Atypical Toothache

Root Canal does not stop excruciating pain of toothache

Typical treatment for toothache is root canal ? Inside nerve removed

If inside nerve was cause pain, pain would go away with root canal ? Yes

What does that tell you about cause pain ? not inside nerve

Did you know a tooth have two sets nerves ?

1) Inside nerves

2) Outside nerves

Looking for answers: When root canal does not relieve pain ?

  1. If it is hidden inside nerve = root canal specialist
  2. If it outside nerve = Orofacial pain specialist

Refer endodontist = root canal specialist

1) 2nd opinion (2 brains better one)
1) Retest inside nerve
2) Even they have difficult choices depending on interpreting data
a) Performs 2nd root canal
b) Refers orofacial pain specialist

An endodontist will refer Orofacial Specialist on any tooth that does not have conclusive evidence on inside nerve

Refer orofacial pain = outside nerve specialist

2) 2nd opinion (2 brains better one)
3) Test outside nerve
4) Manage outside nerve
5) Pain goes away

Do your own research about outside nerve?

  1. Ask dentist if they see evidence grind & clench
  2. Look in your mouth, are flatten, worn, chipped ?
  3. Ask dentist if he is sure it is pulp tooth ?
  4. Face square looking, with enlarge angle mandible, side face ?
  5. Having trouble with broken or chip teeth ?
  6. Gums are receding, are teeth sensitivity
  7. Needing alot dental work and you take good care teeth ?
  8. History broken fillings -crowns-porcelain-composites
  9. Break retainers, nightguards, partials, Hawleys
  10. Do your teeth move, partials & retainers will not insert

Have a few of them, are you convinced: you grind & clench.  

Thoughts:

  1. Dentist did his/her best trying get you out pain with root canal
  2. Once inside nerve is amputated you cannot put it back
  3. Patients just want get out pain
  4. Root canal appears quick fix
  5. Frustration & cost if root canal does not relieve pain

Atypical toothache is one most expensive pathologies to diagnose and treat in todays dentistry. Chasing the pain ghost can take decades of dental reconstruction and can cost as much as small house. After root canal, retreat root canal, then extraction, then implant, then implant removal and you still have pain.  This is close to being an epidemic proportion. The better choice would been second opinion by Orofacial Pain Specialist. An ole saying, Measure twice cut once!

Muscles refer pain into your tooth ?

Root Canal does not relieve excruciating pain of toothache ?
If inside nerve caused pain, root canal would have reduced pain

What does that tell you about cause pain ?
It is not from inside nerve

We need more information to understand real source pain:
Damage muscle refers to area of teeth

Muscle Referred Pain:

1) Muscles damage = trigger point
2) Trigger points refer pain to teeth:
a) Masseter refers lower molars
b) Temporalis refers upper molars

Masseter refers to lower posterior teeth
Temporalis refers to upper posterior teeth

Hints the Atypical toothache is not inside nerve

  1. Not caused by cavity
  2. Comes and goes
  3. Mild moderate level pain
  4. Pain is in area, not specific tooth
  5. Alot hints of muscle

How does muscle get damage?

Excessive demands on chewing muscles:

1) Clench Grind
2) Tension Muscles
3) Guarding
4) Protective reflex
5) Habits
6) Chewing
7) Talking
8) Gum

Do your own diagnostic research:

MusclePulpal
TypeDull AcheSharp shooting
SeverityMild to ModMod to Severe
LocationQuadrantSpecific tooth
AggravateChew FunctionBiting tooth
SpecificityGeneralOne tooth

Text Book: Trigger Point Manual written by Dr. Janet Travell Headache in Pelvis by Wise & Anderson

Joint Loading causes Tooth Pain

Your toothache is caused by excessive loading of posterior teeth due lost space in joint.

Your toothache is caused by excessive loading of posterior teeth due lost space in joint.

1) Sudden disc displacement
2) Bone loss in condyle

Disc thickness in displacement is small; so, goes unnoticed

  1. Loading tooth is discomfort
  2. High pain threshold = ignore
  3. Adaptive response = ignore
  4. Super mom =  ignore
Disc displaces , condyle moves up, Molars loaded, grind clench picks on molars

Bone loss joint=OA TMJ

  1. starts small = unnoticed
  2. mod to severe= tooth pain in molars

Did you see the hidden pain?

  1. yes, loading tooth sets up pain
  2. but, the outside ligament molars is source pain
  3. also, joint pain can make whole area hurt
Yellow = condyle loss bone
White = loading molar

Physics of 3 legged stool: 1) joint, 2) joint, 3) set teeth

  1. One legs of stool losses height
  2. Stool will lean to that side
  3. Load on the teeth increases
  4. Loads teeth on side of loss
  5. Tooth pain in outside nerve
  6. Tooth reports discomfort or pain in outside nerve

Refer orofacial pain = outside nerve specialist

  1. 2nd opinion (2 brains better one)
  2. Test joint
  3. Moderate to severe damage TMJ
  4. Refer to Orofacial Specialist
  5. Chew system orthopedics
  6. Tooth Pain goes away

Do your own research about loss bone or disc in TMJ?

  1. Does dentist see evidence muscle joint damage
  2. Do I have tension in your neck or back or jaw
  3. Ask dentist if he is sure it is pulp tooth ?
  4. Do I carry alot stress & anxiety in my muscles
  5. Have dentist reveal all damage grind & clench

3 Pathologies cause Tooth Pain

Source of confusion:

  1. In 88 % toothaches, inside nerve (pulp)----- dentist
  2. In 10 % toothaches, outside nerve-muscle -joint- orofacial pain
  3. In 2 % toothaches are 3 other pathologies----- orofacial pain

Medical Pathologies feel like toothache:

1) Trigeminal Neuralgia
2) Atypical Odontalgia
3) Misc-sinus, heart, cancer, MS, Pagets

Trigeminal Neuralgia-5th nerve has a trigger near teeth

Atypical Odontalgia -neurovascular pathology of teeth

Miscellaneous (Sinus, tumor, MS, heart attack, Pagets)

Atypical toothache: Cases: Examples

  1. Case I: Series of root canal-crown-extraction on lower right, starting w/ 3rd molar proceeding to 2nd  premolar.- when dentist would question not dental pathology-he would go to another dentist, being engineer he was sure it was tooth-each dental procedure reduce pain short period then pain returned. Diagnose Muscle referred pain
  2. Case II: remaining LL wisdom tooth w/ major interference-moderate grinder. Years later, cementing crown on that tooth, the huge interference set up pain. Dental Tx w/ 2 full equilibration and 11 refinement adjustments,  chasing pain ghost. Dull bite with parafunction
  3. Case III: ongoing lower left molar toothache in 2000. Treatment w/ biteguard-nightguard-3rd extraction, history intermittent restricted opening, pain increasing w/ each lock, finally locked-stayed lock.Complete displace disc
  4. Case IV: sharp shooting pain lasting seconds, a series of pains for days, then go away for weeks, then return, 69-year-old female, no history trauma, dental work, or event prior onset. Trigeminal Neuralgia

Root Canal does not stop excruciating pain of toothache

Typical treatment for toothache is root canal ? Inside nerve removed

If inside nerve was cause pain, pain would go away with root canal ? Yes

What does that tell you about cause pain ? not inside nerve

Did you know a tooth have two sets nerves ?

1) Inside nerves

2) Outside nerves

Looking for answers: When root canal does not relieve pain ?

  1. If it is hidden inside nerve = root canal specialist
  2. If it outside nerve = Orofacial pain specialist

Refer endodontist = root canal specialist

1) 2nd opinion (2 brains better one)
1) Retest inside nerve
2) Even they have difficult choices depending on interpreting data
a) Performs 2nd root canal
b) Refers orofacial pain specialist

An endodontist will refer Orofacial Specialist on any tooth that does not have conclusive evidence on inside nerve

Refer orofacial pain = outside nerve specialist

2) 2nd opinion (2 brains better one)
3) Test outside nerve
4) Manage outside nerve
5) Pain goes away

Do your own research about outside nerve?

  1. Ask dentist if they see evidence grind & clench
  2. Look in your mouth, are flatten, worn, chipped ?
  3. Ask dentist if he is sure it is pulp tooth ?
  4. Face square looking, with enlarge angle mandible, side face ?
  5. Having trouble with broken or chip teeth ?
  6. Gums are receding, are teeth sensitivity
  7. Needing alot dental work and you take good care teeth ?
  8. History broken fillings -crowns-porcelain-composites
  9. Break retainers, nightguards, partials, Hawleys
  10. Do your teeth move, partials & retainers will not insert

Have a few of them, are you convinced: you grind & clench.  

Thoughts:

  1. Dentist did his/her best trying get you out pain with root canal
  2. Once inside nerve is amputated you cannot put it back
  3. Patients just want get out pain
  4. Root canal appears quick fix
  5. Frustration & cost if root canal does not relieve pain

Atypical toothache is one most expensive pathologies to diagnose and treat in todays dentistry. Chasing the pain ghost can take decades of dental reconstruction and can cost as much as small house. After root canal, retreat root canal, then extraction, then implant, then implant removal and you still have pain.  This is close to being an epidemic proportion. The better choice would been second opinion by Orofacial Pain Specialist. An ole saying, Measure twice cut once!

Muscles refer pain into your tooth ?

Root Canal does not relieve excruciating pain of toothache ?
If inside nerve caused pain, root canal would have reduced pain

What does that tell you about cause pain ?
It is not from inside nerve

We need more information to understand real source pain:
Damage muscle refers to area of teeth

Muscle Referred Pain:

1) Muscles damage = trigger point
2) Trigger points refer pain to teeth:
a) Masseter refers lower molars
b) Temporalis refers upper molars

Masseter refers to lower posterior teeth
Temporalis refers to upper posterior teeth

Hints the Atypical toothache is not inside nerve

  1. Not caused by cavity
  2. Comes and goes
  3. Mild moderate level pain
  4. Pain is in area, not specific tooth
  5. Alot hints of muscle

How does muscle get damage?

Excessive demands on chewing muscles:

1) Clench Grind
2) Tension Muscles
3) Guarding
4) Protective reflex
5) Habits
6) Chewing
7) Talking
8) Gum

Do your own diagnostic research:

MusclePulpal
TypeDull AcheSharp shooting
SeverityMild to ModMod to Severe
LocationQuadrantSpecific tooth
AggravateChew FunctionBiting tooth
SpecificityGeneralOne tooth

Text Book: Trigger Point Manual written by Dr. Janet Travell Headache in Pelvis by Wise & Anderson

Joint Loading causes Tooth Pain

Your toothache is caused by excessive loading of posterior teeth due lost space in joint.

Your toothache is caused by excessive loading of posterior teeth due lost space in joint.

1) Sudden disc displacement
2) Bone loss in condyle

Disc thickness in displacement is small; so, goes unnoticed

  1. Loading tooth is discomfort
  2. High pain threshold = ignore
  3. Adaptive response = ignore
  4. Super mom =  ignore
Disc displaces , condyle moves up, Molars loaded, grind clench picks on molars

Bone loss joint=OA TMJ

  1. starts small = unnoticed
  2. mod to severe= tooth pain in molars

Did you see the hidden pain?

  1. yes, loading tooth sets up pain
  2. but, the outside ligament molars is source pain
  3. also, joint pain can make whole area hurt
Yellow = condyle loss bone
White = loading molar

Physics of 3 legged stool: 1) joint, 2) joint, 3) set teeth

  1. One legs of stool losses height
  2. Stool will lean to that side
  3. Load on the teeth increases
  4. Loads teeth on side of loss
  5. Tooth pain in outside nerve
  6. Tooth reports discomfort or pain in outside nerve

Refer orofacial pain = outside nerve specialist

  1. 2nd opinion (2 brains better one)
  2. Test joint
  3. Moderate to severe damage TMJ
  4. Refer to Orofacial Specialist
  5. Chew system orthopedics
  6. Tooth Pain goes away

Do your own research about loss bone or disc in TMJ?

  1. Does dentist see evidence muscle joint damage
  2. Do I have tension in your neck or back or jaw
  3. Ask dentist if he is sure it is pulp tooth ?
  4. Do I carry alot stress & anxiety in my muscles
  5. Have dentist reveal all damage grind & clench

3 Pathologies cause Tooth Pain

Source of confusion:

  1. In 88 % toothaches, inside nerve (pulp)----- dentist
  2. In 10 % toothaches, outside nerve-muscle -joint- orofacial pain
  3. In 2 % toothaches are 3 other pathologies----- orofacial pain

Medical Pathologies feel like toothache:

1) Trigeminal Neuralgia
2) Atypical Odontalgia
3) Misc-sinus, heart, cancer, MS, Pagets

Trigeminal Neuralgia-5th nerve has a trigger near teeth

Atypical Odontalgia -neurovascular pathology of teeth

Miscellaneous (Sinus, tumor, MS, heart attack, Pagets)

Atypical toothache: Cases: Examples

  1. Case I: Series of root canal-crown-extraction on lower right, starting w/ 3rd molar proceeding to 2nd  premolar.- when dentist would question not dental pathology-he would go to another dentist, being engineer he was sure it was tooth-each dental procedure reduce pain short period then pain returned. Diagnose Muscle referred pain
  2. Case II: remaining LL wisdom tooth w/ major interference-moderate grinder. Years later, cementing crown on that tooth, the huge interference set up pain. Dental Tx w/ 2 full equilibration and 11 refinement adjustments,  chasing pain ghost. Dull bite with parafunction
  3. Case III: ongoing lower left molar toothache in 2000. Treatment w/ biteguard-nightguard-3rd extraction, history intermittent restricted opening, pain increasing w/ each lock, finally locked-stayed lock.Complete displace disc
  4. Case IV: sharp shooting pain lasting seconds, a series of pains for days, then go away for weeks, then return, 69-year-old female, no history trauma, dental work, or event prior onset. Trigeminal Neuralgia

Atypical Toothache Navigation

Pearls of Pain

Side effects Appliances

a) soft biteguard: increase grinding, bulky, decrease airway space

b) soft-hard guards (Hybrids): increase clench, can’t…

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