Hide and Seek
Dear Dr. Crapo: Three weeks ago I saw my family doctor for earache pain. He said I had an ear infection and put me on antibiotics. A week later I went back to the clinic because I wasn’t getting any relief. In addition I felt like I had a toothache in the lower jaw, on the same side. I told this to the doctor who was on call. He looked at my ear and said I didn’t have an infection, but rather an inflammation. After hearing about my tooth pain, he said I needed to have that checked out before getting any more medication for the inflamed ear. In seeing my dentist, he noted that I’d had a root canal, but the root canal looked just fine. He tested the tooth and several others in the area but could not find a tooth that would be responsible for the pain level I was having. Neither my dentist nor the replacement doctor want to do anything, because they just couldn’t find enough wrong to do anything. I’m a pretty sane woman of sixty, who hasn’t had many dental or medical problems, but living with this pain is insanity. Sometimes during the day it feels like an earache and other times it feels like a toothache. Just as one seems to subside, the other picks up – it’s driving me crazy!
Elusive pain is the medical and dental profession’s worst nightmare. There are times we feel handcuffed. Over the years I have wished I had x-ray vision and could examine, three dimensionally, these elusive symptoms. When looking for the offending tooth we use many tests to root out the offender but sometimes even after a dozen tests, the problematic tooth may not reveal itself. At this point it is wise to do nothing, even if discouraging for the suffering individual. In most cases time will reveal the problem, but that can range from several hours to several weeks.
In the past three months I’ve had two cases where pain was not discernible by standard methods. Fortunately, we installed a three dimensional x-ray unit two years ago. It can see things that previously lay hidden because of the size of infection (too small for normal x-rays), or because something was obscuring the normal x-ray from revealing the problem. This “new” technology, had existed in medicine for years in the form of a CAT scan. It has become available in the past five years to dentists, though is not available universally because of cost. In both instances we found the hidden infections and treated them because we could see the teeth from every angle. It’s a great relief to see and diagnose situations we never thought possible only a few years ago.