Unexplained severe pain after dental treatment

[Wilmo]

I recently had a new crown put in (top left, half-way back). The tooth had had a root canal filling many years ago and a crown at the time but it came out. In the process of making the new crown the tooth was x-rayed and a low-grade infection in the root found. This was cleaned out, the tooth re-filled and the new crown fitted. The tooth next to it had a large filling replaced during all this too.

Weeks after the work finished I'm now often in severe pain. The pain is sometimes in the area of the recent work and sometimes in the teeth in roughly the same area but in the lower jaw (where there is another old crown). The pain moves around. The pain can be really, really, really bad and is triggered by any food or liquid that isn't room temperature. It's also triggered by cool evening air or car air conditioning. It can hurt alot for an hour or more if I do eat or drink something slightly cold or slightly warm.

I went back to the dentists. They did more x-rays and there is no sign of any infection anywhere. Tapping the two teeth with the recent work with a metal instrument causes slight pain but it's not too bad. They thought there could a root infection somewhere not showing at the moment on x-rays or maybe the replacement big filling goes close to a nerve. But basically they didn't know.

Could there be nerve damage causing this from when I had an injection in the roof of my mouth or gum? The roof area hurts sometimes now too.

The whole thing is quite distressing at times. What could the problem be and what is the solution/prognosis?

[robinnnnn]

ok you guys, you arent helping us by comparing your work ethics, lol......sorry but most of us are distressed here looking for answers, i understand what she meant, that idont thinku cant get soemthign if u think u cant afford it and i understand waht u are saying that do the best thing foryour dental health, but lol my dentsist would not give me mine i paid 375 bux for that piece of junk hard plastic that didnt fit...and irritated my gums....

[ihave been i your shoes or your mouth]

look up Glossodynia

[siren of the sea]

i was an RDA in california for 16 years until recently. i have worked with different drs as well. open mindedness is fine if it is correct. i never met a dr that thought a store bought appliance is worth it. i worked with dr's in private practice and with dr's in big corporations yes. but its not openmindedness that makes the correct diagnosis- its symptoms and treatment. if we had a patient that couldnt afford the nightguards expensive cost without ins paying for it we simply gave it to them at a VERY discounted price because he wanted the best for our patients. to say well since you dont have money then you can go buy a storebrand useless gaurd wasnt in our vocabulary. sometimes you have to protect all the work  you have done and if it requires a large discount then so be it. im not trying to fight and your yelling at me. i just like to give my opinion as well. i just read that you said store bought ng is used to diagnose the problem? i cant ever remember hearing any dr say to use that to diagnose. i know we all get protective over our dear dr's lol . we had a staff of 16 that walked proud into every class we took!

[Ria-pain]

8 yrs is correct, and one boss: NO.  Several bosses, HUGE practice that has multiplied and spread in the past 3 years.  I am not trying to immply that I know everything, though, cause just because an assistant works several years for some fancy corporation does not mean they know everything.  In my office, not only are we requiered to know EVERY area of dentistry, but also each and every doctor and the way they do things.  As you know, they are all different.  Just like with the patients, they are all different.  Not every patient can fork out money so easily to find out if something is the source of a problem. If this store-purchased, uncostly device assists the patient in diagnosing the problem then why not purchase it?  If you read my entire posting you would see I never stated use it forever.  How long have you been assisting? With experiance you would know that not every patient shows signs of grinding at the beginning.  It takes time to show the signs of the wearing away of the enamel.  It doesn't happen over night.  This person could have just started grinding their teeth.  I hardly think that the problems from using a store mouthguard over a short period of time would cause the symptoms you listed.  It takes open-mindedness to be a GOOD assistant.  

[Ria-pain]

I only suggested a cheap mouthguard to rule out the possibility of grinding.  Of course it would need to be replaced with a custom-made one from a dental office if you discovered that indeed was the problem.  My sister had almost the same symptoms as you and her dental office was throwing out multiple possibilities of the problem, since they weren't sure.  For her to fork out $400.00 and not know that was FOR SURE going to help would have been crazy.  If they still don't find the source of the problems your having when you return to the dental office, this would be a WAY cheaper option of figuring out if you grind at night.  If it helps, then purchase one from your dental office later.  If it doesn't, then at least you didn't waist your money!  I don't see what kind of "worse problems" over the counter mouthguards can cause if only wearing them for short periods of time.

[siren of the sea]

i read you have been assisting for 8 years? you should understand how it wont do a bit of good. the dr can look at the teeth and know if they grind, i could. if the store bought gaurd isnt adjusted properly to the bite (which it wont be) then it can cause the tmj to become irritated and cause more pain, popping ect. the musles will then become tight and pull the jaw to the left or right. then they will occlude on different teeth and cause sensitivity elsewhere. you say "waste" $400 on a night guard but i say its worth it. i am a grinder and i have been through several of them. i cant imagine if i crack those what i am doing to my teeth without one. sorry i worked in an office that was very productive and very busy. we had lots of patients that loved and admired our knowledge (asst must be informed on everything) and we welcomed their referrals on a daily basis. i just thought id let you know about nightguards if your boss didnt share that with you.

[siren of the sea]

its very common when a filling is done and its a composite (meaning tooth colored) its easy sometimes to have you leave and its high. if it is you will experience discomfort and you need to have the occlution adj. if you had a filling in this tooth at one time then they replaced it, is it a larger filling now? was it replaced due to new decay or leakage? keep in mind anytime you do work on a tooth-you risk that tooth needing a future root canal. if the xray didnt show infection it could mean the nerve is ok or it is irritated right now. like the other poster said in regards to the bruise. if a filling becomes too large its also time to consider another crown. a filling acts as a wedge in a piece of wood. as you chew and grind it can cause the tooth to split or crack. small cracks are usually not seen by xray but by testing the tooth. your dentist will most likely adj your bite. possibly put you on an antibiotic as some do to calm the tooth. good luck i know it must be hard to have work done and all you feel is pain.i dont suggest getting an over the counter mouthpiece for grinding . they dont fit properly and can cause more problems. i could give you more ideas as to your problem but without your dr its just information you cant use!

[Wilmo]

Thanks for the replies. I'm going back to see my dentist next Thursday (I could only see another since this started as mine has been on holiday). In the meantime, I'm completely avoiding anything hot or cold to eat or drink.

Because it has come on quite quickly after treatment I don't think it's teeth grinding. My dentist checked the bite when he replaced the crown but it could well be that.

Thanks again - I'll let you know what happens.

[Ria-pain]

I'm a dental assistant, so I'm no genious, but I'm thinking from the way it sounds that (even though very painful) it could be something very simple.  One possibility, especially with pain that is not focused and rather moving around from one tooth to another on the same side of the mouth is that you grind your teeth while you are sleeping.  If your not sure you would need somebody to observe you at night.  Sometimes it's apparent, but not always.  Your teeth being sensitive to hot and cold could be a result of wearing away your enamel while grinding.  In that case a simple night guard would relieve your symptoms within a week or so.  Like a bruised knee that needs time to heal, so do your teeth if you grind them.  It's cheep to go to wal mart and buy a sports mouth guard to try out.  If this helps, or if you grind holes into this guard, then you know that was the proble.  (in the near future you would need to purchase a strong one from your dentist, though, since the cheep ones arent thick enough to withstand such force.)
Or it could be that your bight is not write.  This would mean that the occlusion of your teeth need to be adjusted so that you're bighting on both sides of your mouth equally, at the same time.  Too much force on one or two teeth can cause pain.  When you had the crown replaced on the tooth that was re-treated with the root canal, there's a chance that it could be hitting the crown below it, irritating it.
In any case, you need to see your dentist so he can do some tests to help you figure all this out.  Often a tooth that is having sensitivity is ok, becasue this means the tooth is vital.  As long as the sensitivity is not lingering or sending shooting pains up the side of your jaw, it's most likely not the nerve.  Besides, a tooth that's had a root canal is dead and can not feel hot or cold.
It also could be periodontal disease, which effects more than one tooth at a time, although that is something they should've been able to see in the radiographs and during your last visit.
Check it out, because I bet it's not as bad as you think it is.
If it is something to do with the palat where they gave you the shot, I wouldn't know anything about that.  In my 8 yrs. of experience, nobody has ever had any problems with the shots we have given them on the inside of their tooth (towards the tongue on the top).
I hope I helped a little.  Let me know what you find out and good luck!  (you'll be FINE!)  :)

[Jerome Bogin, D.D.S.]

It does sound more likely that    there is an inflammation of the nerve of the tooth. If I was a betting man I would say it was the tooth next to the crown. It is true that an x-ray is not always diagnostic. So you have to go by other symptoms. If you are in that much pain then you have to be proactive in trying to identify the tooth in question.When I say you I mean the dentists.