Solving the mystery of tooth pain from afar

2016 08 22 14 15 49 958 Danenberg Alvin 400

George contacted me by email a few weeks ago. He wrote, "My tooth is still hurting, and my dentist can't find out why." He lives outside of the U.S., found me on the internet, and wanted another opinion.

I responded to him and explained, "I cannot make a diagnosis over the internet. But I will look at your x-rays and review your medical and dental history. Then, I should have some ideas and actions you could take that I will discuss with you."

George emailed back, "That makes sense to me."

He then filled out an online questionnaire and other information. George submitted them to me online. Also, he had his dentist email the dental x-rays. I took a look, gathered my thoughts, and we talked.

George's dental problems

George's acute problems centered around two recent dental procedures: a dental implant to replace his missing lower molar and a completed root canal on a tooth that was abscessed. George then explained the details of his dental fiasco.

Alvin Danenberg, DDS.Alvin Danenberg, DDS.

He had an implant placed in his lower left molar area, which did not cause any pain while it was healing for several months. Then a crown was cemented onto the implant. Within a couple of weeks, he noticed some tenderness in the gum tissue surrounding the new crown. He went back to his dentist who took a new x-ray and told him, "That's normal. You need to clean the area better." George left thinking that it would get better. It didn't.

In addition, the same dentist completed a root canal on his lower right bicuspid, which was abscessed and hurting. The root canal was done while the implant was healing on the left side of his lower jaw.

Shortly after the gum surrounding the implant crown became sore, the root canal tooth became extremely tender. George returned to his dentist to check it out.

The doctor checked that tooth, took a new x-ray, and made sure that the tooth had normal biting pressures when George brought his teeth together. The doctor tried to encourage him. "Your tooth will be fine. It just takes some time to heal after the root canal." It didn't get better.

George lost confidence in his dentist and didn't know where to turn. That's when he found my website and contacted me. Once he decided to schedule a consultation, George requested his new x-rays and they were sent to me, along with other documents for our meeting.

Let's look at the causes of the pain.

The sore gum around the implant crown

The x-ray of the crown on the implant showed a small amount of cement pushed under the gum tissue after the crown was cemented. Excess cement left under the gum tissue is, unfortunately, a frequent problem after the cementation of a crown. This may be difficult to see on an x-ray. However, it is evident on an x-ray when someone looks for it.

I explained to George that the dentist or hygienist would need to take the time to delicately clean out the area. I suggested: "The cement fragment is just like a splinter in your finger. It is an irritant. Your finger will not heal until the splinter is removed completely. And so, the gum around the implant crown will not heal until the cement is removed thoroughly. If the cement remnant is not removed, infection eventually will destroy the jawbone around the implant. That could cause the implant to be lost."

George agreed with me and promised that he would schedule another appointment with his dentist.

The root canal tooth

The cause of George's other problem was more difficult to determine. After his dentist completed the root canal on his bicuspid, the pain not only continued but actually got worse. I suggested that George see a root canal specialist to evaluate that tooth and take a 3D x-ray of the area. I suspected a crack in the tooth root. This specialized x-ray could show a crack better than a standard dental x-ray.

I pointed out to George my thoughts about a crack. It could occur if too much pressure was applied to the tooth by his dentist when he performed the root canal, or heavy chewing pressure could cause the fracture. If the root is fractured, it might have been present even before the root canal was started.

Tooth pain resolved

George was able to have the cement removed that was lodged under his implant crown. Also, George had an endodontist evaluate his root canal tooth and took the necessary 3D x-ray.

The x-ray clearly showed a hairline fracture in the root of the tooth. Unfortunately, the only option George had now was to extract that tooth, so George had the bicuspid extracted. I told him that later on the space could be replaced with an implant or a bridge cemented on the teeth on either side of the missing tooth.

At last, George was able to get his pain to stop. But only after the cement was removed from under the gum and after his cracked root canal tooth was removed.

My recommendation

Pain is a terrible thing, especially when professionals you trust can't make it go away. It is not wrong to get another opinion from another professional. I always encourage patients to seek other ideas from other medical and dental experts if there is a concern or an unresolved question. Sometimes the cause of a dental problem is very difficult to determine -- and sometimes the problem is the result of poor dentistry.

At times, the dental problem is related to other problems occurring in different parts of the body. The mouth is intimately and intricately connected to the rest of the body. Whatever affects one cell will ultimately affect all other cells. The mouth is not an island unto itself.

Whenever there is pain, it could be the result of uncontrolled inflammation and infection. If infection and inflammation become systemic, many other parts of the body will be affected. The source of the problem must be discovered and treated appropriately.

Alvin Danenberg, DDS, has retired from the private practice of periodontics in Bluffton, SC. He continues to be on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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