I have an awful toothache, and my dentist is trying to tell me the tooth is fine!

Dr. Hall,
Over a month ago, I had a toothache and ended up needing a root canal treatment on a lower molar. After that was done, the tooth felt somewhat better, but has never completely settled down. Now this last weekend the pain really flared up. It actually felt like it was the tooth next to this one. It started hurting so bad it scared me. So I went back to the endodontist who did the root canal. He took x-rays of all the bottom teeth on that side. He says that nothing is wrong and I could have all the teeth on that side pulled, including the new root canal and the pain would still be there. He told me to go to a neurologist.
Do you have any advice?
– Kendra from Oklahoma

Dear Kendra,
It’s tough for me to tell what is going on without a personal examination. But I think I can be helpful.

I can tell you that it isn’t uncommon at all for pain to feel like it is coming from a tooth and that tooth is fine. There are several possibilities for pain like this:

• One is referred pain. I have seen where an upper tooth is infected and the pain feels like it is coming from a lower tooth. Or the pain can feel like it is coming from a tooth next to it. You don’t see referred pain crossing from one side of your mouth to the other, but you do see it from upper to lower, and you do see it from teeth that are in the same quadrant.
• A second is some type of neuralgia. Yes, this happens, and it isn’t all that rare—a nerve problem that feels like a toothache. So yes, it is possible that your endodontist is right.
• A third possibility is some other type of pain. A sinus infection, for example, can feel like a toothache. The maxillary sinus often is very close to the roots of upper teeth and infection there can press on those roots and feel for all the world like a toothache. Or that pain could be referred and feel like it is a lower tooth. Other health problems can feel like toothaches sometimes.

I can also tell you that it is possible, from a careful reading of x-rays, to determine that a tooth and its root are healthy. If a root canal isn’t healing properly, there will be x-ray evidence of that.

So I don’t know how to tell, from here, what the problem is. My advice would be to listen to the endodontist.

However, I would allow for the possibility that this endodontist isn’t very sensitive to patients or a good listener. You get some of that in the dental profession. If you have the feeling that he doesn’t really care that much and is trying to get rid of you, it might be smart to get a second opinion, just to be sure you’re getting correct information. Find another endodontist. If there isn’t one in your town, so much the better. It would be worth a drive to go get a good second opinion. But in getting that second opinion, make sure it is a blind second opinion. DO NOT tell the second endodontist the whole story, and especially don’t give the name of the endodontist who treated you or even give any clue that you went to an endodontist. Don’t say anything about the diagnosis you’ve been told. Just say that you had this root canal a month ago and now you have pain flaring up and ask if he or she can figure out where it is coming from. If they press you for more of the story, just be frank with them—tell them you want a blind second opinion and you’re not going to say anything more. They’ve got eyes and training—they don’t need anything more than the basics of the story, their eyes, and x-rays, to come to a diagnosis. You don’t want to complicate the second opinion by having this new endodontist call your old one. They probably know each other and there will be a strong inclination of the one to want to protect the other.

I hope this is helpful.
Dr. Hall

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