I have had an intermittent toothache for the last week and a half.
July 16, 2013 8:45 AM   Subscribe

It comes and goes. Some days I feel completely fine and on others I am in 7/10 degree agony. I have no dental insurance and finally ponied up to be examined today. The dentist took an xray and did an examination and everything looked perfectly fine. She showed me the xray and although she's the professional not me, I have to concur that I saw no abnormalities. She said the gums look fine and that there should be no reason for me having pain. The affected tooth is the second molar in from the back on the bottom lefthand side.

After getting home, I did some googling and apparently sometimes sinus problems can manifest as toothache but that seems to be mostly localized to the upper teeth, and this is lower. Also, I have no discernible congestion of any sort-- no earache, no sniffles, nothing. I also saw that sometimes muscle tension in the neck or jaw can cause this, but again, nada on that score.

Another possibility is that a nerve has spontaneously decayed with no disruption in the enamel integrity or that the pulp has become infected somehow.

While I am not broke, I would rather not drain my financial resources more than need be. In my position, what is most advisable? Should I return to the same dentist or get a second opinion? Also, in the city I am in there is a free dental school and I am thinking about giving that a whirl.

If anyone has any suggestions or similar experiences, I would love to hear them. This pain is very real and it is affecting my life quite negatively.
posted by telomere to Health & Fitness (24 answers total)
Give the dental school a whirl before spending any more money.
posted by Ruthless Bunny at 8:53 AM on July 16, 2013 [2 favorites]

Possibly ear or sinus infection, which can put pressure on nerves that you feel as tooth or jaw pain. So maybe going to a regular doctor to check that is also called for.
posted by thelonius at 8:56 AM on July 16, 2013

I'm sorry you are going through this.

When you say "agony" what exactly does that mean? Pain? Burning? Hot/cold sensitivity?

Did the dentist talk about doing a course of antibiotics to see if it will help?
posted by FergieBelle at 8:57 AM on July 16, 2013

Are you sensitive to hot food or liquids touching that tooth? I had a similar situation where my dentist couldn't see anything on an x-ray, and I had no pain when he tapped the tooth. So he gave me some very warm water to hold in my mouth, and I very nearly leapt out of the chair. Yes, it was a nerve, and a root canal solved the problem.
posted by kimdog at 9:00 AM on July 16, 2013

Dental school sounds like a great idea.

Is there any variation in how much it hurts depending on what position you're lying in? For example, lying on one side vs standing.

It could easily be an infected nerve, which when I had a similar problem was on and off pain for several days - it had also been cold sensitive for some time. The dentist wasn't sure even after the x-ray, except to say 'well, you do need a filling there at least, so I'll start as if to do a filling and see what I find'. 10 minutes later he was like 'yep, you need a root canal. It's badly infected.'

Localization to a specific tooth is unusual for sinus/TMJ issues.

One other thing it COULD be: have you had any recent fillings, or anything 'stuck' in the corresponding opposite tooth? If something is stuck on the opposite tooth, every time you bite you will put a lot more pressure on the opposite tooth and it could cause it to hurt more.
posted by Ashlyth at 9:00 AM on July 16, 2013

I've had tooth pain from sinus infections and allergies, and from what I understand it's a more general thing -- my dentist told me that all or some teeth aching was sinus, but one specific tooth likely wasn't.

Getting another opinion from a different dentist (or the dental school) seems like the way to go. Dental infections can have ramifications for your general health if not treated, so getting it dealt with is definitely the right thing to do.
posted by pie ninja at 9:02 AM on July 16, 2013

You don't have TMJ issues, do you? There's nothing that "wrong" with my teeth, outside one that has a slightly-too-deep pocket. But TMJ and tooth-grinding also makes my teeth hurt.

I didn't know I had TMJ until my dentist helped me figure it out. I wouldn't have thought of my jaw as being too tense, although I knew I was grinding my teeth at night. I have a mouthguard now, which is helpful. Although, pricey.
posted by Coatlicue at 9:03 AM on July 16, 2013

Response by poster: FergieBelle, it's mostly pain. Right now it's a moderate throbbing pain. Also, I feel vaguely feverish and fatigued today but that could be due to having woken up early and had a fairly exhausting day besides. I haven't felt those symptoms before. I don't feel any burning and I haven't noticed any hot or cold sensitivity.

The dentist who was quite kind and seemed smart enough did not suggest any other potential reason for the pain. When I asked her if she had seen cases like this before she did say that she had but didn't tell me of any specific outcomes besides that sometimes it just clears up spontaneously. She is very young and seems in her mid thirties so maybe she is just inexperienced? She did want to see me again in a week, but I think that I will try to get into the dental school sooner rather than later and then weight the options from there.

Ashlyth, I really haven't noticed much variation in the pain depending on being upright or prone. The ONLY thing that has correlated to an increase in pain is being out at very loud concerts and being very tired at them. That could simply be correlation and not causation, however, and if anything could be fatigue mixing in. I haven't been drinking much if any alcohol while out, fwiw.

Coatlicue, I have no known TMJ issues, no.
posted by telomere at 9:05 AM on July 16, 2013

Do you still and/or not yet have your wisdom teeth? I have often had intermittent back molar pain because of wisdom teeth movement. I think YMMV on this one, but mine continued to move gradually after their initial appearance.

Did the dentist check out your whole mouth? Referred pain in the mouth is also a thing that has happened to me: the tooth on the bottom hurt, but it was the tooth above it that was infected.

Also, did the dentist tap your tooth/teeth? Give you a temperature test? In my experience, those clearly highlight the difference between pulp infection/nerve pain (ie, you need a root canal pain) vs. other tooth pain.
posted by snorkmaiden at 9:08 AM on July 16, 2013

Best answer: I had a thing in an almost-identical place on the opposite side that ended up being related to tensing my jaw. No one could figure it out: dentist sent me to a GP, who put me on antibiotics, which didn't work, and ended up on Tylenol 3 which barely touched it. Aleve helped enough to get me to stop clenching my damn jaw in pain, and it took about a month to heal itself. I feel a twinge now and then and now know to baby myself and wiggle my jaw around for a week or so before it goes any farther. Massage also helped--if you put a finger along your jaw line directly below the painful tooth, press moderately hard, and wiggle back and forth along the jawline, see if that does anything interesting. For me, it hurt like hell, but would improve things dramatically within about 10 minutes, for an hour or two.

If you're experiencing any cold sensitivity then it might still be a problem tooth, but sharp downward pain that felt like it was right in the center of one molar, occasionally radiating out to the ear was what I had, and your description of the pain levels is right on.
posted by tchemgrrl at 9:12 AM on July 16, 2013

Response by poster: snorkmaiden, my wisdom teeth have been out for years. Also, I have always had nearly perfect dental health and am very good with brushing, etc. I had one cavity as a teenager and that's it. I also had braces so my teeth are very straight and seem fairly stable in their placement.

I feel as thought she did NOT do a thorough check on my whole mouth, no. Your case of referred pain is interesting and is something I will suggest to the next provider I see.

She did, however, tap the tooth and that honestly didn't really change the pain level at all. It was strange. She did not perform a temperature test. She did spray air on the region and that didn't produce any noticeable difference either.

tchemgrrl, hmm that is very interesting. I did just try doing as you suggested and put a finger to my jaw directly below the painful tooth, pressed hard, etc. For me, it actually -somewhat- lessened the pain. I did not feel any increase in pain. I have no idea if this is just an interference from the pain by stimulating the region but for about thirty seconds after a very short massage it feels better! But right after I stop massaging the pain immediately returns.

And, actually, now that you mention it there has been some feeling that the pain radiates-- it is mostly centered in that one tooth but there have been a few points where I felt like it was spreading. I just figured it was a sympathetic reaction.

That said, I really feel no tension in my jaw. I do NOT have temperature sensitivity. Then again, I have been under quite a lot of stress lately (both physical and mental) and have not been sleeping well at all.

Could you tell me more about what they diagnosed as the problem exactly? Or was there never a name for it and it just resolved on its own and with Aleve?
posted by telomere at 9:22 AM on July 16, 2013

just last week I had a throbby head that I worried was a tooth issue - but my teeth seemed fine, and the feeling came and went. Turns out my sinuses were plugged - I took a neo citron and everything was well again. Try some cold medicine that has a decongestant, or that is made for sinus trouble, and see if that helps any.
posted by 5_13_23_42_69_666 at 9:23 AM on July 16, 2013

Was the dentist able to reproduce your pain in the chair? Did she thoroughly check your muscles on that side for tenderness?
Generally, the fact that you have no decay, no fracture, no failing filling should give you comfort that the tooth itself is not the cause of your discomfort. Muscle pain can refer so strongly that it does indeed feel like a tooth ache.
You didn't mention how long this has been going on, and any pattern to the feeling would also help -- is it more profound in the morning when you wake up, or after a long day,or after a meal or does it just happen when you are doing nothing in particular?
Feel free to memail me if you want to go into further detail.
posted by OHenryPacey at 9:27 AM on July 16, 2013

on preview i missed the title, so week and a half. ok
posted by OHenryPacey at 9:29 AM on July 16, 2013

i will Nth the possibility of a sinus or ear infection (even for a lower tooth) -- i've had the same thing happen to me a couple of times, and actually, last month i went to the dentist as i was afraid i'd cracked a molar, but it was just a terrible sinus infection (which i'd been dealing with for over 2 weeks at that point) -- he prescribed an antibiotic and i felt much better after a few days. apparently this is something that just happens to me now when i get a sinus infection -- i get referred pain in my molars.
posted by oh really at 9:31 AM on July 16, 2013

Response by poster: OHenryPacey, I'll answer your questions here in case anyone else finds the replies to be of interest but I'll send them to you in memail you as well, thank you for offering to help.

Well, she did not induce any new pain in the chair but it was definitely present. She did NOT check the muscles for tenderness, no. Since reading tchemgrrl's comment, I have massaging them and while that has lead to a reduction in pain, I note no tenderness. That said, while I replied to snorkmaiden's suggestion about whether or not my teeth have shifted recently by saying that I felt my teeth were fairly stable I JUST felt what might be described as a bit of a click or snap while massaging between that molar and the backmost one. I am not sure if it is just temporary relief via massage and/or that snap, but it feels marginally better now (though nowhere near perfect).

So, yes, it has been going on for a week and a half. It started while I was camping at a seven day long music festival. During that period, I WAS drinking heavily for three days but then stopped entirely (I just got bored of being wasted, no other reason-- ha)) for the last four. The whole time I was there, I was intensely physically exhausted and sleep deprived.

Actually, now that I count it out I think the pain actually started on July 4th. But it was very intermittent and low level or non-existent depending on the day until Saturday the 13th. That day was horrible but subsequent days have been manageable.

As I mentioned, I have also had a lot of other stress lately (I won't go detail as that seems unnecessary) due to disruptions in my personal life. I have also had a lot of intensive physical activity as I have recently moved and have been biking and swimming a lot.

The timing of the pain seems somewhat random but the worst it has been post-festival is at a concert on Saturday that featured screamingly loud experimental jazz. I was also quite tired that day. That said, the Friday prior I had also seen loud experimental jazz but the volume was nothing like on Saturday. I had only very moderate pain on Friday.

oh really, Hm. I really feel no signs of a sinus infection but since so many of you (and many others I have seen reporting anecdotes via a google search) seem to think this could be the cause, well, I guess it can't hurt to pop a decongestant and see what happens. I only very rarely have sinus problems and do wonder if they could be totally stealth otherwise and ONLY manifest in tooth pain? That seems a bit strange, but I suppose stranger things have happened.
posted by telomere at 9:50 AM on July 16, 2013

Honestly, the doctors did squat; after the second or third time I went I was mostly treated like a med-seeker. They did check for everything else I see listed above except TMJ (which a different dentist has since told me I have some mild symptoms of). They also confirmed that there weren't any concerning masses on the bone or signs of any jaw/skin infection in that area, which I don't see mentioned upthread.

When I gave up on the doctors I just played around, looked at anatomical diagrams to link to what I could feel, and managed to figure out something that worked. At some point, I realized that the trouble started a day or two after a very stressful test, and I also noticed I was tensing up at the pain. I'm trying to remember now if heat or ice helped; I don't think it did but I used it a lot anyhow just for the feeling of doing something.
posted by tchemgrrl at 9:57 AM on July 16, 2013

Best answer: Yeah sinus problems are low on my radar of causes for tooth pain in the lower, and moreso absent any sinus symptoms, it tends to be a catch-all anectdotal cause for many things.
Your past few days of activity would suggest that your entire system needs to return to normal (sleep, activity level, stress) and you might find that your symptoms fade away as it does.
Your very back molars are the closest to your joint, which acts as a fulcrum, so those teeth take the most pressure when you clench. you could not only have stressed the muscles but also the pdl (periodontal ligament) around the roots of that tooth. soft diet and anti-inflammatories can help (if you can take them).
If the discomfort gets worse, you develop swelling or remarkable temperature sensitivity, have the area re-evaluated. some things don't show on an xray in their earliest stages, so a second look can sometimes be enlightening.
posted by OHenryPacey at 10:05 AM on July 16, 2013

Response by poster: tchemgrrl,

Hm, yours does sound a bit like mine and the massaging is helping a bit. I haven't been to a regular doc yet but this dentist did not mention anything about masses on the bone, TMJ or any infection.

Well, this would be the best answer. I am definitely exiting one of the most stressful periods of my life at the moment. Although this would be a new reaction to stress, I suppose it is possible. I will still try the decongestant and going to the dental school, but I really hope that it IS just stress and that massaging it will help. I'm not looking forward to a month of this as you had, but that'd be better than a root canal to extract a mysteriously decayed root. Thanks so much for your help. :)


Thank you so much for the follow up comment! I really hope that it is just stress and muscle clenching as tchemgrrl experienced and you suggest as a possibility. But why would it only express in one tooth (well, there has been a very limited experience of radiant pain in other teeth but not often or persistently)? I think I will make it a big priority to rest well over the next couple of days to the extent possible. I am one of those people who has a hard time setting life down in the face of something like a toothache. Although I do not feel any other indications of muscle tension besides the ache in the tooth, well, I did once experience a horrible pain in my shoulder that turned out to be related to a disc injury in my neck. I didn't feel the neck part of the equation for weeks. I guess the human body can be quite strange in where it expresses damage in terms of pain.

I did see that you are a dentist, would you recommend me returning to the original dentist I saw or trying the med school?

You are all making me feel a lot better about this, but I am still going to have it checked out again by some professional or other in person. :)
posted by telomere at 10:18 AM on July 16, 2013

Certainly can't hurt to have the dental school take a look. I've had sinus, ear, AND eye infections cause pain in the teeth and jaw, FWIW. So you might want to make an appointment with your GP if the dental school agreees with the dentist.
posted by The Underpants Monster at 10:20 AM on July 16, 2013

FYI, I have had a lot of terrible experiences with dental students. They're not supervised closely enough, not careful enough (or don't know what to be careful about), and because they're getting a grade for their work they can be reluctant to admit that they're wrong to the roving supervising profs. Plus your treatments can take twice as long (in hours, and in repeated visits), and the quality of care is often noticeably lesser in my experience. Now that I can afford to go to a real, experienced dentist when I need to, and know what quality care is supposed to look & feel like, I've sworn to never go back to dental schools no matter what my future economic situation is. YMMV, but also buyer beware.
posted by tapir-whorf at 12:20 PM on July 16, 2013

So this happened to me years ago - pain came and went for a week or two and then went away, when it was there - but then I had a bump in my gum swelling out at the base. It turned out to be a hairline crack in my tooth, causing my nerve to die - a slow and sometimes very painful death and then an infection filled in the cavity. I ended up having to have a root canal, but there was no pain at that point - just a dead nerve.
posted by revan at 1:50 PM on July 16, 2013

FWIW I had a cracked tooth that was much as you describe. I knew when I cracked it, I knew what I bit, I felt and heard the crack, and I felt momentary very intense pain. But on going to the doctor (the pain had mostly subsided) he couldn't find anything wrong at all, including in an X-ray, and pronounced it OK. After several more months the crack led to ever-increasing pain, and finally a root canal. So something like that is a possibility.

Another possibility is definitely referred pain. I've had pain I was *certain* was in a lower tooth and the problem was actually in an upper tooth, and vice-versa. One way you can (and dentists often do) check this is to thump the offending tooth with something. They have a little hammer or maybe the handle-end of a dental tool that they use. You could use something like tail end of a butter knife to give the tooth a few thumps of gradually increasing intensity. If you do that and feel shocks of pain in that tooth, that tells you something--and if you don't, that tells you something, too.

And last, the extreme pain I had in a back molar type tooth, that I was just certain was a toothache, cavity, or something of the like, turned out to be caused by a 'high spot' on one tooth. Meaning the two teeth where that high spot meet were grinding together with the force usually distributed across a whole bunch of teeth. The result was something that felt exactly the same to me as the toothache I had when my tooth cracked. However, in this case it was solved rather instantly when a dentist ground of like a tenth of a millimeter off the high spot. In my case the high spot was because of a recently installed crown, but it could be caused by any number of things--including things you might not be aware of at all, like night-time tooth grinding.

The fact that you have recently been stressed etc makes me think of this as a real possibility. Maybe you've been grinding your teeth at night more so than usual, maybe one little spot ground right through leaving another spot to take more pressure than usual, etc.
posted by flug at 2:18 PM on July 16, 2013

Whenever I think I have toothache it turns out to be a gum infection instead. I think usually caused by scratching the gum with hard or spiky food (eg popcorn). The pain feels like it's coming from the tooth but actually it's the gum. Usually dentists can't see anything until it is super swollen and red, which can take weeks to build up. Rinsing with antiseptic mouthwash three or four times a day often fixes it within a week.
posted by lollusc at 9:53 PM on July 16, 2013

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