Question to the dentists here
Discussion
If a patient is complaining of tooth pain (and the root area underneath) to the point where they are having to take pain killer tablets to quell the pain, but despite taking 3 xrays of the tooth, surroundings and gum area there is no sign of any problems (even after a 2nd opinion from another experienced dentist within the practice), what do you do next?
The problem seems to be with my lower right molar #31 (molar #30 removed some years ago after a broken filling from my childhood which became infected and the root canal work destroyed my tooth so I had it out). I am getting a constant dull ache under the tooth and the tooth itself gives me sharp pains if I inhale air over it or sometimes rub my tongue over the top. The tooth feels raised slightly and if I bite down on it it feels squishy in the gum. It's giving me the same pains that the open hole from the broken filling on my other molar caused me, with the same dull ache from an infected root canal. It's particularly problematic at night time.
The new (NHS) dentist whom I've been assigned is nice enough, but she looks like she's only just left school and rightly or wrongly I am beginning to question her abilities on being able to identify problems. After an initial poke around she said she couldn't see anything wrong so took 2 xrays and couldn't see anything amiss on either of those. She got another dentist in and he said to do a different type of xray so she did and said there was no problems showing on that either (she showed me a huge xray of that molar on her screen and said that if there were any problems it would show as a dark coloured line).
She was then advised by the other dentist to test my tooth nerves by applying an ice cold press in the middle of the tooth and the wisdom next to it. There was a mild pain from the molar (but my teeth are sensitive anyway and I also suffer from weak enamel, however ProNamel toothpaste has kept this at bay for well over a decade) but it wasn't a sharp agonising 'hit the ceiling' kind of pain, and no problems at all on the wisdom. She then inserted a pointed contraption on the molar and the wisdom and had me bite down on it to press the pointed bit into my tooth, but no problems found.
At this point she was out of ideas and said that it could be caused by grinding at night. I know for definite that I do not do this.
I know the feeling I get from my teeth as a whole when going from cold liquids to hot, and the kind of pain I used to get from drinking acidic stuff like fresh orange juice which wrecks my enamel, but this is not that pain, it's localised on this one molar or root within and tooth is giving me a near constant throbbing and occasional sharp pains. I'm 110% sure there is a problem there but the dentist can't see anything on the xrays and tells me everything is fine. There has not been any distress to the tooth, gum or jaw that could have triggered it.
What to do? 2 separate dentists reckon everything is fine on the xrays.
The problem seems to be with my lower right molar #31 (molar #30 removed some years ago after a broken filling from my childhood which became infected and the root canal work destroyed my tooth so I had it out). I am getting a constant dull ache under the tooth and the tooth itself gives me sharp pains if I inhale air over it or sometimes rub my tongue over the top. The tooth feels raised slightly and if I bite down on it it feels squishy in the gum. It's giving me the same pains that the open hole from the broken filling on my other molar caused me, with the same dull ache from an infected root canal. It's particularly problematic at night time.
The new (NHS) dentist whom I've been assigned is nice enough, but she looks like she's only just left school and rightly or wrongly I am beginning to question her abilities on being able to identify problems. After an initial poke around she said she couldn't see anything wrong so took 2 xrays and couldn't see anything amiss on either of those. She got another dentist in and he said to do a different type of xray so she did and said there was no problems showing on that either (she showed me a huge xray of that molar on her screen and said that if there were any problems it would show as a dark coloured line).
She was then advised by the other dentist to test my tooth nerves by applying an ice cold press in the middle of the tooth and the wisdom next to it. There was a mild pain from the molar (but my teeth are sensitive anyway and I also suffer from weak enamel, however ProNamel toothpaste has kept this at bay for well over a decade) but it wasn't a sharp agonising 'hit the ceiling' kind of pain, and no problems at all on the wisdom. She then inserted a pointed contraption on the molar and the wisdom and had me bite down on it to press the pointed bit into my tooth, but no problems found.
At this point she was out of ideas and said that it could be caused by grinding at night. I know for definite that I do not do this.
I know the feeling I get from my teeth as a whole when going from cold liquids to hot, and the kind of pain I used to get from drinking acidic stuff like fresh orange juice which wrecks my enamel, but this is not that pain, it's localised on this one molar or root within and tooth is giving me a near constant throbbing and occasional sharp pains. I'm 110% sure there is a problem there but the dentist can't see anything on the xrays and tells me everything is fine. There has not been any distress to the tooth, gum or jaw that could have triggered it.
What to do? 2 separate dentists reckon everything is fine on the xrays.
Go to another dentist practice and pay private rates
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
TwistingMyMelon said:
Go to another dentist practice and pay private rates
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
Rollin said:
How long have you had symptoms from the tooth?
10 days. No problems with it or surrounding area prior and it was 7 years ago that the molar next to it was removed. Other than a bit of descaling and a polish I've 'passed' all my yearly check-ups since.Ref the other comments above, I am aware of the time constraints vs income ratio that NHS dentists have to deal with, however I don't see why this should have any effect on their ability to identify and diagnose problems at the annual check-up, unless there are some other complications that I'm unaware of, hence this thread to the dentist folks on here.
Edited by Lemming Train on Wednesday 3rd October 13:50
Retired dentist, am I allowed to comment?
It sounds to me like your dentist has followed most of the diagnostic tests I would’ve done. If there’s no shadows on the root apex on the X-ray and there’s a positive response to the cold test, then it looks like the nerve is OK, so I wouldn’t try root treatment.
She’s checked for a fracture with the thing you’ve been biting on, and that was ok too?
That just leaves what we call parafunction, which could be grinding on the tooth or clenching hard, which you may well not be aware you’re doing... so I’d try checking your bite out very carefully to see if that threw up anything.
Hope this helps.
It sounds to me like your dentist has followed most of the diagnostic tests I would’ve done. If there’s no shadows on the root apex on the X-ray and there’s a positive response to the cold test, then it looks like the nerve is OK, so I wouldn’t try root treatment.
She’s checked for a fracture with the thing you’ve been biting on, and that was ok too?
That just leaves what we call parafunction, which could be grinding on the tooth or clenching hard, which you may well not be aware you’re doing... so I’d try checking your bite out very carefully to see if that threw up anything.
Hope this helps.
If two dentists couldn't establish what is wrong while actually looking at your teeth, then for a dentist to figure it out from reading your description on an internet message board would paint the original 2 as incompetent in the extreme. Good luck with that though.
I'd be arranging a private appointment, at least that way you can choose someone 50+ with the commensurate experience.
I'd be arranging a private appointment, at least that way you can choose someone 50+ with the commensurate experience.
GordonL said:
Retired dentist, am I allowed to comment?
Sure - all welcome, Gordon.GordonL said:
It sounds to me like your dentist has followed most of the diagnostic tests I would’ve done. If there’s no shadows on the root apex on the X-ray and there’s a positive response to the cold test, then it looks like the nerve is OK, so I wouldn’t try root treatment.
She’s checked for a fracture with the thing you’ve been biting on, and that was ok too?
That just leaves what we call parafunction, which could be grinding on the tooth or clenching hard, which you may well not be aware you’re doing... so I’d try checking your bite out very carefully to see if that threw up anything.
Hope this helps.
Hmm that's not good news then. Pretty sure I'm not grinding or clenching. I sleep with my mouth ajar which is also confirmed by my OH and the embarrassing wet patches on the pillow too She’s checked for a fracture with the thing you’ve been biting on, and that was ok too?
That just leaves what we call parafunction, which could be grinding on the tooth or clenching hard, which you may well not be aware you’re doing... so I’d try checking your bite out very carefully to see if that threw up anything.
Hope this helps.
. I am 99% sure I do not grind and never have done. As I clench my teeth/tooth right now I can feel it is raised higher than normal in my gum and a squishy sensation under the tooth area. Constant dull ache and occasional sharp pain for a split second from the tooth itself 
.I believe the thing I had to bite on was to check for a fracture, yes (not 100% sure though) and she didn't find any problems.
I've got another appt booked for Tues next week for a scale and polish as there wasn't enough time at my appt yesterday. Naturally I'll want her to check again but is there anything else she can really check for to find the source of the problem?
