuss this with him when I next see him, but perhaps the crown is just precautionary - I have read that not all root canal teeth need crowns? Obviously, if my symptoms change or if I start to experience pain then I'll go back sooner.

The above aside, if either you, Matt or anyone else has any other suggestions, or think my wait-it-out strategy is flawed, then please let me know.

Thanks again for your continued help.

 

[Busybee]

Hi Stephen I'm so glad you are not in pain.

It tends to be a dentist who refers you to an endo. Some do so as a matter of course, others are more likely to do so in more complex cases.

Leaving a tooth uncrowned can sometimes create long term problems as infection can get back in, or the tooth can crack because the enamel can go more brittle as it's like a dry bone with no marrow. A crown seals and strengthens. You should be careful what you eat on that tooth while it's uncrowned. RCT failure or a crack in the root is more costly long term than a crown now. But take your dentist's advice as he knows what the load is on that tooth.

In terms of the numbness in your lip that should pass. Could be just down to the local anaesthetic.