Toothache questions

February 1, 2009 1:05 AM

I noticed today that when I prod my top right-most molar with the tip of my tongue that it aches dully. I DO intend to make an appointment with a dentist, but don't have too much experience with tooth problems of any kind (I've had two cavities ever), so I wanted to get opinions on what this might be before I go.

I have no dental insurance right now. I was laid off last month, and my previous dental insurance has just expired today (and would likely have not covered much, since the premium was so high). I have a nest egg, but still would like to pay less if possible, so any tips on that would also be welcome.

Details:

• Tooth only seems to ache when I push the middle of it with the tip of my tongue. It does not ache when I push at it with my finger or fingernail, even in the middle. Tapping with my fingertip is a little different...it doesn't ache, but is sensitive when I do that (I can feel a slight sensation, where I'd usually just feel pressure).
• I read online that an infected tooth is usually sensitive to extreme temperatures. Tried very cold water and holding a ice cube to my tooth, and nothing. Hot water, however, did produce the same dull ache.
• General tooth care info: I brush daily, usually after eating. Sometimes twice. I do not floss regularily (flossed maybe twice this year). I haven't been to a dentist for at least 7 years. I'm having trouble remembering, but last time may have been in college.
• Might possibly be sinus-related, since I sometimes have sinus problems, and I am stuffed up right now. I'm guessing that's not it, though.
• All four of my wisdom teeth were removed during surgery 10+ years ago, as well as a couple of my other top teeth (because my top row was too crowded).

Although I'm hoping that it's a cavity, internet research tells me it could be an abcess or an infection that might require either a root canal or removal.

So, my questions:

1. Anyone out there have a good idea of what this might be? I want to try to prepare myself ahead of time.


2. I am a big baby about pain, and about needles in particular (I have something approaching a phobia about needles). If something needs to be done, is it okay/normal to ask to be gassed first? Any complications if I do that?


3. This tooth is on the very end of the right top side of my mouth, and my top teeth are pretty crowded, even after the surgery mentioned above. That particular tooth is very tight next to another tooth. If I'm told that I need a root canal, should I ask for the tooth to be yanked instead? What are the differences between those two options, in terms of pain, money, complications after the procedure?

Any advice would be appreciated. (Can you tell I'm nervous? Yeah.)

posted by anthy to health & fitness (13 comments total)

Just realized that if I push at the tooth with my tongue from behind (not in the middle of the tooth) that also aches now. So adding that as another data point.
posted by anthy at 1:12 AM on February 1

Your tongue can touch a lot more areas than your fingernail because it is so...whats the word that means it can change shape?....well whatever it is.

I think you may have an exposed or near-exposed nerve. I don't think its that big of a deal, dentists probably see this on a daily basis. I believe thats what they are checking for when they use their sharp tools to push down on your teeth.

I'm in SoCal, and "medicine" is VERY different here; sometimes it seems the focus is on making you a happy customer, regardless of whether your problem is treated as correctly as it can be.

For instance, my dentist offers "sedated dental exams". They give you the gas, make you pass out, then do a routing cleaning/exam. Sure thats great for all you people scared of dentists, but the dentist gets no feedback when he searches for exposed nerves.

In any case, I'm sure it will be less painful than you think. Good job making the appointment before you try anything crazy (hint hint).
posted by hal_c_on at 1:23 AM on February 1

In my experience the time the teeth that hurt don't have any cavities, and the ones with cavities don't hurt. The only cure for your curiosity is a dentist with an X-Ray machine.
posted by salvia at 2:14 AM on February 1

Okay, that didn't make any sense. Cut a few of the extraneous words in the first sentence, so it reads: "In my experience the teeth that hurt don't have any cavities, and the ones with cavities don't hurt."
posted by salvia at 3:56 AM on February 1

This sounds pretty similar to the early symptoms I've had when I've had abscesses. In my experience, the symptoms lists you'll find online are really only a general guideline and everyone is different.

If it is an abscess, you'll need a root canal. Don't get it extracted - I don't think most modern dentists even do this anymore except as a last resort. Root canals cost more, but are usually no worse than getting a filling (they just take longer) - I've had eleven, count'em, eleven. They numb you up, they do their thing, they give you a prescription for painkillers and antibiotics, and that's about it.

As it's a molar, if you do need a root canal, you'll need a crown afterward. Again, this is no big deal - it only hurts the bank account :( By this point, the tooth shouldn't feel pain so you may not even need anaesthetic for this part.

Is there a university near you that has a dental school? That would be one way to get it checked out and taken care of for a lower cost.

Thing is, if it is an abscess, the sooner you deal with it the better. The pain will only get worse, and in the case of severe infection, there's something about the bacteria than cancels out the anesthetic (and that's when root canals become painful, hence their bad reputation).

Good luck to you.
posted by chez shoes at 6:51 AM on February 1

Could be a ton of things, sensitivity from a receding gumline, stress from tooth grinding, cracked tooth, flare-up in sensitivity from sinus pressure, or...nothing. I've had a lot of dental work done from an early age, and I wouldn't worry about the pain. That's what novocain is for. Just close your eyes when they pull out the needle to give you the shot (I'm serious), and it's not a big deal.
posted by dreamphone at 7:30 AM on February 1

This sounds like something that, if it is tooth-related, should get taken care of right away.

However, why not wait until after your sinus cold subsides? Often when I get a sinus cold my entire bottom jaw aches. And then it goes away.
posted by KokuRyu at 8:58 AM on February 1

It could possibly be a cavity or a root canal.

Regardless, I prefer these questions be more geared to 'what can I do to help my tooth in the meantime', and one recommendation I'd make (I am not a dentist) is to disinfect that sucker with some Listerine or at least some booze. Also, put some Orajel on it.
posted by kldickson at 10:32 AM on February 1

If you floss twice a year and haven't seen a dentist in seven years, you probably have Periodontitis. This could be more serious than the one sensitive tooth: "Your teeth are fine, but your gums have to come out". Go see a dentist.
posted by and for no one at 12:56 PM on February 1

Thank you all for your ideas. I guess the consensus is it could really be anything (but to prepare for the worst), and that I'll have to go to the dentist to see for sure? And that it won't probably be as bad/painful as I am imagining? I'd done some searching on the internet before posting here, looking for my symptoms, and found a LOT of horror stories about root canals and rotten teeth in general. After reading these replies, I feel better.

I've gotten some recommendations of good dentists from relatives, so I'll call them up tomorrow and find out if they are willing to use gas. I'll still go if they don't, but man, it would be nice. I really am terrified of needles (comes of having hard-to-find veins; kneejerk reaction now even when veins are not an issue). One dentist comes with a recommendation as a "gentle" dentist, so I'll call that one first.

hal_c_on: I wish they had those sedated medical exams in Ohio, but if they do, I've never heard of them. (If they did, I'd go to the dentist much more frequently.) I'll ask around, but I don't have too much hope. Don't worry - I'll go, and I won't do anything crazy. :)

salvia: You've got a point. Last time I went, they found two cavities that I had no idea that I had...no pain at all in those teeth. I expect them to find at least one other cavity that I don't know about, so it's probably better I'm going in any case. I've put it off too long.

chez shoes: Thank you for your info on abscesses and root canals. It is good to hear from someone who's had that much experience. I'll go with whatever the dentist thinks is best when it comes to root canals or pulling. For dental schools: good idea, but...I am a little leary about that, since students would be less experienced/more likely to make mistakes. So I may go with a more expensive but safer option.

dreamphone: I will definitely try closing my eyes (and, you know, looking forward to it being over).

KokuRyu: I really want that to be the case. But on the other hand, I don't want it to get worse because I waited. It's more sniffles/drainage than a full-blown cold (temperature change, I think), so though that could be it...probably best to get it checked anyway. (If it was more than one tooth, I'd probably wait, since I'd figure not that many could be infected...but with just one, I worry.)

kldickson: That's actually a very good idea. I have some Act, so I'll use that too (along with brushing/flossing) in the time before the appointment.

and for no one: You've got a valid point. I hadn't heard of Periodontitis, but I know that forgoing flossing is bad, and I fully expected someone to bring that up. I don't really have an excuse for that.

I will update this question after the appointment. Again, thank you all.
posted by anthy at 5:33 PM on February 1

I'd done some searching on the internet before posting here, looking for my symptoms, and found a LOT of horror stories about root canals and rotten teeth in general.

I've had a root canal, and it wasn't all that bad. For one thing, the nerve wasn't infected and there was no abscess. However, the tooth had decayed so much (the same tooth had been giving me troubles for nearly ten years at that point) that the root needed to come out. It was fast and painless.

Anyway, based on your description, on a scale of 1 to 10, with 10 being the most serious situation, you're at a 1.
posted by KokuRyu at 6:41 PM on February 1

If you don't get regular cleanings for financial reasons, you might be interested to know dental schools often offer $10 cleanings, sometimes free. Just call and ask, there should be lots of opportunities.

If think you suspect have gum problems and want a little preventative boost, use mouthwash twice a day and take CoQ10 and vitamin C. Works for me!

***

As early as 1973, Drs. T. Matsumura and Karl Folkers performed a double blind trial of CoQ10 versus regular periodontal treatments for serious periodontal disease.

Twenty-four patients suffering from severe periodontal disease which had not responded to extensive flossing and brushing were studied. 13 subjects received 50 mg of CoQ, 11 received placeboes. Nine of the thirteen CoQ patients improved dramatically. Only 3 of 11 placebo recipients showed minor improvement.

In 4 of the CoQ patients, symptoms of the disease completely disappeared within 8 weeks. "The therapeutic improvement ... with CoQ was better both the number of improved patients and the degree of improvement," reported the doctors.

Further studies at the U.S. Air Force Medical Center showed that periodontal patients dramatically improved the depths of their "pockets" by taking 75mg of CoQ a day. Another study in Japan confirmed that 60 mg a day of CoQ10 could improve diseased gums.

How does it work? Apparently by boosting the immune system to help battle the bacteria which can cause gum disease.
posted by aquafortis at 7:43 PM on February 1 [2 favorites]

Aw, nice that you followed up, thanks.

I think you may be fine. I know a few people who didn't see dentists for seven years (myself included). One ended up with something wrong, but I didn't. So, don't worry. Very little might be wrong and you could be worrying for no reason. But I did feel so much better once I knew everything was okay.

Googling around (cost for dental checkup and xrays), it looks like you might pay $175-$350 to know for sure what's going on (plus see this website). Then you either know that things are great or that something is going on, and then you can make a plan to solve it as cheaply as possible. A random easy filling costs like $100-300 it sounds like, whereas if you let things get worse, a root canal and crown costs much more, so it's well worth it to stay on top of these things. In any case, you should ignore random advice from us and see a dentist. :) Good luck.
posted by salvia at 10:22 PM on February 1