Dental Pain FAQ.

Or: This is going to hurt me more than it does you...

The anticipation of pain is perhaps the biggest deterrent to the acceptance of professional dental care, yet the management of oral pain is perhaps dentistry's most appreciated virtue. We discuss this apparent paradox...

Q: Hi I went to this dentist and was told I needed a root canal. The first day she took the nerve out. On the second visit she started filling the canal. Now ever since I left her clinic I have been in excruciating pain. I have been on painkillers and still no relief. On the second visit the only time she x-rayed my tooth was after she was done filling. Do you have any suggestions on why the roof of my mouth hurts when I speak, eat, laugh, even when I sit and do nothing.

Thank you.

A: Although the intent of root canal treatment is to eliminate infection and pain, this does not necessarily happen immediately. Quite the contrary-- some amount of pain during and immediately after root canal treatment is to be expected. This is because the process may irritate sensitive tissues surrounding the root of the involved tooth. Additionally, septic material may be forced through the tip of the root during instrumentation, causing an acute flare-up of the pre-existing infection.

Your dentist should be made aware of your severe pain; he may be able to take steps to relieve your symptoms. Good luck!

Q: Three weeks ago I had a tooth filled. Now it seems sensitive to cold and hot. What does this mean? The dentist said it was a deep filling.

A: Some postoperative thermal sensitivity is normal, especially after a deep filling. This sensitivity may persist for several months. Occasionally, if the filling is made of a thermally conductive material, the tooth will continue to be more sensitive than other teeth, but this usually isn't manifest unless you expose it to something VERY hot or cold.

If the tooth becomes less sensitive over time, you can assume that no further action is necessary. If the sensitivity continues, is particularly severe, or begins to increase in severity, a return trip to your dentist is warranted...

Q: HELP! I always seem to get canker sores on my tongue, and they are annoying, and they hurt. What's a good way to get rid of them fast?

A: Unfortunately, we can put a man on the moon, but we haven't yet found an effective treatment for canker sores. In fact, the cause of these ulcers is still not well understood.

There was a time when canker sores were treated by cauterization with an escarotic (caustic) agent, such as silver nitrate or trichloroacetic acid. This approach is now believed to be of little use, and may further delay healing.

Perhaps the only way of dealing with these lesions is symptomatic treatment until they heal on their own. Warm saline rinses, oxygenating rinses (Amosan, Vince), application of topical anesthetic agents (e.g. Anbesol), or topical "bandages" (Orabase, Zilactin), all available over the counter, are useful in limiting the symptoms.

Good luck!

Q: I received a temporary filling for a root canal. One day the tooth started hurting and the dentist put me on penicillin for 10 days. I took the medication faithfully. Well, 3 weeks later, the same tooth, still with temporary filling, is in more pain; I believe it has an absess. The pain started Sunday, my dentist is closed and today is a holiday. My inlaws have some penicillin I can start taking. Would it be ok to take some? I'm in a lot of pain, and the pain medicine I'm taking is not working. What do you suggest?

A: Whatever palliative effect that you might get from re-starting antibiotics would not result in any pain relief before tomorrow at the earliest. It is generally not appropriate to use medication prescribed for others, or for a use for which the medication was not specifically prescribed. There are different types of penicillin; in fact, many people use the term "penicillin" in the vernacular as a general reference for many different antibiotics. It is risky to use antibiotics in an inappropriate fashion.

In our experience, the most effective over the counter oral analgesic is ibuprofen (Nuprin, Advil, or generic), and may be used to good effect as long as there is no history of allergy or peptic ulcer disease. If you have not tried this yet, we would advise you to do so.

Tomorrow is not a holiday, and your dentist will hopefully make some provision to provide palliative care at that time. The kind of relief that will result from your dentist draining the infection will be more immediate and effective than any medication.

Q: Can a bad tooth cause sinusitis ...or is it that sinusitis just causes a tooth to feel bad?

I had a root canal done on a tooth that was filled but never capped..I lost the filling in that tooth, havent gotten it refilled, I don't have the money to get it done. ....Now I have sinusitis and the tooth is very painful. What should I do?

A: Can a bad tooth cause sinusitis ...or can sinusitis just cause a tooth to feel bad? Both! The roots of the upper molars and premolars can be situated either close to or within the maxillary sinus. The teeth and the sinus are also supplied by branches of the same sensory nerve. As a result, pain originating in one of these structures may mimic pain from the other. Also, infection from a dental abscess may extend into the sinus, although the reverse is uncommon.

