Q. I have pain on the left side of the jaw. Is it due to an impacted tooth or a tooth with large filling?

Hi doctor,

Approximately six weeks ago, I got niggling wisdom teeth pain. The left top and bottom wisdom teeth were breaking through the gums. I got sudden pain which was severe in intensity around the back of my mouth and the lower left side. It got aggravated especially on chewing and radiating to the next tooth and along the jaw. The dentist suggested a wait and watch for few days. The next day when the wisdom tooth started to come out, the pain got severely worse over the jaw and the temporomandibular joint. I was unable to tolerate. I cannot even rest my top and bottom teeth together. I got complete numbness on the left side of the chin and lower lip and difficulty in opening my mouth for more than one or two fingers. I could not sleep and felt ill because of the pain. On the X-ray, the wisdom tooth is horizontally impacted, and there were no signs of infection or abscess. The tooth next to the wisdom has a large old filling nearing the pulp. But there are no signs of anything wrong with it on an X-ray. The dentists could not find whether it was the pressure of the impacted tooth on the next tooth or problem with the filled tooth. So, I was just given antibiotics. By the end of the antibiotics, it was slightly better, but I still felt ill. Again, the dentist decided to wait and watch.  As I felt iller than the previous time, I was given another course of different antibiotics. The pain was reduced. But I still have numbness in the chin. However, most of the numbness on the lip has resolved.

A constant cramp sensation along the bottom of my jaw and temporomandibular joint with the discomfort temporarily ease with rubbing or stretching or massage. I regained most of my mouth opening back, but it is uncomfortable to open and hold in that position. I also think the jaw discomfort and cramping are worse on the days when I have to talk more. The wisdom tooth and the next tooth are still mildly tender. I can eat soft foods comfortably, but I get pain in the two teeth and the gum surrounding the wisdom tooth on eating hard foods like a raw carrot. The pain will last up to an hour or more. I have never had any hot or cold sensitivity or nasty taste in my mouth. The dentist I saw thinks that it is because of the nerves from the filled tooth and wants to do root canal treatment or extraction. How would this change any of the nerve or temporomandibular joint pain? I am worried that if the impacted tooth's pressure is causing the pain, then it will make no difference anyway. Do you know a way to differentiate? Which do you think is the more likely cause?