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'Toothache'- except it isn't...!

(16 Posts)
Draylon Wed 13-May-15 18:34:59

...apparently!

2 months ago I quite suddenly developed a hot/cold sensitivity in about lower left 6 or 7. Hard to localise.

My mouth is like a Cornish tin mine, I should add!

Got around to going to the dentist who did the blower thing and reckoned 6, already filled, as is 5,6, and 8! She thought it looked intact, however, and took an xray that showed no root damage at all on either that or the adjacent teeth. Then gave me an appt 3 weeks hence for filling removal and replacement, which went ahead. I did make sure she checked the exact tooth as it was all a bit non-focused.

It didn't solve it but, around that time (so not necessarily after that treatment) I have begun to get actual toothache in that area. Nothing triggers it; it comes on once or twice a day, starting around lower left 6-7-ish and it's excruciating. It spreads all along that side of my jaw, to the middle front and back up to my ear-hole. It, at worst, is 'all consuming'. Ibuprofen brings it back under control; sometimes the pain abates by itself in about 20 minutes.

Obviously I went back to the dentist, who'd sought a second opinion and xrayed my upper teeth at that area looking for referred pain. Needless to say, drew a blank!

So, two issues: still hot/cold sensitivity in 'a tooth' (probably still number 6) which temporarily stabs when stimulated by hot/cold, momentarily; and this low, grinding, non-provoked big pain that appears to originate from the same area.

Neither my dentist or I know what to do! I have made another appt for 4 weeks' time, hoping this second pain will localise. Otherwise, she suggests what sounded like sedative fillings, one by one- take out a filling, put a sedative thing in to see if that stops the pain, in order to localise the pain, and repeat til one does (assuming one ever succeeds!) but obvs every filling destroys yet more already scant tooth structure.

In the meantime, if ibuprofen were licensed, I'd be buying shares.

Would an OPG be in order? Those little dental films are very localised, to the extent that I, as a radiographer, would have been expected as a final year student, to image more jaw and root per film, but anyway! Is it idiopathic neuralgia?? Say no!

I don't really know what to do. But god, it hurts!

Baddz Thu 14-May-15 07:38:41

Watching with interest.
Same issue here!

Mrsmorton Thu 14-May-15 07:44:52

Its unlikely an opt would reveal much. Certainly if it's neuralgia then obvs nothing would show but sometimes it's nice to exclude sinuses and you can see the jaw joint to look for any changes. So, as you expected, no right or wrong. ALARA says only if it would change your treatment and from the sounds of it, your dentist is doing all the right things. Bah! This is the worst sort of toothache.

Mrsmorton Thu 14-May-15 07:46:55

Oh, I had a patient like you a few years ago. He'd been referred to the pain clinic and already had a tooth out to try to help but it hasn't. I did the removing fillings thing and got lucky as the first tooth had a hole under the filling that was causing the pain. Boom! Lucky us!!

Baddz Thu 14-May-15 07:59:43

I've had 3 composite fillings over the past month.
(My dentist is very good btw)
BUT the second filling (lower left molar) he hurt me doing he injection Nd my jaw was incredibly painful afterwards, to the poi I could barely open my mouth! Anyway, that's better, but still not gone. The pain radiates from my jaw, up to my ear and is causing ear ache.
Accept that now all 3 (upper and lower left) teeth are very hot/cold sensitive and I am in pain all the time.
Dentist has fitted me for a night splint - he thinks it's a jaw problem.
My teeth were all cracked and tbh are mostly filling, not tooth sad
Any tips?

Baddz Thu 14-May-15 08:00:11

Oh, and I've had x Rays too which show nothing.

Pispcina Thu 14-May-15 17:33:36

IME it's always a tooth. Have they tapped your teeth with a metal thing?

Draylon Thu 14-May-15 18:31:55

Thanks, all!

Yes the dentist started originally with the tapping thing, which doesn't 'set me off'.

I have 'the pain' right now. Began mid afternoon but I held off on the ibuprofen to see if it went by itself- I worry that not only will I have intractable toothache, but my liver will look like tripe if I'm not careful!- but gave in about 10 minutes ago. I think 'Ah! it's lower 6!' Then, a bit later, 'Wow, no, that peak of pain was around lower 5!' etc etc.

My teeth aren't cracked, as such, as far as I know, but just about all the molars are filled.

Willdoitinaminute Thu 14-May-15 21:04:06

Could be caused by bruxism (grinding or clenching). Excess pressure on tooth which contacts first when you bite together causes bruising of the tooth which becomes sens to hot and cold. In addition it also results in inflammation in the joint so when you bite together you experience pain in the joint, often the brain mistakes this for pain in the teeth because it happens when you bite down. The muscles are tensed for long periods of time and become very tender - think how painful your thigh muscles become after prolonged exercise.
You can fracture a tooth while clenching or grinding, I have seen patients split teeth on occasions.
Since most of the pain results from inflammation that may be why Ibuprofen gives relief.
There are a number of treatment options. Sometimes a short course of antiinflammatories is sufficient. But since bruxism is usually due to stress and anxiety identifying a cause may help. Then mild antidepressants can help.
A bite guard worn at night may give some relief but only if you brux at night. Your dentist should be able to identify signs of grinding by wear patterns on your teeth.
I suffer with the problem occasionally. The last episode happened last year when DH was facing redundancy. I could quite happily have had all my teeth on the left side extracted. But after a couple of weeks the pain just disappeared. Because I know what causes it I know it will go, but if you have never experienced it before it can be intolerable. It is real pain but because it is a type of referred pain it is often misdiagnosed.

GlitterTwinkleToes Thu 14-May-15 21:14:35

Oh I've suffered with this! It's a bloody nightmare, started when I was 12.

I took the extreme approach and after seeking out a dentist who's happy to do it, I'm having every single tooth removed. I'm fed up being down the dentist every week with extreme toothache and swelling sad

Only six weeks left till they are gone for good

WhenMarnieWasThere Thu 14-May-15 21:20:52

My toothache that was triggered by hot and cold, by eating or drinking, by brushing my teeth or that just came in by itself WAS neuralgia. And I only found that out after a tooth removal and a filling replacement failed to fix my problem.

However, neuralgia doesn't respond to normal painkillers so if that is effective then yes if be looking at teeth as being the problem.

Willdoitinaminute Thu 14-May-15 21:25:02

Another remote possibility, but unlikely if you are under 50, is it could be an early sign of angina. Although you wouldn't expect sensitivity to temperature. I have been caught out in the past when we couldn't get to the bottom of pain in the lower left. Both patients went on to develop more typical angina symptoms over the following months. Subsequent treatment of the angina solved the tooth pain. I have a feeling that this type of referred pain is more common in men though.

WhenMarnieWasThere Thu 14-May-15 22:17:15

I had the full MOT from the dentists when I went. Tapping, prodding, ice cold spray. Nothing set it off.

But the wind on my face half an hour later had me in agony. And I was seriously considering avoiding brushing my teeth as the splash of water on a particular tooth had me on the floor with pain.

Hard to pinpoint sounds classic to me.... pain that can occur anywhere along the path of the trigeminal nerve rather than just in one tooth. My pain could be in my molars, front teeth, cheek, ear.

My tooth brushing pain would come and go in a flash.
The other pains, however, would come on and build and last for minutes and then pass.

It might not harm to go to the gp as well as the dentist and see if they recognise it as neuralgia. My pain is almost completely under control now with medication and it's such a relief.

I'm afraid it sounds like Trigeminal Neuralgia to me sad PLEASE do NOT let your dentist do anything more to your teeth until you have seen your GP.

Read up on TN... often you get electtic shock level pains, but mine started just how you describe.. and the pain was like nothing else. My dentist took out two perfectly good back upper teeth before it dawned on us it was not a hidden tooth problem.

I was lucky..my GO had just come back from a conference on nerve pain and realised what it was. I was started on Tegretol, which made me sick so we switched to Gabentin (another nerve pain med..both are also epilepsy meds but the stop the signals just the same) and after HUGE doses my pain stopped. I'm on a much lower dose for keeps.. and it works. Normal painkillers do not work as it is nerve pain.. often the trigeminal nerve has got squished. it runs down each side of the face (so usually just one side affected, runs along the top and bottom teeth and into the eye area. Any of that area can be affected

Wind is a known trigger.

Please see your gp as soon as you can ..if you read up and think it;s TN.. beg for the first line treatment which is Tegretol, not amitriptyline or anything less!

Pispcina Fri 15-May-15 06:12:09

I think it is worth the filling thing she's suggested. If they are already filled it won't cause very much more harm to have the fillings removed and replaced.

I had exactly the same issue with non localised pain that came and went. It was one of the teeth but I can't remember which one now. It took a couple of months to really become acute and once it was treated, everything was fine.

It's just hard to pin down sometimes. Of course it could be TGM but it sounds far more likely to be a tooth - the presentation is classic.

I hope you get an answer soon as it sounds horrible.
There are other painkillers, not sure how appropriate in your situation, but talk to the pharmacist or dentist if you are concerned about overdoing the ibuprofen.

AnUtterIdiot Fri 15-May-15 10:18:05

Hullo. Sorry to piggyback but I have a similar thing. Tooth that was filled about 8 years ago and dentist told me at the time that he thought it would need crowning in a year. It was OK until about a year ago when it started to feel infected. The pain has never reached that sort of crazy hot ice pick pain but the inside of the tooth will suddenly throb a lot and then subside. No swelling but the underside of my jawbone is a bit sore. I also have a sore throat on that side, in that corner where it's half your ear and half your throat (although am prone to tonsillitis plus sleeping with mouth open!).

Dentist x-rayed and said he can't see any infection but it's a deep filling on the nerve. Plan is to see if removing the filling and putting oil of clove paste plus zinc oxide soothes the pain, then if it is all settled after 6 weeks crowning. I know this is perfectly reasonable so not complaining at all (love my dentist) but was wondering if it is common for an infection not to be visible on an xray as the tooth just really feels "wrong".

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