Continuing pain in root canaled tooth
I had a root canal in tooth four (tooth in a bridge) one year ago and retreatment of tooth five (next to the bridge) two years ago. During the root canal for tooth four, I experienced significant pain when water was squired into the tooth to clean it. I also felt pain when my dentist replaced the temporary filling with a permanent one.
I’ve had ongoing pain since last summer. It’s not constant. It’s usually a dull ache but flares up occasionally and becomes more severe at times. I also feel pressure in the bridge. Heat worsens the pain, as does sleeping with my right cheek against a pillow. I don’t feel pain when chewing but notice an increase in pain 45 minutes to one hour after chewing on that side. Tooth four was very sensitive when the endodontist did the cold test. Tooth five was mildly sensitive.
The endodontist says both teeth look fine, and there is no sign of infection, inflammation, or fracture. She recommends an apicoectomy for teeth four and five. She also said there is a small piece of extruded material next to tooth four that could be contributing to the problem. She said that the crooked root tip in tooth five could be pressing on my gum and causing pain.
I am reluctant to undergo an apicoectomy since there are no signs of infection or inflammation. I’m considering extraction and dental implants, but I would really rather not lose a tooth.
Does this sound like a microfracture of tooth four, even though the pain is delayed after chewing? Could it be something else, like a ligament injury or inflammation that never improved? I am allergic to NSAIDS, so it does take a long time for inflammation to get better. What about atypical odontalgia?
I am 63F and have asthma. I do clench my jaw at night at times. I’ve had to stop wearing my upper nightguard because it irritates my problem area. I am getting a nightguard for my lower teeth but don’t have it yet.