Fortunately for those of us who have experienced a lingering toothache, relief typically follows a visit to the dentist. Whether a filling, a crown (cap) or root canal therapy was necessary, pain reduction is common within 24-48 hours. But when a toothache won’t go away in spite of the fact that the tooth pulp is healthy based on examination and x- ray investigation, believe it or not, it may be due to a sprained ligament.
To understand how a toothache can be the result of a sprained ligament, a quick review off the anatomy of a tooth is essential:
Every tooth in the mouth is anchored to the bone in which it sits by a structure called the periodontal ligament or PDL. This ligament is no different than any other ligament in the body, and when healthy, is responsible for maintaining the tooth in a stable position. This ligament, which is mainly composed of water, also acts as a shock absorber. The PDL is teeming with nerve endings, which gives it a great capacity to guide our chewing movements and tell the brain how much force to exert based upon the consistency of food in the mouth.
In addition, the PDL is the “GPS system” of the oral cavity and is so fine-tuned in its functioning that it can find a small fish bone in the midst of a mouthful of food. This capability helps protect the teeth and the surrounding soft tissues from injury that could otherwise occur during normal function.
- Tooth pain is typically the first symptom of a PDL sprain. Common ways that sprains happen are:
- Biting on food that is harder than anticipated
- Impact from an expanding airbag
- Chin trauma that forced the teeth together
- An accidental collision with a baby’s head
- Dental or oral surgery
- Daytime overuse such as nail biting or pencil chewing
- Nighttime clenching or tooth grinding (bruxism)
Once sprained, these ligaments may take some time to heal simply because it is difficult, if not impossible, to avoid using the tooth or teeth involved during chewing, speaking, and even at times, swallowing. Over time if the PDL is continually insulted, the tiny nerve endings in the ligament will become sensitized (similar to being sunburned) and as a result pain levels will increase and often spread to the surrounding gum tissue and neighboring teeth. And, if daytime overuse behaviors continue and/or sleep bruxism persists, the pain will likely continue.
Because this problem is not in the tooth pulp, or due to compromise of hard tooth structure, any dental efforts to fix the problem will likely lead to even more exacerbation of the pain. Like all ligaments if a sprain occurs, rest and support are often needed in order for healing to occur.
The key therefore is to identify why the sprain occurred before treatment is planned. If due to a single and identifiable event, time is the best therapy as healing will usually occur. Taking an anti-inflammatory medication like Advil or Aleve for five to seven days can also help along with avoidance of chewing on the painful tooth. If you suspect that night clenching or grinding of the teeth is the cause, then the use of an oral appliance while sleeping may be the best remedy.
At times trauma to a tooth may cause ligament pain that lingers and becomes chronic due to nerve endings that begin to fire spontaneously even when provoked by normal daily activities like speaking, swallowing and eating even soft foods. These situations may require medications that work to quiet irritable nerve endings. The most important thing to remember is that these problems are not solved by root canal therapy and this direction of care should be avoided.
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Thank you so much! I have a gold crown and a couple months ago I was under a lot of stress and my jaw tightened up. I woke up with my teethe clenched. My tooth hurt terribly. Even taking a breath in hurt it. The tooth above the sore tooth also has a gold crown but I had a root canal in that tooth years ago so it was not painful from clenching. Anyhow, I don’t normally clench and have worked with a physical therapist and have jaw therapy I do before going to bed if I feel like my jaw is tight. I have clenched some here and there since the original injury and the tooth will have some pain but not near as bad as the first time. It still feels like the crown is too tight though. My dentist has talked about a root canal if it doesn’t get better. I don’t want another root canal. I’ve read they are terrible for your health. Again Thank you for the clear explanation. I take very good care of my teethe and had just had them checked and feel sure it is not infected. My dentist agrees and feels sure I “sprained” it.
You are quite welcome, Sue. I’m glad you’re getting good care and feeling better.
Dr. T.
I was currently diagnosed with “:=Bruised tooth syndrome” My dentist made an adjustment correct my bite. This was 10 days ago. Although the pain has subsided substantially, I still have some pain and still cannot chew medium type foods (not soft or hard) The ligment under this tooth is still swollen all the way down to my jaw. My question is, how loing will rhis take to heal on its own? My dentist said about a week but, it’s been 10 days.
Hi Toml
These problems are stubborn, and in my experience, can sometimes take upwards of a month to get better.
Good luck and feel better,
Dr. Tanenbaum
I had a RCT 3 weeks ago and since then it feels bruised and aching the whole time. Sore, painful and a deep severe ache. The endo has checked the X-rays and done a CBCT which are clear completely. Could ligament and tissue inflammation cause issues like this sort of pain to linger for weeks after a major RCT?
Thankyou
Dear Samuel, Yes, the ligament may well be irritated and it may take weeks to months to settle down. Best of luck, Dr. T.
A month ago I bit into some burnt French fries and a hamburger. I felt a pain in my lower front tooth. Number 24. I went to the dentist who first thought I needed a root canal, then after a CT Scan, said I could have a possible crack in the bone. After several weeks, I went to an endodontist for another opinion. He at first said I did need a root canal, but after further tests,said I have 60 percent life in the tooth, so should perhaps get another opinion. We agreed to wait a month to see what happens. The pain seemed to get better, but recently has been achy again. More so after eating. I don’t know what to do.
Discuss with your dentist: perhaps anti-inflammatory medications and if pain persists, a 1/2mm vacuform appliance worn during the day may help.
Good luck!
Dr. Tanenbaum
I have a crown on #8 (No RCT, vital pulp) and 3 weeks ago i hit it accidentally hit it pretty hard with a glass drinking glass. I did a cone beam scan and the tooth doesn’t had a root fracture or any physical damage to the crown or core. I have had lingering dull pain around the gum line that is irritated if I try to use the tooth. I guess “itchy” would be a good description. I am suspect of the PDL being the culprit, but i am getting somewhat discouraged after 3 weeks of lingering pain. What else could be going on here?
Remember, the PDL is teaming with sensory nerve endings so that along with inflammation, there could be some neuropathic sensitization that causes the lingering symptoms. I would ask your dentist about medications such as nortriptyline that could be helpful. Thanks for reading, Dr. T.
Hello,
My dull ache pain started in Dec 2021 on the upper right side tooth #2 or 3. I felt it was due because i have been eating solely on that side since April 2021 when tooth 14 & 15 on opposite side got root canals. Since those teeth got root canal they have always hurt me, fast forward to now (may 2022) both of those teeth have been extracted and im strictly eating on my right side. I have seen two endos and both said no RC is needed. The PDL has widened around both tooth 2 and 3, but 3 looks like theres widening in the furcation area. I have invested in a bite stabilizer or splint since march 2022 and it still bothers me! I have gotten my bite adjusted several times . help! what can i do? I have been eating soft foods for several months now. what are my options? how can i heal or fix this? I would say ive given it a solid 3 months to heal and no relief. would i need to extract the tooth? I have done CBCT scan and no infection or RC is needed. The only thing i can think of is possible hairline fracture, but not enough to hurt when biting or chewing and not enough to wake me up at night. please help. Im scared if i remove these two molars im really going to have issues since then all my upper molars would be missing. Thank you Jenn
This sounds as if it could be the ligaments in the extracted teeth and now the sensitive teeth are giving rise to your pain. Not an easy problem as you can see. There may be some medications that can help, but you would need to consult with someone with training in these difficult orofacial pain problems. Go to the American Academy of Orofacial Pain website to find a doctor in your area. Look for one who has the designation: Diplomate. Best of luck!