Though it seems strange, a toothache can be caused by arthritis. This was what happened to one of my patients this past year. It all started when John began to experience acute pain in an upper right molar. His dentist could not find a reason for the pain, since upon evaluation there was no decay or other problem apparent. So John was sent home with instructions to use Advil or Tylenol and hope for the best.
But John’s tooth pain persisted. He returned to his dentist’s office where more x-rays were taken and a root canal procedure was scheduled, albeit reluctantly. But even after the root canal, John’s tooth still ached and at times a neighboring tooth seemed to hurt, as well. John’s complaints ultimately led to the extraction of the offending right molar.
Then John started to experience pain in the extraction site and the teeth surrounding it. To make matters even worse, the same scenario began to unfold on his left side. And still, his dental team (comprised now of a number of specialists) found nothing on x-rays or during examination to explain it.
John’s suffering grew to the degree that the quality of his life was completely compromised. In desperation, he agreed to yet another root canal and subsequent tooth extraction. No change.
By this time there was no doubt that the source of John’s wicked tooth pain had to be of non-tooth origin. His persistence in seeking care and his unwavering belief that “there must be something wrong with my tooth” led him finally to me.
We found the answer to John’s suffering and was buried in his medical history. About one year before his tooth problems began, he had sought care for multiple joint pain throughout his body. The diagnosis was a (systemic) inflammatory condition called Spondyloarthropathy, which causes pain similar to what is associated with arthritis. A rheumatologist prescribed a few months on Enbrel, a medication used to treat inflammatory autoimmune conditions, and John’s body pain symptoms went into remission.
Let’s discuss arthritis for a brief moment: Arthritis essentially means “inflammation within a joint.” This same type of inflammation can occur in tendons and ligaments, the attachment sites in muscles and joints that keep us moving and functioning. Ligaments are also what attach your teeth to their bony sockets. They are called periodontal ligaments. Therefore, unexplained tooth pain can be due to an irritable periodontal ligament.
John’s medical history was the key to finally figuring out why he experienced acute tooth (and tooth site) pain that did not respond to conventional dental treatment. His tooth pain was the result of irritated periodontal ligaments. It took only three weeks back on Enbrel for John’s tooth site pain to go away. If his arthritis condition flares-up again, his tooth pain may reemerge. But, for now John is pain-free and able to enjoy his life again.
Here’s the moral of the story: As a patient you must share your medical history with any doctor who is having difficulty with a diagnosis. And as medical professionals, we must remember to ask all the right questions, request records and collaborate with other doctors on behalf of our patients.
Pain is real and no stone should be left unturned to find the source.