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Dr. Katz
Dr. Katz, Dentist - DDS
Category: Dental
Satisfied Customers: 2073
Experience:  Dentist and Anesthesiologist for 34 years.Anesthesiology Fellow-Johns Hopkins School of Medicine.Evaluator for Maryland State Board of Dental Examiners.
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I want to know do gums have nerves separate from the tooth.

Resolved Question:

I want to know do gums have nerves separate from the tooth. My tooth does not hurt but the gum is painful if food gets stuck in between my teeth, if i brush my teeth too hard, or if i use a water pik pressure around the tooth. If i have a root canal would that eliminate the gum pain or just tooth pain

Submitted: 1 year ago.
Category: Dental
Expert:  Dr. Katz replied 1 year ago.
Welcome .I will do my best to answer your question.I am not a great typist,be patient and feel free to ask if anything is unclear.Yes the gums are innervated separately from the teeth.Teeth have their own nerve s that enter through the tip of the root deep in the bone.When a root canal is done,the remains of the hollow chamber inside the tooth which contains the nerve are eliminated.So it is possible to have a dead tooth with no nerve inside of it and ,have pain in the gum surrounding it.It is also possible to feel pain in a tooth that has been root canalled.This pain is transmitted by the ligament that surrounds the tooth which is innervated by the bone.If you had a high spot on a filling in a root canalled tooth for example,the tooth would still hurt because the ligament around it is being traumatized and the ligament has a different nerve supply than the tooth.The root canal should eliminate any pain in the tooth itself,you would not feel hot or cold.But if there was a gum infection or the gum was inflammed,you would still feel pain in the gum.Does that make sense to you?
Expert:  Dr. Katz replied 1 year ago.
Is there anything that is unclear?
Customer: replied 1 year ago.

Thanks. I'm a bit unclear. Are you saying, that even after a root canal or filling, it is still possible to have pain around the tooth in the gum? Would an extraction eliminate the pain around the tooth in the gum? What does one typically do if the separately innervated ligament/gum line is the real problem? Does the nerve in the bones have to be removed somehow or just covered better without taking out the tooth?

Expert:  Dr. Katz replied 1 year ago.
You can still have pain from a root canalled tooth if it is in hyperocclusion or if the tooth is fractured because the ligament around the tooth would be inflammed.Gum pain is not really related to the ligament.The tooth has its own nerve.The gums are innervated by other superficial nerve that are not transmitting tooth pain.Gum pain is characterized by a dull ache.The nerve in the bone is never removed.If you are having gum pain it is either from the fact that there is something going on in the gums unrelated to the tooth.Gum disease can cause pain because there can be inflammation around the tooth from plaque or food being trapped in pockets around the teeth.If you have gum disease and if you have missing teeth,the gums can be sore from inflammation.If you have a tooth with periodontal disease around it,your gum could be sore but may have nothing to do with the tooth itself.Once your gum problem is cleared up,the pain will be gone.Have you been told that you have periodontal disease? Do you have missing teeth that have not been replaced?
Customer: replied 1 year ago.

I do not really have much tooth pain or sensitivity.I was told that I have a cavity and some perio pockets (4-5 deep) around the tooth.


 


I mainly have pain around the lining or gum line of the tooth which makes me wonder if a root canal, root scaling/cleaning, or extraction would alleviate this. What is your opinion? I'm considering perio cleaning first, then extracting the tooth if this will stop my gum line pain around the tooth.


 


But if the ligament or gum nerves are exposed is there a way to close it and alleviate the pain?

Expert:  Dr. Katz replied 1 year ago.

I am really not sure of the nature of your pain.If you have no sensitivity at the gumline when touching the tooth itself and you have no sharp pains to the tooth,doing a root canal or extracting the tooth is not indicated.If you are having dull nagging pain around the tooth and you have not had a good thorough deep cleaning recently,that is where you should start. There is no indication at this point that this tooth either needs to be extracted or root canalled.Get you teeth cleaned and the cavities filled,then you can always go to plan B.You have not stated whether you have any missing teeth that have not been replaced.

Customer: replied 1 year ago.

Thanks. I do not have any missing teeth. The tooth which I'm referring to is the upper molar next to my wisdom tooth. It does have a deep cavity and perio pockets around it. The tooth itself has no pain/sensitivity that's why I was wondering how could my gum line be hurting so much when i apply pressure (touch, cleaning with water pik around and in between especially). I was trying to figure out where could the exposed nerve be located that's causing this.

Expert:  Dr. Katz replied 1 year ago.
Is the wisdom tooth fully erupted or impacted?.Nerves do not sit out in the open.Nerves will transmitt pain from an inflammation.If you have a deep cavity in a tooth and you have a periodontal pocket around the tooth,those are two things that can be treated so that the pain will go away.If your arm hurt,you would not want your arm to be without a nerve supply,you would not be able to feel it or move it.You need to deal with the disease process first,fix it,and the pain will go away.
Customer: replied 1 year ago.

