My teeth hurt! What do I do?
October 2, 2010 12:21 PM   Subscribe

You are not my Dentist: My teeth are causing me a great deal of pain and anxiety, but I'm not sure if my dentist is giving me the right advice. How do I determine a course of action to become pain-free?

About a year ago dental coverage from my employer came through. One dentist visit later and I was scheduled for two fillings and a root canal in one of my canines. Fun, right? But then things got worse.

A short time after the first visit I started experiencing a dull, persistant pain in my back teeth and jaw, mostly on the right side. The pain would be increase gradually over time, and it felt akin to a sinus headache in my mouth. The pain was also maddening in its inconsistency, increasing and decreasing in severity seemingly at random throughout the day. Over time it got worse, and I was taking a lot of over-the-counter meds(Extended Release Tylenol and Extra Strength Ibuprofen), but even in combination they could only dull the pain. My dentist thought I may be grinding my teeth, and was fitted for a night guard. This helped a bit(I no longer felt like I had lockjaw all the time and I was able to stop taking the pills), but the pain has persisted. I haven't had a truly pain-free day in a long, long time.

Here's the situation as it stands now:

My dentist wants to remove my wisdom teeth, as he feels they may be responsible for some of the pain. He also says that my bite is bad, and that it is likely I will need extensive ortho work that would cost thousands of dollars (Which I can ill afford - my dental plan isn't that good) followed by dental surgery to re-set my jaw and improve my bite(Which evil socialized Canadian medicine will cover). This is all especially delightful after having spent years in braces only to have all that work seemingly come undone.

The tooth removal worries me because I've already had four molars taken out - two top, two bottom - during my teenage years due to the aforementioned braces. This may sound stupid, but I'm honesty afraid I won't have enough teeth left back there to chew properly. Further, I think that the removal of the wisdom teeth is the first step in a plan I can't afford to finish. I'm afraid that the job will be left half-done and more problems will crop up as a result.

This all come to head(har!) in a completely overwhelming time in my life, which includes(but is not limited to) bed bug infestation, a new therapist, and a pretty severe uptick in anxiety and suicidal thoughts. I don't know who to ask for help, or even how to begin a plan of attack.

Help me, DentalFilter, I'm tired of hurting all the time.
posted by Gin and Comics to Health & Fitness (19 answers total) 2 users marked this as a favorite
Get a second opinion. Heck, get several. Speak directly with an oral surgeon and possibly with an MD who might be able to point to other, nondental causes of your pain. It's possible that your dentist is right; none of us have seen your teeth, and most of us are not medical experts, so we can't tell you whether your dentist is right. But keep seeking consultations until you're satisfied with the treatment being offered. Jaw surgery is not something to mess around with unless you're confident of your course of treatment.
posted by decathecting at 12:28 PM on October 2, 2010 [1 favorite]

I'm not sure how Canadian dental insurance works, but can you get a second opinion? I've read articles about how two dentists will have radically different interpretations of what's going on in your mouth, and I found that to be true after I switched from one dentist to another due to a move.

As for the wisdom teeth causing pain, that does ring true to me. I had mine out in high school and my one enduring memory of the process is my amazement as to how much better my face felt so quickly. I didn't realize how much pain I was in until it was over. There's a reason babies cry when teething, after all.

Good luck!
posted by sugarfish at 12:30 PM on October 2, 2010

I had almost identical symptoms for years and years.

I saw specialists. They first removed my wisdom teeth, but that didn't solve the problem.

They wanted to fit me with a nightguard, but I knew that I wouldn't be able to wear it consistently, so I refused. I also disagreed that I was grinding my teeth since my jaws were not sore in the morning.

I saw another specialist who said that I had worn some enamel down and microtubules were exposed and nothing could be done.

Years later and still in sporadic, but excruciating pain I asked the dentist to do some more tests: an electric pulp test to see if the tooth is sensitive. He can also do this with a hot/cold test. If that's the problem, I think you need a root canal.

Mysteriously, my teeth were fine. It is very hard to localize pain, so I always thought the pain was in my teeth, but the problem was that sometimes my gum would get infected. Are you flossing every day?
posted by esprit de l'escalier at 12:33 PM on October 2, 2010

The inconsistent pain in the jaw and neck plus sinus-like headaches sounds like my TMJ symptoms. It can often be brought on by nighttime clenching or grinding coupled with stress.

My first episode was brought on by going to the dentist - apparently all that stretching and trauma is bad. ;) According to my dentist, the best thing I can do for my (very mild) tmj is to ignore it and not mess with my jaw too much.

Best of luck to you, jaw pain is terrible.
posted by WowLookStars at 12:33 PM on October 2, 2010

Second opinion, yes.

Were the fillings that were put in white fillings? I've talked about my extended dental drama on here, but I had abscesses develop after the placement of white fillings, which ended up needing root canals. I also had extended problems with my bite after the placement of some fillings/crowns (in fact, going to a new dentist next week to get a crown adjusted that the first brushed me off about). Of course, I'm not a dentist and I'm really just thinking aloud, so really, I'd ask another expert.
posted by PhoBWanKenobi at 1:01 PM on October 2, 2010

(Oh, and for the bite problems, adjustment of the fillings was all that was needed. But, like, repeated adjustment of the fillings. 3 or 4 times.)
posted by PhoBWanKenobi at 1:03 PM on October 2, 2010

Further on WowLookStars' comment... You probably know we can get a serviceable muscle relaxant OTC here; get thee to a drugstore and pick up some generic Robaxin. If that helps -- and it fixes my TMJ hassles right up, in a way regular painkillers do not touch -- do suspect TMJ.
posted by kmennie at 1:04 PM on October 2, 2010

Response by poster: kmennie: "Further on WowLookStars' comment... You probably know we can get a serviceable muscle relaxant OTC here; get thee to a drugstore and pick up some generic Robaxin. If that helps -- and it fixes my TMJ hassles right up, in a way regular painkillers do not touch -- do suspect TMJ"

I've tried Robaxin, and found it no better than comparable painkillers.
posted by Gin and Comics at 1:37 PM on October 2, 2010

If you do have TMJ and/or a bad bite, there are way less dramatic ways to alleviate the pain and adjust your bite than surgery. Granted they take awhile. I went to a specialized TMJ center at a major US dental school/medical center (Tufts/New England Medical Center in Boston) and they were very anti-surgery except as a last resort.

I had already had my wisdom teeth removed (indeed my TMJ problems started right after I had them out which suggested to me that something went wrong like they forced my mouth open too wide or something during the surgery). Anyway I had to wear day and night guards consistently for at least a year (I wore the night guard for a little while longer and then was less consistent with it until it dried out and couldn't use it any longer). Every 2 or 3 weeks that would file down my guards to gradually realign my bite. They also taught me some how to self-administer pressure to selected acupressure points to alleviate pain (and I was also on an anti-inflammatory for awhile). Like I said, this was a long term commitment and it wasn't cheap (the guards were $500 each and were not covered by either my dental or regular health insurance). But I didn't have a lot of choice because by the time I got to the point where I sought them out, my jaw had locked to the point where I was only able to eat soup or other soft, pureed type food.

Thankfully it worked and my jaw rarely bothers me now, except during dental appointments and need to keep my mouth open for an extended period. I sometimes have some morning stiffness, but again, it's inconsistent and not painful. I underwent this treatment over 15 years ago, so the positive affects have been long lasting. Ultimately it was worth it for me even though I had to put most of the uncovered stuff on credit cards. Hardly ideal, but it wasn't a horrific amount other than the initial expense of the night and day guards. I was able to cover most of my follow up appointments in cash.
posted by kaybdc at 2:24 PM on October 2, 2010

Meant to add that while your jaw is bothering you, you need to watch what you eat. No hard or chewy foods. I found bagels or hard, crusty, chewy breads to be the worst. It's not a forever thing, but for now try to eat as much soup and other soft food that does not require a lot of chewing to give your jaw a break.
posted by kaybdc at 2:27 PM on October 2, 2010

A second and maybe third opinion can only be a good thing. Ask co-workers for recommendations of dentists, and ask them if the dentist seems to try to up-sell cosmetic services, or recommend a lot of expensive dental work. Ask if they trust the dentist.

When talking with any dentist about work to be done, always ask what alternatives there are. My dentist sometimes will say something like, "The guaranteed treatment is blah blah, but chances are good that I can do less and it'll be a long time before you need to go further."
posted by wryly at 2:47 PM on October 2, 2010

FWIW, I had to have my bicuspids removed when I got braces and years later I had all of my wisdom teeth out. I only had two wisdom teeth and you didn't mention if yours had crowned or were impacted or not but soon after I got health and dental insurance, my mouth started hurting like whoa. I went to a dentist and I had an infected impacted wisdom tooth so I went on antibiotics for a week, then he popped the tooth out. I had the other one out a few months later. I have big teeth and a small mouth so I definitely don't feel like I don't have enough teeth but having teeth removed for braces and wisdom teeth out later isn't that unusual.

A friend of mine had wisdom teeth and didn't know whether to keep them or have them removed because one dentist told him to have them removed and another told him they could stay. He finally went to another dentist who said, look, you can keep them and there's a chance they'll be fine. There's also a good chance that someday while you're on vacation or something, they'll start hurting *bad* and then you'll wish you had just gotten them out before.

By all means get a second opinion. If you have a good doctor, ask them what they think. Before you can get braces or have surgery, you're going to have to meet with an orthodontist and a surgeon - maybe you can meet with them sooner rather than later and ask them what they think.

I don't know much but jaw pain sounds like TMJ. Of course, it could be a lot of other things. Most doctors will do consultations without costing you much. Ask your friends if they like their dentists. See if anyone has had similar problems. I know you have anxiety problems but this isn't something to be ashamed of. Is there a university with a school of dental medicine nearby? You can always go there. Best wishes!
posted by kat518 at 3:02 PM on October 2, 2010

Get a second opinion, even if you pay out of pocket, because it's still cheaper than the things this dentist is proposing.

I don't know how dental things work in Canada (they work terribly in the US!) but I went through a long agonizing process to find a dentist who made me feel good. I went to three dentists who made me feel crying-in-the-parking-lot scared and miserable, and after two or three years finally found one who made me feel okay. Can you find one of those?

As far as being able to chew, if I'm counting right (I'm missing my wisdom teeth) you'd still have three molars and you would be absolutely fine to eat if this is the direction you needed to go in. Do due diligence--teeth can't be replaced if someone gives you bad advice--and trust that you'll be able to eat either way. Even with two I think you'd be fine.

And I'm assuming this has been done but if it hasn't for the love of God get a good full set of x-rays.

Sorry about your teeth--I have a hundred horrible teeth stories. I don't go to the dentist without Xanax and an iPod, even though I like the guy and I really like his staff and office.

After a rough patch, everything is okay now, so although I know teeth are this really visceral and scary thing you can get through and it'll be all right and you don't have to deal with this forever. (I had a therapist once tell me she couldn't even count the number of people who'd sat in her office and bawled about their teeth fears. It touches a lot of nerves.)

You'll be okay.
posted by A Terrible Llama at 3:23 PM on October 2, 2010

-teeth can't be replaced if someone gives you bad advice-

I don't know why I said that, it's bullshit, you can get an implant or bridge if it comes to that. I just meant it's something you want to avoid if you can. I have an implant. It's just dandy.
posted by A Terrible Llama at 3:24 PM on October 2, 2010

Second opinion!! I had the EXACT same thing. I really feel your pain. I can remember how crazy I felt after not having a single decent night's sleep for a month (waking up 2-3 times a night to take Tylenol). After trying to get the dentist that did the original filling to help me and only being offered the night guard "solution" or a root canal, I saw another dentist and they immediately diagnosed the problem: the original dentist drilled too close to my nerve. New dentist took out the filling, put in some sort of clove solution, then refilled. The relief was immediate and I couldn't believe how good I felt - I seriously had grown so used to being sleep deprived and in pain that I barely remembered what it was like to feel good.

Go see another dentist and ask them to check your fillings, even if that's not where the pain is. Part of the confusion with my tooth was that I was feeling pain on the bottom, but the problem was actually with the filling on the top. The nerves in there don't really correspond the way you'd think they would.
posted by coupdefoudre at 4:23 PM on October 2, 2010

Oh forgot to mention - I've also got the dreaded jaw realignment surgery in my future, but (according to my dentists) your current dull pain that never really goes away shouldn't have anything to do with that.
posted by coupdefoudre at 4:27 PM on October 2, 2010

disclaimer: i think that a great many dentists are quacks out to make as much $$ as possible. if a dentist has a fancy waiting room, flee

I've had dentists tell me TMJ and night guard and braces and then I've fled to other dentists who have said "what the heck? no, you don't need any of those things" then insurance changes and I have to go to another dentist who then tries the hard court press and tells me I need something else. I so do not trust them.

Take your xrays, because YOU PAID FOR THEM, and go to another dentist. Then go to another one. Hopefully at some point you will get lucky and find an honest dentist.
posted by micawber at 7:23 PM on October 2, 2010

Definitely second opinion.

Similar story as you with pain happening after that root canal (which sucks because the pain is supposed to go away after a root cancel, right?).

Turns out that the root canalled tooth had a very big post and at night when I was clenching my teeth, I was grinding that post right into my lower jaw nerves.

Night guard completely ended the pain. YMMV.
posted by dzaz at 5:34 AM on October 3, 2010

I know it sounds weird, but I might actually try getting a second opinion from a dental school if you have one nearby -- if you have money, I'd go through the dental faculty's practice, and if you're broke like me, I'd go through the clinic run by the dental school.

It sounds counterintuitive, because the dental students are students, but I've gotten much better treatment from the dental school than I ever have from dentists in private practice. (I also had the filling-too-close-to-a-nerve problem, which was compounded by the fact that the dentist who filled the cavity used an expensive, but weak, filling material on a molar -- I had to get a root canal, crown lengthening surgery, and crown, but my tooth doesn't hurt for the first time in about seven years. The dental school students and instructors totally fixed me without any pain or badness, and it's been a lot cheaper than if I had used a dentist in private practice.)
posted by kataclysm at 11:29 AM on October 4, 2010

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