Update: 5 years after not (very serious) car accident

I don't know. I only started learning about dentistry a couple weeks ago, and I don't have the full picture. I'd like to believe all you'd need is some orthodontic adjustment and it'd be fixed. But do you know exactly why that feeling exists? I don't. Whether it'd actually work or not depends on exactly what causes it.

Why do you feel those teeth? Is it merely the positioning? I don't know, but the microanatomy is very complex. The teeth aren't merely in gums and bone. There's all these layers of different kinds of tissues, like a forest, with trees, and vines, where it's all alive.

If you get some trees knocked down, then prop them up, the roots can keep growing, and the tree can be back in place, but you know it changed things beneath the surface. It tore some thinner roots, it changed the compactness of dirt in different areas, and it's not exactly the same by just propping it back up.

There's all these nerve fibers, and vasculature, and connective fibers, and tubules, and the bone itself moves, bends, shifts. It's all something that grows into place, in a deeply integrated way, and when it's disrupted, what was affected? Did some nerves get damaged, and change the electrical signals to the brain, so you've got a mismatch of sensory information? Maybe you're feeling the missing signals from some of the nerve fibers. Maybe some of the tissues got twisted and smashed into an awkward position when pushed back, and everything had to adapt and grow around it where the nerves are fine but it's got some pressures in odd places.

I don't know. It seems like there's so many possibilities, and people who spent decades researching this stuff would have better guesses, but we don't live in a society where we get people to dedicate tons of time investigating our particular case. Most dentists don't really understand much about the microanatomy, because they spend most of their time working with the objects they can touch and feel with their hands and instruments. What if your problem is so subtle and invisible, where it's not even easily understood? Who will take the time to try to explore the subtle sensations, with gentle probing, and really talking to you in depth, to get a better idea of what's going on? They've got an hour or so scheduled, and then it's on to the next patient. Often they only really look for minutes.

So it'd be nice if you could simply get some braces or something and help push it into place where it all resolves itself. But if it's injured nerves, that won't work. If some tissues were torn and couldn't heal perfectly, that won't change much probably. That's why I feel like we might be talking about something so subtle that no doctors can really help. We don't really have that kind of technology, with nanorobots or something to go deep into the body and see the tiny things that are wrong, and try to fix them at that level. Dentists don't usually even use a microscope, they just work with what they can see.

Then there's the risk that if it's not known exactly what the problem is, that anything done could potentially make it worse. I just don't see dentists who are like teeth whisperers who are getting down to the root of these kinds of problems and gently finding ways to promote healing. They just seem to do crude stuff, like cut some gums, plaster on some gunk, or tie wires to push and pull everything into place. That's so rough, and if it were simply that the teeth are out of place, then maybe that'd work.

But I'm not sure, because the bone adapts anyways, and even if they were out of place, the natural pressures should have helped them find a balance, as bone naturally absorbs and is regrown, and the tissues around it can heal and reform attachments. It sounded like you're not wearing a retainer anymore, so they should've been free to find a more balanced place on their own. I have doubts that anymore orthodontic kind of work would really address the underlying problem. I'm sure it'd make them look superficially more straight and aligned, but what good is that if it still feels wrong?

I don't understand it all, but I'd lean more toward something with the nerves. In between the tooth and the bony socket is the periodontal ligament. There's nerves in the periodontal ligament that register pressure. It's like a cushion, and when we bite down, the tooth kind of floats in this fluid suspension, but it's all these tissues, and there's nerves in there too. So if those nerves were misfiring for some reason, they might give sensations of pressure that weren't right. The other teeth would be in a normal state, so you don't register any sensation, but if those are affected in some other way, then it could register differently.

But why? Is there damage? Why didn't it heal by now? Is there permanent nerve damage? Or is there something else that's really applying pressure in a different way? I don't know. I don't understand it all, and I don't know everything you feel. I doubt many doctors who did understand it would take the time to listen.

So your best bet might be to try reading in a college textbook about the microanatomy of teeth, and look at pictures and diagrams to understand as much as you can, and feel around yourself to get more information and maybe you can guess better what's going on deep in there. Maybe then you'll know if you think braces could help, or some other idea you have. But I'd want to understand the underlying cause better before investing too much to try for a cure.

One of the books I was reading recently is "Pathways of the pulp". It's for endodontists, and so it has some info about what goes on inside the tooth, and around it. Here's one quote about nerves:

Once a nerve has been sensitized via injury or disease it may remain so and present as a peripherally sensitized nerve. This peripheral sensitization and the ongoing pain (nociceptive barrage) that accompanies it can induce changes in the central nervous system. Peripheral sensitization and central sensitiza- tion can potentially impact the clinical presentation of a neuropathy. A typical clinical course of someone with an undiagnosed neuropathy might consist of treatment for a toothache. When the pain does not resolve with nonsurgical root canal treatment, it might then be followed by apical surgery and then perhaps an extraction. The extraction site might then be explored and debrided in a misguided attempt to remove any potential source of the patient’s ongoing pain. After each treatment, there tends to be a reduction of the pain for a short time and then a return to its original, or even increased, level of pain intensity. It is likely that this is a result of a new neural injury consisting of reorganization and resprouting that increases the inhibition of nerve firing for a time. Surgical approaches to neuropathies are not effective because they do not desensitize the nerve. On the contrary, surgical intervention may aggravate the situation by inflicting an additional neural injury in the periphery and contributing to the already present nociceptive input. This intervention therefore puts the patient at increased risk of developing persistent pain, which is supported by a couple of long-term observational studies and further supported by the observa- tion that patients with pain following root canal therapy did not uniformly experience elimination of this pain with apico- ectomy surgery.

This stuff is more complicated than just the physical stuff we can see. Some people can get a tooth extracted, and still have pain where the tooth was. It's because it's all connected to the brain, and the nerves interact with our sense of the world, but they can get mismatched in strange ways, with phantom tooth pain. So for all I know, everything is fine physically with your teeth, but somehow some nerves got repositioned, which subtly changed the way they are stimulated, and that changes the signals to the brain, and there's some mismatch where it's perceived as some discomfort, but really it's some kind of phantom experience.

I don't know. All I know, is life and people are really complicated. So I hope you figure it out, but if you can't, you might have to learn to adapt. We have to face so many mysterious puzzles like this, and we can't always understand or find the best solutions. That's why we also need to try to live the best we can, without always expecting too much. Sometimes there's simply nobody who can help us, and no answers advanced enough to fully solve our intricate needs. But we're flexible creatures, and we can get through so much. So I think you'll find peace with this, one way or another, eventually.

/r/Dentistry Thread Parent