I see. The wisdom tooth is actually super erupted. Since I'm more so having pain with the gum I will seek a periodontist that can possibly treat and clean first. Do you think that would be a good start and do you think that will cause more nerve damage/pain if they go digging around cleaning it? There is exposure somewhere around my gumline (front and in between teeth) which hurt really bad when food gets in or when I use my waterpik flosser.

Expert:  Dr. Katz replied 1 year ago.
I think that I would start having the supererupted wisdom tooth removed.These teeth just impede adequate cleaning around the second molar.There does not seem to be a need to go to a periodontist at this point.You need a good experienced general dentist who will extract the wisdom tooth ,fill the decayed tooth and do a thorough cleaning.The whole process may take about an hour.I would not waste any money on a periodontist at this stage.Any good dentist should be able to handle this,it is not complicated.There will be no nerve damage anywhere.Please understand that your nerves are not the problems here,you have two separate disease processes going on here.Get the cavity filled,remove the supererpted tooth and get your teeth cleaned.Within three days of having this done,all of your pain should be gone,and there will be no nerve damage anywhere.
Dr. Katz, Dentist - DDS
Category: Dental
Satisfied Customers: 2073
Experience: Dentist and Anesthesiologist for 34 years.Anesthesiology Fellow-Johns Hopkins School of Medicine.Evaluator for Maryland State Board of Dental Examiners.
Dr. Katz and 3 other Dental Specialists are ready to help you
Customer: replied 1 year ago.

Thank you. I have one last concern. Does having a missing tooth or extracting tooth cause bad breath usually?

Expert:  Dr. Katz replied 1 year ago.
No missing teeth do not cause bad breath but can cause other problems.After a tooth is extracted,the socket takes about 6 weeks to heal completely and some patients will get food trapped in the socket and can occaisionally cause a bad taste in your mouth.There can be many reasons for bad breath,The most common ones are:gum disease or periodontal disease,gastric reflux,sinus infections,lung infections,food and systemic disease.
Customer: replied 1 year ago.

Dr. Katz. Could you tell me if extracting an upper molar could cause damage to the sinus? Should a dentist extract an upper molar while the gum line is inflamed, extremely painful, or is causing pain in the face, throat, and ear?

Expert:  Dr. Katz replied 1 year ago.
Extracting an upper molar can sometimes open a communication into the sinus.This can be done during the extracting procedure by either removing too much bone accidentally because of the root formation or sometimes forcing a portion of the root into the sinus.Removing the tooth while the gum is inflammed,painful or causing pain in the face or ear should really have no bearing on the decision to extract a tooth if the tooth is the cause of these symptoms.Pain in the throat is rarely if ever a symptom of tooth pain.Pain in the ear is rarely related to an infected tooth itself.
Customer: replied 1 year ago.

I've been on amoxicillin for my upper molar tooth but now my tooth/gum (behind it and all around) is MORE painful (especially when i touch it with my tongue or chew food) to the touch. The back of my throat (tonsil area and sinus area all hurt now). Could an infection have spread and the amoxicillin not be strong enough? Will extracting a 2nd molar be more painful in this condition (when novacaine where's off? If my sinus gets damaged, will it heal itself or require surgery?

Expert:  Dr. Katz replied 1 year ago.
The amoxicillin takes at least 48 hours before you begin to see any effects of its action.You should be on 500mg every 8 hours.If you have been taking amoxicillin for a long time,it is possible that the bacteria have become resistant to it.If not,the amoxicillin is a good broad spectrum antibiotic.If the second molar is extracted and that is the problem,you should feel better after the local wear off.You may have some post op surgical pain,but that is normal.I cannot comment on damage to your sinus if it has not happened and without seeing it.There is no reason to believe that ther will be any damage to your sinus but in most cases , small perforations which sometimes occurr will heal on their own.Just make sure that whoever is doing the surgery is experienced and by all means making the correct diagnosis that this tooth is the problem before you proceed.
Customer: replied 1 year ago.

Thank you.

Expert:  Dr. Katz replied 1 year ago.
You are welcome,let me know if there is anything else that I can help you with.
Customer: replied 1 year ago.

Dr. Katz. Its been a week since my tooth extraction on my upper molar. I went to the dentist for follow up regarding slight pain I was still feeling. He asked if I smoked. I replied NEVER. I asked him why and he said my site is not healing well. He irrigated and pulled stuff out and I began bleeding and in pain all over again. Is there anything I can do to help the tissue heal? What could be causing bad tissue and not healing?

Expert:  Dr. Katz replied 1 year ago.
It could have been that you had some food trapped in the socket or maybe the dentist did not properly currette out the socket area when the extraction was done.It may have been that a piece of the alveolar bone surrounding the tooth fractured and a little piece of it remained in the socket which would also delay healing.It takes a socket 6 weeks to close up completely.

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