It's unlikely that your failure to properly restore the tooth is the cause of your current pain, although it is possible that a vertical fracture of the root could account for the symptoms. It is also possible that the root canal treatment is failing and the infection has returned. Finally, it is also possible, as you have guessed, that an unrelated sinus infection is causing pain, and your dental status is irrelevant to the problem.

Your first priority should be to eliminate the pain and a possible infection; restoring the tooth is a secondary consideration now. We'd advise a visit to your dentist to either rule in or rule out a dental infection. If none is found, a visit to your personal physician is in order, as a sinusitis is not withing your dentist's jurisdiction to treat.

Q: My father who is seventy five years old recently changed his dentist and was surprised to be told he needed four fillings, although he was not in pain. He had previously been with a UK private dentist (with regular 6-month checkups) but switched to NHS to save money. The new dentist uses fresh garduates from the EEC countries. After one of the four fillings, he complained of a dull ache and sensitivity to hot drinks. He returned to the dentist who found no obvious problem. My question is, what should he do next and what are the common causes associated with post-dental filling operations.

A: The placement of a dental filling has an irritating effect on the pulp of a tooth. This can manifest as increased sensitivity to extremes of temperature. The severity will depend on the depth of the filling, the amount of heat generated near the nerve while drilling, the technique and/or filling material used, and the pre-existing state of the dental pulp.

Transient thermal sensitivity is not a serious sign, and usually disappears over several days to several weeks. Sustained sensitivity, or sensitivity that increases over time, is a red flag that something is amiss in the pulp of the tooth. We would advise your father to wait in order to determine whether the symptoms are trending up or down in severity. If several weeks have passed and there is no improvement or if the situation worsens, this merits a return visit to the dentist.

Q: When I eat or drink my jaw tingles for a little while and then stops. This just occured recently but seems to be getting worse. I'm not too worried about it but I would like to know what it could be. Any thoughts? Thanks

A: This would be speculation, but what you describe could be either spasm of one of the jaw muscles, or inflammation in a salivary gland. Since you describe the phenomenon as occuring when drinking (which does not involve chewing), we'd give higher relevance to the salivary gland inflammation. This can occur as a result of certain medications, viral infections, or obstruction of the salivary duct. Other possibilities would include Eagle's Syndrome (calcified stylomandibular ligament) or trigeminal neuralgia, but these are less likely diagnoses. If the problem continues, we'd advise a consultation with your dentist.

Follow-up question: I went to the dentist and he said the jaw and glands were inflammed from teeth grinding; they fit me with a night guard and said that it would help. Does this sound likely?

A: Tooth grinding (bruxism) could cause pain in the jaw muscles, but not in the salivary glands. Sore jaw muscles would not explain pain when you drink fluids (most of us don't chew our drinks!), but it's conceivable that muscle spasm could be exacerbated by application of cold stimuli to the affected muscles. It's worth a try, but it sounds like your dentist is trying an educated guess rather than working with a confirmed diagnosis...

Q: What are canker sores and how do I get rid of them in my mouth.

A: Canker sores, known technically as aphthous ulcers, are of unknown cause. They have been associated with certain types of bacteria, but direct cause has not been established. They may occur singly or as multiple lesions; in certain recognized syndromes they may form giant aphthae, which are quite debilitating. They form on the loose movable tissue on the floor of the mouth, tongue, cheeks, and occasionally the throat.

Canker sores have been remarkably unyielding to new forms of treatment. Often, the most that can be done is to make them more comfortable while they heal. Topical agents such as Zilactin, Anbesol, and the like provide an anesthetic effect. Intraoral bandage preparations such as Orabase also provide relief. Orabase can also be formulated with a corticosteroid, but this is usually reserved for more severe lesions, and is only available by prescription.

Q: What can a dentist do to alleviate the problem of sensitive teeth? Are there any other more permanent options than special toothpastes such as Sensodyne?

A: Whenever a patient presents with sensitive teeth, a thorough diagnosis must be made. Whether there is a cavity, post-operative symptoms from a deep filling, an acute pulpitis or degenerating nerve, an undiclosed fracture of a tooth, or idiopathic tooth hypersensitivity, the presenting symptoms may be similar. This may include a sensitivity to heat, cold, pressure, or tactile stimuli greater than that which is normally expected. That is why it is important not to jump to a final diagnosis too soon.

