Why Am I in Pain?

Amy Dukoff, D.M.D.
Why Am I in Pain?

Amy Dukoff

HY am I in pain?” is a question that practitioners hear often. Pain is the chief complaint that plagues many frustrated patients. A few patients have been in “pain” yet state, “My dentist doesn’t see anything!” Patients who are feeling pain without an obvious cause may emphasize the fact that they are sane or not crazy. These patients sometimes reinforce to me the feeling that no one believes them but that the pain is unbearable. Many times patients with continuous pain have seen physicians along with neurologists and psychologists only to be referred back to the dentist. The patient just feels pain and needs help.
    Of course, non-surgical root canal therapy is not the answer every time, but many times it just is. Yes, migraines or sinusitis can be the differential diagnosis, but many times non-surgical root canal is the needed treatment therapy.
    Patients who have a history of grinding or clenching tend to have obliterated pulp chambers, which signify a chronic pulpal response to an aberrant force. Sometimes a patient will not admit to night grinding or clenching, but the flattened cusps reveal the pattern of excessive wear. Usually, if one asks a patient whether she or he has had periods of stress, the patient will reluctantly acknowledge the problem of grinding or clenching.
    On radiographic examination, the tooth in question, which is provoking pain in the quadrant, is usually found to have a calcified radicular pulp. Calcification is the clue to the practitioner that the tooth is undergoing changes. With age, calcifications are normal, and we don’t perform non-surgical root canal on every calcified pulpal chamber. However, if a patient consistently complains of pain, then the tooth with a calcified pulp chamber or radicular space should be evaluated as a tooth that may be undergoing aberrant pulpal changes.
    Calcified pulpal chambers are a key to removing the source of a patient’s chief complaint, pain. Even if the patient does not have gross decay or a periapical radiolucency, we have to begin with the assumption that the patient is right about feeling pain. If the patient is in pain, we must believe the patient and sympathize with him or her. If there is a clacified pulpal chamber or radicular space, we as practitioners should evaluate the obliterated pulpal chamber as a chronic condition that could produce pain.

April - June 2008

Non-surgical root canal therapy is not the answer every time, but many times it just is.

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