Lemming Train said:
One more thing : is the patient allowed a copy of any xrays or is that the property of the dentist/practice only? I have no idea about these things. Was just idly wondering if I could get a hold of them for a 2nd (3rd) opinion perhaps?
Any dentist doing a second opinion for you will probably want to take a new xray.GordonL said:
If you can feel it higher when you clench then it would suggest that it’s moved in your bite a bit and would be worth checking. It isn’t just at night time that parafunction happens, I clench pretty badly when I’m concentrating on something very hard.
I never clench when I'm awake so that rules that out.So there's nothing else to check/do then and you've never seen or heard of this in your career as a dentist? If an experienced dentist such as yourself has no idea based on the description then it seems fruitless paying more for a private dentist who is most likely to take a couple of xrays him/herself and repeat what my own dentist said about there being nothing showing on them.
Obviously it’s easier to diagnose when you can actually see the patient and the x-rays :-)
Sometimes it can take a while for things to get bad enough to help make a diagnosis, sounds horrible but we’re dealing with a complex process, things aren’t always black and white.
Just going from your description of your symptoms it still sounds more like a traumatic bite to me, it would be easy and quick to check and eliminate if this were the cause.
Sometimes it can take a while for things to get bad enough to help make a diagnosis, sounds horrible but we’re dealing with a complex process, things aren’t always black and white.
Just going from your description of your symptoms it still sounds more like a traumatic bite to me, it would be easy and quick to check and eliminate if this were the cause.
TwistingMyMelon said:
Go to another dentist practice and pay private rates
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
Hmm...I go private and you can count in seconds the amount of time I spend in the chair. All the donkey work is done by a hygienist. I have a tooth which intermittantly bothers me - she wants to whip it out and sell me an implant. The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
The only upside is she did turn out one Christmas Eve (it was a Sunday, too) to stick a crown back on.
GordonL said:
Obviously it’s easier to diagnose when you can actually see the patient and the x-rays :-)
Sometimes it can take a while for things to get bad enough to help make a diagnosis, sounds horrible but we’re dealing with a complex process, things aren’t always black and white.
Just going from your description of your symptoms it still sounds more like a traumatic bite to me, it would be easy and quick to check and eliminate if this were the cause.
What is this easy and quick check? Sometimes it can take a while for things to get bad enough to help make a diagnosis, sounds horrible but we’re dealing with a complex process, things aren’t always black and white.
Just going from your description of your symptoms it still sounds more like a traumatic bite to me, it would be easy and quick to check and eliminate if this were the cause.
Rollin said:
TwistingMyMelon said:
Go to another dentist practice and pay private rates
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
The NHS dentists are fine if you have straightforward simple teeth , but dont have time or experience for more complicated stuff, im not knocking them, but for the money they get their hands are tied.
I've had similar and have spent several appointments with really skilled dentists mulling over and taking their time to work out every cause
On my occasions when I had pain similar to yours, the first was caused by a tiny infection on the root, the dentist told me there was a very faint shadow and we tried a root filling, a crown, but in the end it had to come out. The second time they advised it was probably grinding, which I do do from time to time
How can you be sure you dont grind your teeth, I do, but never know or realize?
I would try a more experienced practice for a second opinion and 200% rule out teeth grinding
Pretty straightforward in my mind get a second opinion from a different practice .
Small update for anyone interested. I saw my original (now private) dentist today for a thorough exam and he concurs with the opinion of the other dentist and assures me that there is nothing wrong with 'problem' tooth, nor my teeth in general, nor my bite nor my gums. He has ruled out grinding and disagrees with the other dentist on that as he says it would apply be happening on both sides and not just the localised area on the lower right tooth. He says there absolutely no evidence on his xrays of any abscess on my gums, jaw or roots so is equally as stumped as the other dentist. He's referred me to hospital to have a DPT (?) scan to see if that turns up anything and if not then I would have to go for a CT scan and possibly even an MRI scan to find out what the cause is as it's beyond the limits of his xray equipment.
Quite the puzzle.
Quite the puzzle.
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