Good day Dr. Hall,
I am 24 years old and broke off at least 1/3 of my left front tooth when I was 21 or 22. I was in France at the time and had to have an emergency root canal as the nerve had been exposed. When I got back to England (where I lived then), I went straight to my dentist who drilled out the filling to check the work. He concluded it was good, refilled it and later put a crown on it. This was fine for a long time, with no pain.
In November 2010, after I moved to Georgia, the crowned tooth became excrutiatingly sensitive to hot and cold, and occasionally ached when not eating or drinking at all. So after a couple of months, the pain had become far less intense and only now sensitive to very cold. I decided I would still go and have it checked, after an x-ray and some wiggling of the tooth my dentist could not tell what was wrong, so referred me to an endodontic specialist. The specialist said he thought the symptoms were coming from the tooth next to it as I have been putting pressure on that tooth in my sleep.
So nothing has been done to the crowned tooth and the wiggling of the tooth which they both did actually made the pain come back again. It is still bothersome and I am very worried. The pain is starting to get a little worse again, now. With both dentist and specialist saying they can’t see anything wrong on x-rays, and I have no pain when they tap the tooth, I am at a loss. I fear that I will eventually lose the tooth if nothing is done to solve whatever is wrong. What do you think this could be? I find it strange that the tooth gave me no trouble for over a year and then all of a sudden became unbearably sensitive. I very much look forward to your reply, and thank you in advance for your advice.
Danielle from Georgia
I’m not sure why there is so much puzzling about this tooth. This isn’t that difficult a diagnostic situation.
Let me clarify a couple of points to bring some sense to what has happened to you..
First, I’m understanding you had a root canal treatment on your left front tooth 2 or 3 years ago. That removed the nerve from the tooth, so there is no way it could have any sensation to hot or cold, unless the root canal treatment wasn’t really done. It is very rare for this upper front tooth to have any extra canals or other strange anatomical features that a dentist might miss in doing a root canal treatment.
Second, not seeing anything on the x-ray is no great mystery. When the pulp of a tooth is inflamed, it doesn’t show up on the x-ray until the inflammation progresses to infection and the infection begins to leak out the end of the tooth into the bone. It also isn’t sensitive to tapping until that happens.
Going back to the original accident that caused your left front tooth to fracture. As large as the fracture was, there had to be some trauma to the teeth next to it. So for one of these teeth to be acting up at this point is not the least unexpected. I have seen that before where a tooth has been traumatized and it is fine for several years and then begins to act up.
If the pain is pretty much gone now, it could mean one of two things. Either the tooth has recovered, or the tissue inside the tooth is dying. If it is dying, that will show up on the x-ray in time, plus the tooth will turn darker. So as long as it is not hurting, there is no great urgency and I would leave it alone and get an x-ray at your next regular check-up and see what it shows. If it shows nothing, count your blessings, but have the tooth x-rayed again every few years, just to be sure. If the tissue does die, which is what will probably end up happening, it means that you’ll need another root canal treatment and a crown – it’s not that difficult to fix.
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