If the more serious possibilities have been ruled out, only then should a dentist prescribe a course of symptomatic treatment for tooth hypersensitivity. The use of desensitizing toothpastes such as Sensodyne has the advantage of being an inexpensive, effective, conservative approach that can be continued indefinitely. It is true that this is not a permanent cure, but continued use of the toothpaste can perpetuate the salutary effect. This is not a liability, since most persons will use a dentifrice anyway when they brush; it is no more effort to continue to use the desensitizing toothpaste than any other.

In addition to such toothpastes, the dentist may administer chemical desensitizing treatments in his office; these treatments may be more effective, but also need to be repeated to maintain their effectiveness.

As a last resort, if the areas of the tooth that are sensitive can be identified, they can be covered by either a thin layer of bonded resin or a filling. We prefer to avoid this if possible, since these fillings, if next to the gum line, can accelerate the rate of gum recession, necessitating "chasing the gum down the root" with additional fillings in the future.

Some things you can do:

  • Avoid prolonged contact with highly acidic substances on your teeth (citrus juices, vinegar, acidic soft drinks such as colas).
  • Examine your tooth brushing technique; overzealous brushing is often a factor in gum recession. Also, make sure your brushing and flossing is acheiving its goal of controlling and removing plaque, which will also accelerate gum recession.

Q: Recently I felt pain simply by chewing my food. I found out that one of my teeth is a bit "exposed". What I mean is that the bottom of it has gone a little flat, like it's edge has been polished down leaving it kinda bare so that even a gentle rub at that area is causing pain. What do you think is the problem and how can I fix it? Is it absolutly necessary to see a dentist?

A: It sounds like you've worn through the enamel on the chewing surface of a tooth, exposing the underlying dentin. This can result from habitual tooth clenching and grinding, excessively abrasive diet, poorly formed soft enamel, softening of the enamel from an acidic diet or frequent vomiting, or an opposing tooth with a porcelain cap.

These areas seldom decay due to their highly polished surfaces and the cleaning action of the continued abrasion of these surfaces, which discourages plaque accumulation.

It is not absolutely necessary to fix it, but you may be more comfortable if you do. You may want to try a trial course of desensitizing toothpaste such as Sensodyne. In the longer term, you may want to be analytical about what is accelerating the wear on the tooth, and take steps to avoid it. You may ultimately need to have the lost tooth structure restored by a dentist if the abrasion continues.

Q: Hi! I was wondering if someone could describe the symptoms of oral herpes in depth for me. In addition, I heard somewhere that canker sores or cold sores are herpes; I wanted to know which one it is. Please help.

A: Oral "herpes" is caused by the herpes simplex virus. There are two common antigenic types: type I, which is generally associated with oral herpes simplex infections, and type II, which is most commonly thought to predominate in genital herpes infections. The distinction is not clinically significant, since either serologic type can infect mucous membranes almost anywhere in the body.

Primary herpes simplex infection usually occurs in infancy or early childhood, and manifests as a systemic viral infection, with malaise, fever, prostration, and an exudative rash or blisters in the mouth or other mucous membrane sites. The infection is soon suppressed, but is never eliminated; the virus persists indefinitely in the various sensory nerve cell bodies (nuclei or ganglia). In this behavior, herpes simplex is similar to other adenoviruses, such as herpes zoster (the causative agent of both chicken pox and shingles), Eptein-Barr virus, and cytomegalovirus.

In times of physiologic or other stress (surface tissue injury, for example), the body's immune mechanism is sufficiently depressed so that these dormant viruses can follow the nerve fibers out to their cutaneous endings, where secondary viral dermal lesions form. Even before the redness and blisters, there are prodromal sensations of pain, burning or itching. This is followed within a day or two by the characteristic red clusters of blisters, which rapidly break and form a crust. In the oral area, this is most commonly located at the muco-cutaneous junction between the skin of the lip and its vermilion border.

It is important to avoid contact with the lesions, since it is possible to innoculate the virus on other parts of your or someone else's body. This is particularly unfortunate if the virus spreads to the eye, where it may cause permanent scarring of the cornea.

In common parlance, oral herpes infections are called "cold sores" or "fever blisters" (canker sores, or aphthous ulcers are unrelated to herpes). There is no cure for the permanent infection, but there are many over the counter preparations that confer relief from the itching and burning.

Depending on the frequency or severity of the herpes problem, your dentist or physician may prescribe certain antiviral medications, such as Zovirax (acyclovir), Famvir (famciclovir), Valtrex (valcyclovir), or Sorivudine (BV-araU - not available in the U.S.)

left arrow. Back to FAQ Contents   left arrow. Previous: Toxic Conspiracies     Next: Fixing Broken Teeth right arrow.