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Medical Forum / General / Dentistry / November 2007My left tooth... again
Some things I wanted to try to better understand further before I opt to get the tooth pulled: - How can a successfully RCT-ed tooth still cause pain? I've been told if it has a crack in it, but what is the mechanism? The only living thing the crack could be touching is the periodontal ligament. Can that really cause significant pain? - Can gutta percha overfill that is visible on an x-ray and seems to be coming out of the tooth root apex be the cause of pain? I would think so, especially if it is impinging on the nerve in the jaw. Is that actually a possibility? See http://geocities.com/dtminer40/tooth.jpg for the xray, which I've linked to before on a file sharing site, but this one is easier to get to. - Is there a good explanation for these pain symptoms: dull ache all the time, ranging from almost unbearable to almost nonexistent; not much increase in pain with downward pressure; significant increase in pain with lateral pressure. Thanks for any thoughts, John. > Some things I wanted to try to better understand further before I opt > to get the tooth pulled: [quoted text clipped - 3 lines] > living thing the crack could be touching is the periodontal ligament. > Can that really cause significant pain? Yes. > - Can gutta percha overfill that is visible on an x-ray and seems to > be coming out of the tooth root apex be the cause of pain? I would > think so, especially if it is impinging on the nerve in the jaw. Is > that actually a possibility? See http://geocities.com/dtminer40/tooth.jpg > for the xray, which I've linked to before on a file sharing site, but > this one is easier to get to. That doesn't look like a gutta percha overfill, it looks like a puff of sealer there. Either way, these rarely if ever cause pain. The sealer is gradually resorbed by the body (gutta percha won't be). > - Is there a good explanation for these pain symptoms: dull ache all > the time, ranging from almost unbearable to almost nonexistent; not > much increase in pain with downward pressure; significant increase in > pain with lateral pressure. > > Thanks for any thoughts, I remember this x-ray. The most likely causes of pain are fracture or a missed canal, leaning toward fracture. However, I cannot see it. If the tooth is re-x-rayed, there may be more evidence if there is a fracture. Steve > John.  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Nov 1, 11:12 am, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > > Some things I wanted to try to better understand further before I opt > > to get the tooth pulled: [quoted text clipped - 5 lines] > > Yes. Can you elaborate a little? Are we talking pinching? Bacteria getting in the crack and irritating the periodontal ligament? Something else? > > - Can gutta percha overfill that is visible on an x-ray and seems to > > be coming out of the tooth root apex be the cause of pain? I would [quoted text clipped - 6 lines] > sealer there. Either way, these rarely if ever cause pain. The sealer > is gradually resorbed by the body (gutta percha won't be). A related question: how close is the nerve in the jaw to the tooth apex usually? Any way to see the nerve via some contrast imaging method? > I remember this x-ray. The most likely causes of pain are fracture or > a missed canal, leaning toward fracture. However, I cannot see it. If > the tooth is re-x-rayed, there may be more evidence if there is a fracture. I've been told by an oral surgeon that because of the orientation of the tooth, it would be difficult if not impossible to locate the crack. Does this make any sense? What method could he have been talking about? (Yeah, I know, why didn't I just ask him? Well, I was taken aback by his condescending attitude and curt responses, so I got derailed...) John. > A related question: how close is the nerve in the jaw to the tooth > apex usually? Any way to see the nerve via some contrast imaging > method? Although the picture is not of the highest quality, I think you can see the nerve canal running below the apices of the molars (the dark line in the lower right corner of the radiograph). It is nowhere near the apex of the RCTed premolar. Regards, George > On Nov 1, 11:12 am, Mark & Steven Bornfeld > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 9 lines] > getting in the crack and irritating the periodontal ligament? > Something else? If the crack extends to the periodontal membrane a periodontal abscess will almost certainly result. The degree of pain is variable, depending upon how acute the abscess is and whether drainage is occurring. >>> - Can gutta percha overfill that is visible on an x-ray and seems to >>> be coming out of the tooth root apex be the cause of pain? I would [quoted text clipped - 9 lines] > apex usually? Any way to see the nerve via some contrast imaging > method? Not close enough for the overfill of the canal to be a factor. >> I remember this x-ray. The most likely causes of pain are fracture or >> a missed canal, leaning toward fracture. However, I cannot see it. If [quoted text clipped - 8 lines] > > John. It's usually difficult to directly see a fracture on x-ray unless it separates or is directly perpendicular to the plane of the film. If it's separating you usually can be pretty certain of fracture based solely on mobility of the tooth. Also, an area of bone destruction on x-ray at the side of the root is often suggestive of fracture. But the statement of the oral surgeon as you put it is pretty meaningless--he's probably not a great communicator. Steve On Nov 1, 10:34 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > > On Nov 1, 11:12 am, Mark & Steven Bornfeld > > <bornfeldm...@dentaltwins.com> wrote: [quoted text clipped - 52 lines] > > Steve Thanks for the additional info. John. Did you ever try an NTI to eliminate any clenching as a potential problem? Steve > - Is there a good explanation for these pain symptoms: dull ache all > the time, ranging from almost unbearable to almost nonexistent; not [quoted text clipped - 4 lines] > > John. > Did you ever try an NTI to eliminate any clenching as a potential problem? I've considered clenching as a possible contributing factor, but I don't have any of the typical symptoms (headaches, tmj pain), and my dentist doesn't see any signs of clenching on the teeth themselves. John. |
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