Interesting Case: Severe Tooth Pain from Biting on a Nail

 

Recently one of my patients, a 40 year old female, was eating at a restaurant and bit down on a nail that was in her food!   The result was severe tooth pain.

The tooth in question was an upper second molar. Complicating the matter was a wisdom tooth behind this tooth that had  “supra-erupted significantly (this means that the wisdom tooth, instead of just erupting into a normal position in harmony with all of the other teeth for good chewing function, well, it has continued to erupt and is actually dropped down so it sticks out. This can happen when there is no tooth for the wisdom tooth to chew against.).”

When she came into my office the entire side of her face was hurting. I referred her to my endodontist for a possible root canal evaluation. His opinion was that she was experiencing severe muscle pain in the area. In fact, the pain abated somewhat in the next few days with the help of some pain medication.

The wisdom tooth had to be extracted next. This was necessary, especially if some treatment needed to be done for that second molar. That procedure went well.

Finally I was able to tell that she had a small fracture on the outside part of the tooth. When I had her bite down on some plastic, the sensation was consistent with a fracture. She had a large filling in that tooth, and by biting on the nail she actually fractured the outside part of the tooth. A crown preparation was performed, and all went according to plan thereafter.

When trauma takes place, it is sometime important to wait for the acute problems to subside and then determine what needs treatment. During this time, only palliative treatment is recommend, usually in the form of pain medication and possibly antibiotic coverage.