Dr. Naveen Thomas
Dentistry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have been having severe pain in my left side jaw and cheek frequently for about two years. It seems it radiates from the last tooth of the upper jaw and lower jaw. Both are treated with root canal treatment and placed with crowns. The pain radiates from those two to the left jaw, cheek, and inner ear. I have seen many dentists, and all said that it is not a dental issue. One said it was TMJ (but he could not confirm it) issue. Another said it was not TMJ but a facial muscle issue and prescribed Sirdalud 2 mg twice a day for six weeks. Personally, I suspect malocclusion due to poor crowning of these two teeth. I feel they are banging against each other. One dentist prescribed a nightguard, which I am using while sleeping. It did not make much difference. I have a very recent OPG and X-rays. I also take Diovan 80 once daily. Please help.
Hello,
Welcome to icliniq.com.
I understand your concern.
You may have an abscess related to root canal-treated teeth. As the pain is only on the left side of the face and near those teeth, there might be a relation. Please attach your OPG (orthopantomogram), X-ray, and pictures of your jaw inside the mouth area where you have pain.
Regards.
Patient's Query
Hi doctor,
Thank you.
My last dentist examined me physically for any gum issues, abscesses, loose teeth, or crowns, but nothing of that sort. However, have a look at the photographs I took for you today, maybe, something was missed. You will notice some black spots on one of the crowns, these are not cavities. They are scratched during final leveling. Two points to add. I am a heavy dental floss user, and many times the pain was triggered by flossing around these two teeth. Secondly, always when I wake up in the morning (after wearing the night guard and removing it before breakfast), my teeth feel subtle and normal. Almost all the time, the irritation starts with these two teeth after eating. On the pain scale, I am at 5/10 most of the time, but when the episode starts it goes after seven or eight hours. Sometimes it is unbearable, and the only way out is to take Ibuprofen 400 mg. Sometimes when it hits while sleeping, it will wake me up. Please help me with your diagnosis and your recommendation on how to solve this issue. I was thinking to redo the crowns again for both the top and the bottom teeth. I think these two teeth (upper and lower) have missed my bite profile. Unfortunately, none of the dentists I have seen commented on any of that. Actually, two of the dentists were against redoing the root canal treatment and re-crowning. They were saying it was fine, but one of them agreed to do it after my continuous insistence. Please help.
Hello,
Welcome back to icliniq.com.
I have seen the photographs (attachment removed to protect patient identity).
I think your upper left first molar teeth have root canal treatment and a crown. Suppose it is infected, it needs re-treatment or extraction to solve your problem. One of the upper left first molar roots is infected, and you have to get it treated again. If you have constant pain, get it extracted or contact an experienced endodontist. About the lower teeth, there is not much problem with root canal treatment of those lower teeth, but as the bridge is done there, there is some food impaction in the anterior of the bridge that may be causing the problem. But the main problem, in my view, is about the upper crowned molar. So, treating or extracting that should reduce pain. If possible, get an IOPA (intraoral periapical radiography) X-ray of the lower first molar to check closely at their root apex area for any abscess.
Hope this helps.
Kind regards.
Patient's Query
Hi doctor,
Thank you so much for your help.
Hello,
Welcome back to icliniq.com.
You are welcome.
Feel free to ask in case of more queries.
Patient's Query
Hello doctor,
Thank you.
I took a new X-ray of my upper and lower teeth (before last) on the left. My dentist gave me the options of deep cleaning and re-treatment of the root or extraction followed by implantation. That is what he is recommending. I would like to have your opinion and if you have any other alternatives.
Hello,
Welcome back to icliniq.com.
I understand your concern.
I need to know more about the current problem. Do you have pain and inflammation in the lower treated teeth or upper or both? In the current given X-ray (attachments are hidden to protect the patient's identity), the roots do seem fine, but food impaction is there between the lower teeth beneath the crown, so deep cleaning will be good.
Revert with answers.
Thank you.
Patient's Query
Hi doctor,
Thanks again.
I had sudden chills last week due to a sudden high fever. I went to the hospital, my temp was 39.8 Celsius, and they put me on IV Paracetamol and did blood work. CBC was high (see the attached reports). The chills stopped with the completion of IV Paracetamol, but the doctor said I had a severe infection somewhere and need more investigation. So they transfer me to emergency service. I went to ER yesterday, they did CBC, UTI, and brain CT, and all came normal. The ER doctor advised me to see my dentist because I continuously have dental pain and not getting any relief, while my old dentist blamed the trigeminal nerve, and nothing was wrong with the teeth. So I went to see a new dentist. She examined me and gave me antibiotics (see attached). Today my temperature is normal, and had an appointment with another dentist. I am not sure if he was an endodontist or an orthodontist. My dentist did a deep cleaning for the top tooth only and will see me after I finish the antibiotics. But his long-term plan, as he explained, is to extract them both and replace them with implants. These are the same two teeth I consulted you about before, and since that time, I did not do anything with them cause my dentist at that time until very recently insisted there was nothing wrong with them, and the headache and facial pain I am continuously getting is from my trigeminal nerve. Just this evening, I felt very relieved by the antibiotics and the deep cleaning, so I decided to get your professional opinion. Is it necessary to extract, or we can try treatment? Please let me know.
Hello,
Welcome back to icliniq.com.
I understand your query.
You can try taking antibiotics for a week, and maybe the problem will go away along with deep cleaning. Currently, the X-ray (attachments are hidden to protect the patient's identity) shows mild infection in the mesial root of the lower first molar either ask your endodontist for re-treatment. Do root canal treatment again after removing the crown first. The previous endodontist may have missed a canal which may be causing this infection. A well-experienced endodontist can easily do it. Else then you have to get it extracted followed implant, if possible, or a new bridge.
Hope this helps.
Thank you.
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