diagnostics

[cinq_a_sept]

I am writing on behalf of a friend (a healthy 51-year-old female) who has had numerous dental problems in the past six months for which she has been unable to find relief.  She previously had healthy teeth and no major dental problems (other than an occasional cavity) until October 2007, when she developed an acute thermal sensitivity and generalized severe pain in her upper front teeth.  After many inconclusive visits with her doctor, an ENT, and her dentist, who is very highly regarded in our city, an x-ray seemed to indicate a large abscess in tooth #7.  A root canal was thus performed, and she was told that the infection was one of the worst the endodontist had seen in 20 years.

However, once the pain of the procedure diminished, the original pain returned.  The dentist and endodontist were stumped.  My friend then traveled to Los Angeles in January 2008, where her brother (an FAGD) practices.  He told her that there was no evidence of infection, but that the tooth was severely cracked and needed to be extracted.  So it was pulled.  Again, her chronic, generalized dental pain continued.  He referred her to a dental group where we live to begin the grafting/implanting process to replace the missing tooth.

Upon examination, the new dentist found many additional teeth that were cracked and/or needed new crowns.  The latest new crown, installed February 2008, is on a lower molar.  She has intense pain and sensitivity on this tooth now.  The dentist determined that it needed a root canal, thus rendering her new crown a colossal waste of money.  Today (March 13), the endodontist told her that it would be extremely difficult to perform a root canal on this tooth, that there really was no infection there anyway, and that it probably would be best to extract this tooth too.

I know that you cannot offer specific advice, but here are my main questions:  

1) Is it unusual for someone like my friend to suddenly have her teeth begin to self-destruct in a domino-like way, with no known cause?

2) Might the cause be some other problem referring pain specifically to her teeth, thus making the numerous crowns, root canals and extractions that are lined up nothing more than a wild goose chase?

3) Most importantly, knowing that dentists primarily seek to resolve dental problems with dental solutions, and that her primary care physician is out of ideas, where should she go for more diagnostic testing?  A neurologist?  An oral surgeon?  

She's really demoralized by the whole thing, and doesn't know where to turn.  I write to you in the hope that you can help me point her in a hopeful direction.  Thank you in advance.

[lynn117]

she could have cracked tooth syndrome. people who have this usually only have one or two need repair at a time but there are an unlucky few who get it all at once. most of the cracks are not visible to a dentist even thru an xray which makes it a guessing game. if the cracks extend toward the root under the gum line the tooth usually is considered unsavable. unfortunately since the cracks can be invisible the wild goose chase starts. maybe a crown will help...no well lets try a root canal....no again well lets pull it. for many teeth root canals can be done thru the top of the crown. google cracked tooth syndrome and get more information and good luck to your friend!

[scottma]

Most dental pains are dental origin. However, it must be remembered that dental pains may have muscular or central nervous origin,which are rare. Pain develops after new restoration is commonly associated with occlusion, particularly molars.Sensitity to cold stimulus is commonly regared as a sign of pulpitis. However, The development of pulpitis after new restoration is commonly caused by occlusion.The diagnosis of dental pain is generally not complicated. If there is no dental pathology identified, dental treatment is usually not helpful to eliminate the pain.Hope this piece of information helps.