Amy Dukoff, D.M.D.
Why Does My Tooth Hurt?
Amy Dukoff

Amy Dukoff

MVERY ONCE IN A WHILE, a patient comes to our office complaining that a tooth hurts, but the cause of the pain is elusive. The patient without hesitation reports that “this tooth hurt all last night.” However, the tooth doesn’t hurt anymore. Furthermore, the frustrated patient reports that a general dentist did not see anything wrong. Yet still the tooth hurts at times. The patient is sure that something is bothering him or her. The patient is adamant that the tooth hurts and implores us to help. Now, we may wonder, with some trepidation, whether the patient is going from to doctor to doctor for second and third opinions, questioning whatever advice was given previously.
    The cause of pain like this may be condensing osteitis.
    A patient with condensing osteitis may present symptoms of low-level pain that the patient seems to be able to tolerate. The patient usually seems to be “living” with a pain that can only be reproduced by the patient’s complaints. Therefore, it is hard to render treatment without being able to reproduce symptoms.
    Condensing osteitis is a reaction to an infection in an area at the periapical region. This reaction is seen as a radiopaque lesion. In this periapical area, bone is being produced rather than destroyed. This condition can be caused by a low-grade infection in the tooth’s pulp or in the periapical tissue surrounding the root. Sometimes, the tooth in question “looks fine,” for it is without caries or an abscess or any other visible defect. Condensing osteitis, typically, does not produce noticeable pain or swelling. Yet, the offending tooth over time does become increasingly symptomatic.
    The treatment for a symptomatic tooth that has a definitive condensing osteitis lesion is endodontic therapy or extraction. Typically, treatment is rendered only in symptomatic cases that exceed the tolerance level of the patient. Unfortunately, patients who tolerate fleeting symptoms may feel frustrated because the treatment that will relieve the condition that led to their complaint is usually delayed. Condensing osteitis is a challenge for the practitioner to diagnose and treat as well as for the patient who complains, “Why does my tooth hurt?”
April - June 2009

Condensing osteitis is a challenge for the practitioner to diagnose and treat.

Essential Dental Seminars

Remember to make sure to get a reliable, accurate, and repeatable reference point when taking your measurement control. Sometimes it may be necessary to flatten a cusp tip rather then use the cusp slope when measuring. You can use an indelible marker to make a small mark on a crown surface to give yourself further accuracy and repeatability during the visit. Also remember to re-measure as you instrument because canal straightening ultimately can shorten your measurement control by .5 mm to as much as 1 mm.

Doug Kase


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