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Julian Chen
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience:  Practicing General Dentist since 2002
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I have had pain in my two front teeth for 7 weeks, Both had

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I have had pain in my two front teeth for 7 weeks, Both had root canals a few years ago. Above my front tooth is a bone where my gum is. It really hurts as do both teeth. Some specialists that I have seen say it is nerve pain, other say TMJ. I am a physician and just do not know what to do . Do you have any thoughts?
Submitted: 5 years ago.
Category: Dental
Expert:  Julian Chen replied 5 years ago.
HiCustomer

Even after the CT scans and X-rays, your dentist and his specialist referrals have no solid clue as to why your 2 front teeth are hurting?

Were there any history of pain immediately after the RCT were done? Or had the 2 front teeth been completely asymptomatic, until 7 weeks ago?

Any recent trauma that you can associate w/ the onset of pain?

Regards,

JulXXXXX XXXXX, DDS
Customer: replied 5 years ago.
Hi- The RCT's were uneventful. No problems until seven weeks ago. The bone on top of my two front teeth is so painful. The suggestion has been neurontin.....
Expert:  Julian Chen replied 5 years ago.
Has there been any swelling of the gingiva? Any bleeding?

I'm assuming there weren't any trauma? (sports injury, elbow to the anterior teeth, etc...?)
Customer: replied 5 years ago.
No bleeding, Just very very sore. I did hit the tooth with a tea cup but they assured me that there was no crack , although that was my original thought!

Many Thanks!
Expert:  Julian Chen replied 5 years ago.
If the onset of pain approximately coincided with hitting your tooth with the tea cup, or shortly after, then I suspect that the incident resulted in fracturing the root. The cracks may be very small, oftentimes microscopic. These fractures result in irritating the periodontal ligament space as bacteria is carried down via saliva and crevicular fluid into these gaps. And the presence of the bacterial metabolic byproducts results in a low-grade inflammation of the tissue and pain often result.

Unfortunately, it may take upwards of 6-8 months before enough changes have occurred around the socket to confirm that there are stress fractures present.

However, since the tooth is still intact, with the exception of constant soreness/irritation, I would not rush into any treatment. I would recommend consulting with your restorative dentist and formulate a Plan B: worst case scenario, root fracture -> extraction. Would you rather go with an implant restoration? Or would you prefer to go with a fixed partial denture (bridge)? It's better to get all the information now so that if/when the time comes to make a decision, you won't feel rushed into making a rash decision.

The reason I didn't list retreatment of the root canal + new crown as an option is because whenever there is root fracture, extraction would be necessary. Re-treating the root canal will not be able to seal the cracks and extend the life of this tooth.

In the meantime, taking some NSAIDs would probably be the best way to management the pain.

Regards,

JulXXXXX XXXXX, DDS
Customer: replied 5 years ago.
This is really helpful. I have one last question. If it is a fracture would more than one tooth hurt? I forgot to ask you that. My two front teeth hurt. Finally does this man I will be in pain or 6-8 months???

Many thanks. This is all really helpful.
Expert:  Julian Chen replied 5 years ago.
It is possible that both roots may have fractures. This would depend on how well you remember the impact with the tea cup, whether it was just on one tooth, or evenly across both teeth.

The thing about root canal treated teeth is that once the nerve and blood supply is removed, the tooth structure becomes more and more dessicated over time. And the root as well as the tooth structure above the gum line (and/or under the restored crown) becomes more and more brittle.

So even if the impact didn't feel all that significant when it occurred, if it was a sudden impact, it would have been more than enough to produce stress fractures.

As to your question of whether you'll be in constant pain during this next 6-8 months before we take another X-ray to see if we can observe radiographic changes, the answer would unfortunately be yes. Somedays the pain will be greater than others. Other days, it will likely just be a dull, low-grade throbbing ache that is manageable with pain medication. However, you could also follow-up with your general dentist in between to have him/her measure your gum pockets around these 2 teeth. Generally, if the root fractures were vertical, and located cervically (as opposed to apically), then sometimes, a vertical perio pocket can be detected with the perio probe. We could see the normal 2-3mm as we walk along the gumline and then suddenly, we'll see a 5 or greater pocket in one spot. However, if the fracture is horizontal in nature, then we will have to give the process time to cause decalicification of the bone so we can visualize it on the X-ray. I guess these are the things that test men's souls.

The fact that both teeth were root canal treated, plus the incident with the tea cup, and assuming the onset of pain coincided with that event (or very shortly after the impact), the most likely scenario is the presence of root fractures.

I certainly would like to be proven wrong in this case, which is why I would rather that you endure some pain and wait it out, than to doom the 2 front teeth to extraction. And since I do not have the opportunity to examine your teeth, as well as review X-rays, at best, XXXXX XXXXX merely speculating here.

But just to cover all basis, I would encourage you to explore restorative options now, so that IF we ever have to cross that bridge, you'll at least have had some time to think over your options to decide the course of action.

Best of luck to you.

Regards,

JulXXXXX XXXXX, DDS
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience: Practicing General Dentist since 2002
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