Question

I have major problems with my teeth. I have had severe toothache for about four months. My dentist replaced four amalgam fillings with plastic, but the problem remained. A root canal treatment was carried out on one tooth. Since then, my gums have been sensitive. My dentist can't understand this. He said that a nerve could be to blame for the pain. A specialist could determine this. Who could? What advice would you give me? A. G. in E. 

Short answer

Toothache can have various causes. The actual dental treatment depends on the cause of the toothache. The dentist decides which treatment is necessary based on the findings. It may be useful to take x-rays. Occasionally, an ear, nose and throat examination or a neurological examination is also necessary. 

If there are medical or dental problems, there needs to be a clear reason (indication) before any treatment is carried out as to why this particular treatment should be carried out and not another. The indication is determined by the doctor or dentist on the basis of a targeted clinical examination and the performance of specific tests geared to the existing problem. If necessary, examinations using imaging techniques (e.g. x-rays) or laboratory tests are required. The data found in this way (findings) result in the diagnosis (disease). 

According to your description, the diagnosis of your problem is still unclear at the moment. Effectively, it is not always easy to find the cause of pain. However, it only makes sense in very rare cases to carry out treatment as a "trial" without a clear diagnosis. Such a procedure may do more harm than good to your teeth and also costs too much. 

Coordinated investigations 

Before you undergo any further treatment, it is advisable to have a detailed examination carried out as suggested by your dentist. In such situations, it is often necessary to consult other specialists. At best, your family doctor or dentist should coordinate this examination. 

I would only carry out further therapy once a possible diagnosis has been found. The following areas could be the cause of your pain: 

Dentistry: dental nerves, gums, bones, muscles, temporomandibular joint, grinding and clenching, bite position, etc. 

Ear, nose and throat examination (ENT): Maxillary sinuses, etc. 

Neurology: facial nerves etc. 

General medicine: the rest of the head. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on December 02, 2009