Toothache. V grim - then gone. Leave well alone?

[Miljea]

I have a mouth like a Cornish tin mine 😂 I'm in my late 50s, loads of fillings, a couple of root canals, a couple of crowns.

To the horror of dentists, I adhere to the '2 yearly check up unless you need to go more often' philosophy, which I believe has a basis in fact (this is what happens when you financially incentivise health issues...).

Anyway, obvs my NHS dentist's employers (BUPA) don't like this so I usually eke 18 months out before I'm threatened with being kicked out. So I book.

3-4 years ago I got awful lower and upper 7/8 pain. Grinding, awful pain. Dentist xrayed, discovering nothing, I got sent to a hospital dentist who was non-plussed (tho woefully under-equipped), so sent back to my dentist, then was getting one filling after another redone to no effect, before we hit upon trigeminal neuralgia as the cause.

It was horrible, gabapentin, hot/ cold presses, drugged to the eyeballs- til it receded after a merciful 3 months. All gone.

So, 3 weeks before this last check up, I suddenly got left upper 6/7 hot sensitivity. Then developing into 'holding my face' pain. At the check up, (New) dentist xrayed, found nothing but his hot/cold probe certainly detected UL6 as the culprit. Appt made for a re-fill, along with him saying that might not cure it, appt for 2 months hence. I bore the 'no pain/excruciating pain' thing, waiting this 2 months out- but, as the weeks went by, the pain receded, then disappeared.

I've moved that appt to 2 further months ahead, now (March)- as I think I'm willing to risk it suddenly escalating again, versus it never troubling me again.

I am taking the 'Leave well alone' trajectory, esp given that the X-ray was negative. And the trigeminal neuralgia.

Would you have done the same?

If they identified the cause of the pain then you need it treated. If it was trigeminal neuralgia they wouldn't have identified a cause.

I think you will most likely need the tooth root treated. It sounds like the classic toothache pathway, which does get better but then will get worse again. Prolonging it just brings up the chance you are going to get toothache again. If you don't treat it there is a 100% chance of the toothache reappearing.

There is no basis in fact for 2 yearly check ups. You have a heavily restored dentition, you really need 6 month check ups. You should be going at a minimum yearly for oral cancer screening anyway, even if you have no fillings.

The recall intervals are set based on rate of decay progression and likelyhood of basic non-symptomatic decay progressing into toothache and then tooth loss. You have no idea how many of your root canals could have been prevented if you had followed appropriate recalls. Once a tooth is symptomatic it is already pretty compromised.

NHS dentistry is incredibly cheap for what it is, and the system is set up so people follow appropriate recall intervals, if you aren't willing to follow these you should be private. It is unfair to expect a private service at NHS prices

I have atypical facial pain, a type of neuralgia which means I have toothache in multiple teeth, plus burning pain in my gums, despite everything being clinically healthy. My approach - recommended by my dentist - is to have three monthly checkups. That means if the pain is actually being caused by a tooth which needs treatment, it can be caught early. It also helps me keep on top of my anxiety, because the pain moves about and I worry it is a tooth gone bad, not just the nerves. In your shoes I would definitely keep the appointment and have regular checkups.

I have trigeminal neuralgia. DIagnosed only after my dentist - who did not diagnose it - removed a tooth and filled another.

TN is well known to relapse and remit, so it can come and go and you can have periods of remission. I haven't had any remission in 5 years, but my friend has it too and has had a good few years clear before it's now come back.

You need to get back on the gabapentin, if it agreed well enough with you and gave you pain relief. When I asked my gp how long I carry on taking the medication even if I thought I was in remission they said 'A very long time' as it's usual for it to come back and you are back to square one with starting to build up the tablets to an effective level again, all the while in pain.