Suggest Treatment For Dull Pain On The Tooth

Posted on Tue, 16 Dec 2014

Question: Had a dull “toothache” for about a week before seeing my dentist. Showed him where the ache seemed to come from (1 tooth past #32 at the root level, but I have no number 33). Took x-rays and poked around but couldn’t identify the problem. Sent me to an ENT. After several weeks of antibiotics, a visit to an oral surgeon (incl panorex), and a visit to endodontist where I ended up with a root canal on #32. Also got a CT scan showing no abnormality.

Now I still have the original dull ache on number 33, and I have a sharp pain on (or within an inch) of the tragus area. I also have a general achiness of the right side of my face and scalp. The ENT wants me to continue with a new antibiotic to finish combatting the tragus infection. Feels I need f/u with a dentist for possible TMJ (to fix “general achiness of the right side), and also pursue finding cause of problem with #33.

What do you think? And with whom should I follow up on the TMJ issue and the #33 issue (one “general” dentist, and/or an endodontist?)

Answered by Dr. Sumit Bhatti (13 minutes later)

Brief Answer:
Toothache is not tooth specific.

Detailed Answer:
Hi,

Thank you for your query.

1. Toothache is not always tooth specific and hence identifying the exact tooth is difficult.

2. The pain in the face, scalp and tragus is probably referred pain as the nerve supply for all these regions is the same (Trigeminal or Fifth Cranial Nerve).

3. Malocclusion is a strong possibility, hence get it ruled out.

4. Neuralgic painkillers are different from muskulo-skeletal painkillers, hence ask for a prescription.

If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (25 minutes later)

Thanks for your prompt response, and per your "invitation", here are 4 follow-up questions:

Re: Your Comment #1------The endodontist who performed the root-canal, tested the tooth before working on it. He determined that it was dead

Re: Your Comment #2 ----- How do I use the info about “referred pain (Tgigeminal or Fifth Cranial Nerve)) to help my current problem?

Re: Your Comment #3.----- I do have a class 3 occlusion. What can I do about that within the context of finding a cure for my aches?

Re: Your Comment #4.----- Ask for what kind of a painkiller?
XXXXXXX

Answered by Dr. Sumit Bhatti (20 minutes later)

Brief Answer:
Detailed answers below:

Detailed Answer:
Hi,

Thank you for writing back.

1. If the tooth was dead, that it was unlikely to be the cause of the ache. Chances are that the dental pulp was damaged. The root canal procedure destroys the remaining pulp. Hence if the pain persists, that was not the tooth.

2. The entire one side of the face, teeth, ear, scalp, jaw are supplied sensation by a single nerve (Trigeminal Nerve). Hence any of these areas can have a pain sensation from any of these areas. This is the basis of 'referred pain'.

3. If you have a class 3 occlusion, it is known as prognathism. An Orthodontist will have to be consulted. Yes, this type of malocclusion can cause TMJ, scalp pain and headaches.

4. Neuralgic painkillers include amitriptyline (Tryptomer), carbamazepine (Tegretol), gabapentin and pregabalin. You will require a prescription from a local doctor for these. They all cause drowsiness.

If you have any more questions I will be available to answer them.

Regards.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar