Dear Sir/Madam,
For some time I have had problems with my upper central incisor. A year and a half ago I had veneers made because of diastemas, and they were made very nicely. Shortly afterward the central incisor started hurting. Nothing was visible on the X-ray, the tooth was vital, so the doctor said we would wait a little and perhaps the pain would settle.
Since this did not happen for several months, he opened the tooth, devitalized the nerve and treated it. Then he closed and filled the tooth. The pain did not stop, so he treated it again.
Even after that the pain is still present. It does not hurt spontaneously as much as before, but if I touch the tooth, the pain is still very severe. I also have pain under the nose on pressure.
The dentist says the pain will subside and that I should be patient for a while. Nothing is visible on the X-ray, the filling looks very good, yet the pain is still present. It has already been two months since the last filling.
What could this be and, in your opinion, is there any other solution?
Thank you very much in advance for your answer.

Question

Dear Sir/Madam,
For some time I have had problems with my upper central incisor. A year and a half ago I had veneers made because of diastemas, and they were made very nicely. Shortly afterward the central incisor started hurting. Nothing was visible on the X-ray, the tooth was vital, so the doctor said we would wait a little and perhaps the pain would settle.
Since this did not happen for several months, he opened the tooth, devitalized the nerve and treated it. Then he closed and filled the tooth. The pain did not stop, so he treated it again.
Even after that the pain is still present. It does not hurt spontaneously as much as before, but if I touch the tooth, the pain is still very severe. I also have pain under the nose on pressure.
The dentist says the pain will subside and that I should be patient for a while. Nothing is visible on the X-ray, the filling looks very good, yet the pain is still present. It has already been two months since the last filling.
What could this be and, in your opinion, is there any other solution?
Thank you very much in advance for your answer.

Accepted Answer

Dear Sir/Madam!
I suggest another X-ray (a few months after the last filling). Only after some time do changes in the periodontal tissue at the root apex actually become visible. The X-ray will either confirm or rule out suspected periapical inflammation, which is presumed to be the cause of the pain you feel, although sometimes we simply cannot confirm the symptoms reported by patients with diagnostic procedures. Ultimately, if the tooth hurts and the X-ray shows a good root filling, the next step in treatment is apicoectomy (root-end resection).
Have a nice day!

Dentist Tomaž Rotar answers: