I need help.
Title: 22M/F - Spontaneous sharp pain in tooth #26, increased pericemental space on 3D CT, but clinic says it is just "anxiety". Need Endodontist second opinion.
Age: 22 years old
Affected tooth: Region of tooth 26 (FDI system) / #14 (Universal system) — Upper left first molar.
History of the problem:
I started feeling a very strong, sharp pain in the region right after flossing between teeth 25, 26, and 27. It felt like a mechanical trigger. Now, even without touching the tooth, I experience spontaneous sharp throbbing/pain at rest. A few days ago, the pain was so intense that ice was the only thing providing temporary relief.
What the clinic told me:
I was evaluated by general practitioners at a clinic. They performed tests, including a cold test. During the test, I reported an absence of normal cold sensitivity at first, but later felt relief when ice was applied. They looked at my tomography and told me that visually "there is nothing wrong," my gingiva has just receded slightly, and the pain is simply a reflex of anxiety.
Exact findings from my 3D Cone Beam Computed Tomography (CBCT) report (Morita X800):
- Tooth 26: Four root canals, increased apical pericemental space (widened periodontal ligament space) in the MV (mesiobuccal) and DV (distobuccal) roots, and apical rounding of the roots.
- Tooth 27: Four root canals, isthmus between MV1 and MV2 in the middle third, normal periapical region.
- Tooth 28: Developing, impacted on the distal of tooth 27, crown facing buccally, and root apices in close contact with the floor of the maxillary sinus.
My question for the dentists on the sub:
Isn't this increase in the apical pericemental space on tooth 26, combined with spontaneous pain and the mechanical flossing trigger, a classic indication of acute pericementitis secondary to irreversible pulpitis or pulpal necrosis (especially since ice relieves the pain, pointing to gaseous expansion in necrosis)? Or could it be occlusal trauma?
Is it biologically possible for a widened pericemental space to be caused solely by anxiety or mild gingival recession? Should I seek an Endodontist urgently for a second opinion?
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