A young ,female adult patient experienced intense toothache from her upper or lower molar teeth. She spent her lunch break in tears before I could see her that day. The pain was unlocalised. It was not sore to percussion (tapping on it). Hot and cold sensation did not initiate the pain. The patient did report that she was a grinder and this may have intiated the pain.
The x-ray was inconclusive but I was suspicious of her first molar tooth which appears to have a radiolucency above her disto-buccal root apex.
The electric pulp tester (EPT) revealed that her upper second molar tooth had a decreased response when compared to her other teeth and had a slightly more exaggerated response to cold testing. It was therefore decided to root treat her upper second molar tooth.
It is often very difficult to locatetoothache or acute dental pain when the inflammation involved is still within the root canal system. Often patients are confused to the location due to the transference of pain to higher points along the nerve branches. This stimulus may then be carried along other branches of the nerve to the opposing arch and NEVER to the other side crossing the mid line. The dentist has to use his investigatory skill, common sense, clinical knowledge and expertise in order to identify the origin of the pain.
In this case, the diagnosis was confirmed when removing the composite filling in order to gain access to the pulp. There was heavy staining at the composite-dentine margin. It appeared that the composite filling was leaking and introducing infection to the pulp with concomitant inflammation and pain.