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Lingering Toothache – Is It A Sprained Ligament?

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: May 1, 2014

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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16 replies on “Lingering Toothache – Is It A Sprained Ligament?”

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.

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?

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.

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!

Hello! Have been searching for an article like this and see from above I’m not alone… which is nice. My story with this type of tooth pain starts back in April of 2020. The pain started as a dull, almost itchy/burning ache in my front lower teeth and gums. Mainly front (#25, 24 but also affects 27, 26, 23, 22 as well). I could also feel pain in my chin below said teeth that would come and go. Almost like a bruise healing. After the pain started to get worse, I went to my dentist. Initial x-rays and visit showed that I needed a RTC on #25 (previously had an RTC on #24 back in Jan of 2019). I had the RTC done and the pain was still present even after healing from RTC procedure. I went back to the endo for follow up and they suggested to re-do RTC on #24 from 2019 to make sure all was good. Had that procedure done…. still did not change.

After several more visits with the endo and then back to my dentist, they suggested to make a mouthguard that would buffer the contact in the front teeth as we talked about clenching/teeth grinding. This was also done as they removed a permanent retainer from when I had braces in my teen years. At this point, it’s October 2020. I continued to wear the guard for several months and the pain did subside with occasional relapses. In March of 2021, the pain returned and was once again chronic. I visited an endo as well as a periodontist to check my gums (all was good). The endo I visited did a full 360 x-ray to check for any hairline fractures that could be causing the pain but nothing was revealed.

At this point, I just continued to wear the guard at night and around June 0f 2021… the pain stopped with almost no relapses at all. It was as if it was fully healed. This lasted until about January 0f 2022 and it began to come back slowly and eventually back to original pain.

I went to a new dentist and they did a deep cleaning of my teeth and also did a scan to fit me for a new mouth guard that would only be on the top teeth as my original one was on both. After the deep cleaning, teeth felt better but still experienced pain. I then started to wear the new mouthguard and it proved to make things worse. Pain is now present in my back upper jaw as well when opening my mouth. I will be visiting my dentist for a follow up in a week here to discuss next steps, but will also visit the link you provided the last commenter above to find local members of the AAOP in my area. Apologies for the novel but figured I’d post here as the pain truly has been a terrible experience and would eventually like to get back to some normality.

Dear Martin, I’m sorry to read about your suffering. Without being able to examine you in person, I have to GUESS that what you’re experiencing is neuropathic pain because it emerges episodically and then lingers persistently in your tooth structures, such as the periodontal ligament or supporting bone. These are not easy problems to solve, as you have discovered. It MAY relate to the overall functioning of your neuroimmune system influenced by a wide array of factors, leading to lower pain thresholds and the experience of pain. Solutions MIGHT be found with medications. In some cases, this type of pain abates and/or disappears for no apparent reason. In the meantime, look for an AAOP Diplomate for insights and strategies. If you can’t find a provider close by, know that many orofacial pain specialists now see patients through telemedicine. So, don’t give up! Best of luck, Dr. T.

Hi there, thank you for writing this article. I am hoping that this is an answer for what I have been experiencing. I underwent a lot of teeth reconstruction about ten months ago, having many teeth worn away (genetics, bruxism, decay) and subsequently replaced with crowns and bridges. In the last 6 weeks, I have been experiencing dull pain around some of the front teeth and sensitivity in the gums, however most startlingly is these odd sensations I get when eating or drinking, it feels like a bubble or clicking feeling, sometimes more of a light shock, and of course startles and stops me in my tracks me every time – especially when speaking to someone it can be quite distracting and sends me into a panic because I worry a crown is starting to come out.

The timeline of this coincides with an accidental slap to the mouth from my niece, which I felt more so on one tooth specifically. I took a visit to the dentist who x-rayed, examined and cleaned. She said all was fine but the feeling still persists and sensitivity has gotten worse (perhaps due to the cleaning?).

I would really appreciate your thoughts on this – hoping it has a simple explanation, particularly around the sensations mentioned. Thank you so much in advance.

Dear Laura, The odd sensations are transmitted from the tooth to your brain where interpretation and reaction occur, making you worry. The transmitting tissue might be the ligament that binds the tooth to the bone and is like a GPS system, guiding the brain and muscle on how hard to bite on food or avoid something…our protection system. If this is the case, it may take months for this to clear up. For some patients, a class of medications that are low-dose tricyclic antidepressants has been helpful. Best of luck, Dr. T.

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