Q. I have severe radiating pain over the upper last tooth. Is that due to TMJ problem?

Answered by
Dr. Naveen Thomas
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 11, 2020

Hi doctor,

I am having severe pain on my left side jaw and cheek, frequently for about two years. It seems it radiates from the last tooth of upper jaw and lower jaw. Both are root canal treated and crowned. 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 is TMJ (but he could not confirm it). Another said it is not TMJ, it is facial muscle and prescribed Sirdalud 2 mg twice a day for six weeks. Personally, I am suspecting 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 other x-rays, which I can send to you on mail.



Welcome to icliniq.com.

You may have an abscess related to root canal treated teeth. As the pain is only on the left side of face, and near to 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.

Thank you doctor,

My last dentist examined physically for any gum issues, abscess, loose teeth or crowns, but nothing of that sort. However, have a look at the photos I took for you today, maybe something was missed. You will notice some of 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 time the pain was triggered by flossing around these two tooth. 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 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. Sometimes when it hits while sleeping, it will walk 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 top one and bottom one. I think these two tooth (upper and lower) have missed up my bite profile, unfortunately none of the dentist I have seen commented on any of that. Atually 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.



Welcome back to icliniq.com.

I have seen the photos (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 lower teeth, there is not much problem with root canal treatment of those lower teeth, but as the bridge is done there, and 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 much 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.

Hi doctor,

Thank you so much for your help.



Welcome back to icliniq.com.

You are welcome. Keep in doubt for futher doubts.

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