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Dr. Katz
Dr. Katz, Dentist - DDS
Category: Dental
Satisfied Customers: 3565
Experience:  Dentist and Anesthesiologist for 37 years.Anesthesiology Fellow-Johns Hopkins School of Medicine.Evaluator for Maryland State Board of Dental Examiners.
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I have been on this site several times asking for advice on

Customer Question

I have been on this site several times asking for advice on a situation I have. I havre had an ongoing problem with a front tooth that was injured 21/2 years ago. The tooth has been brtherswome since the injury. I have been to an endotinist 2x, but not to recently, both he and my dentist thought it was related to my trimengial neuroglia condition. I have suffered terribly with trigmenial for 3 years. Neither doctor feels the tooth should be touched. We know that there is no absess, but there is definetly I feel nerve pain. I feel it in the gum like a lighting bolt at times. The tooth is not necessarily that sensitive to hot or cold, sometimes to cold but not Always. My dentist referred to another condition that may be causing it, which in turn he said the root canal would not help. My neurologist and neurosurgeon fear me getting a root canal for fear it may make my trigeminal condition worse. I also will add that I do feel almost like a pressure in the gum at times. My question is just what your opinion may be and if this and could it be from my condition.
Submitted: 1 year ago.
Category: Dental
Expert:  Dr. Katz replied 1 year ago.

Can you post an xray of this tooth? Do you grind your teeth or do you feel that the opposing tooth comes in contact with this tooth in any excursion of your lower jaw? Do you have any swelling above this tooth or do you have anything that resembles a pimple in the gum above the tooth?

Customer: replied 1 year ago.
I did have any e xray taken last week, I can get that over tomorrow. I do not have a pimple on the gum. I do grind my teeth, and because of my trigmenial I am not able to wear the mouth guard that was made for me, I am able at times to wear a small store bought one.
Expert:  Dr. Katz replied 1 year ago.

In most cases,trigeminal neuralgia will not affect one tooth.It will more than likely cause discomfort in a number of teeth along the nerve path.Without an xray,I cannot give you an accurate diagnosis but from your posting,you may have something more simple going on than you think.Most dentists overlook problems with the periodontal ligament because they do not stress this in training.It is one of the most overlooked problems in dentistry.The most likely cause for your type of pain is coming from the ligament around the tooth and not the trigeminal nerve.If this ligament is traumatized by hyperocclusion from the opposing tooth and then aggravated by grinding,by relieving any pressure on this tooth by some simple selective buffing of the opposing tooth can very likely eliminate the pain within 48 hours.You need to go to an experienced dentist and have him do a careful bite evaluation and remove this tooth from any occlusion.The whole process is painless,takes only seconds,and you should get some relief quickly.From your description,this is not anything related to neuralgia.I would be glad to look at the xray when you get it.Make sure that the xray shows the entire root tip.

Customer: replied 1 year ago.
Thank you doctor. I will send the x ray over to you tomorrow when the dr's office opens. I guess I am looking for some validation that the tooth does not need a root canal. I do know that there is no absess present, but the lighting bolt pain in my gum is terrifiying.
Expert:  Dr. Katz replied 1 year ago.

Basically,teeth that are indicated for root canal treatment will show pain to heat,pain to biting pressure,have swelling in the gum,have fistula formation and show some xray evidence of bone loss at the root tip.If you do not have most of these symptoms,it is unlikely that a root canal is indicated.Pain from an aggravated periodontal ligament ,will feel just like a toothache.If your tooth is in occlusal trauma,it can be fixed in seconds and your pain will vanish.

Customer: replied 1 year ago.
if I understand you correctly, ligament could be aggravated from the teeth not being even basically? I know that the two front teeth are not even, the one that is injured does not aligned with the other. I notice it, but neither dentist did, I was afraid this may be indicative of a root canal as well. But looking at your last answer I do not have most of those symptons. I do have aching and a bit of pain in the tooth occassionley, but it is mostly the shock like pain in the gum
Expert:  Dr. Katz replied 1 year ago.

It is not something that you will necessarily see.It is the way the opposing tooth hits the tooth in question when you bite ,chew or grind.Some people even have a habit of forcing the jaw forward and causing the tooth to hit prematurely .That is why the first step is to take the tooth in question out of occlusion.

Customer: replied 1 year ago.
ok, thank you. I will send you the xray in the AM. Just if you do not min me eating myself, just for my on piece of mind, is the lighting bolt issue all related to this? Also, the tooth being injured so long ago, could that still be causing this problem or has it become exasperated due to the occulusion?
Expert:  Dr. Katz replied 1 year ago.

As long as the tooth is in hyperocclusion,the pain will persist.Sometimes the tooth may even feel a little loose.

Expert:  Dr. Katz replied 1 year ago.

I am going to be offline for a bit.I will look for your xray.

Expert:  Dr. Katz replied 1 year ago.

Can you please leave a rating so that we can maintain good quality control and so that I can move on to help other customers? Thanks

Customer: replied 1 year ago.
Dr Katz, I have my x-ray that you asked for, how do I send that to you?
Expert:  Dr. Katz replied 1 year ago.

You can upload it using the paper clip icon or check with customer service and they can direct you.

Customer: replied 1 year ago.
what e-mail address do I send my x ray to?
Expert:  Dr. Katz replied 1 year ago.
Expert:  Dr. Katz replied 1 year ago.

There is nothing abnormal on this xray except that there may be some slight thickening of the periodontal ligament which would be an indication of some occlusal trauma.There is no indication that root canal therapy is necessary.

Customer: replied 1 year ago.
Thank you for your response. Could you please explain to me what an occlusal trauma is? Also, would the shock type pain I am experiencing be indicative of this?
Expert:  Dr. Katz replied 1 year ago.

Occlusal trauma is the same thing that I have been describing since the beginning.It is the opposing tooth that is striking the tooth in question too hard in some excursion of your lower jaw.Yes the same pain would occur with this this type of problem.

Customer: replied 1 year ago.
Thank you for explaining it again. Reading your advice more closely, I do see where there is a bit of swelling on the gum above the tooth. ther eis no pimple. Now I am petrified!
Expert:  Dr. Katz replied 1 year ago.

Inflammation of the periodontal ligament would not cause any notable swelling.Can you upload a picture of what you think is swollen?

Customer: replied 1 year ago.
I just e-mailed the picture
Expert:  Dr. Katz replied 1 year ago.

The swelling looks like a localized gum problem and should not have anything to do with the ligament around the tooth.These type of problems can come from foreign objects like food particles under the gumline,medications , gingivitis or systemic disease.If the area around the gum is inflamed,it will increase the fluid in the area and could very well make the tooth sit out of the socket slightly to cause a hyperocclusion with the opposing tooth.

Expert:  Dr. Katz replied 1 year ago.

Are you still there?