Pain that persists after a dental procedure, in a tooth or socket where the dentistry itself is sound and imaging shows nothing wrong.
What it feels like
A persistent, deep, burning or aching pain in a tooth, a socket or the gum around it, going on for months after an extraction, a root canal, an implant or a restoration. It is often constant rather than triggered, it is poorly localised — patients frequently cannot say precisely which tooth — and it does not behave like normal dental pain: no swelling, no response to hot or cold, no abscess.
Examination and radiographs are normal or show only expected post-treatment change. This is sometimes called persistent dentoalveolar pain, and it was previously known as atypical odontalgia or phantom tooth pain.
Why it happens
In most cases it is neuropathic: a branch of the trigeminal nerve has been injured or sensitised during the procedure, and continues to signal pain from a site where the tissue has healed. The nerve, not the tooth, is generating the pain.
More dentistry usually makes it worse
This is the most important thing on the page. Because the pain feels like it is coming from a tooth, the common path is another root canal, then an apicectomy, then extraction — and then the pain continues in an empty socket. Each procedure is a fresh injury to the same nerve. If two treatments aimed at a tooth have not resolved the pain and nothing abnormal is being found, that pattern itself is the diagnosis, and the next step is a nerve assessment rather than more dentistry.
What we do
A diagnostic trigeminal branch block under image guidance answers the question directly. If anesthetising the nerve supplying that area abolishes the pain, the pain is neuropathic and arising in that nerve — which both explains why dental treatment has not helped and points at what will.
A sphenopalatine ganglion block is an option for upper-jaw and midface distributions, and needs no injection into an already painful mouth.
Neuropathic pain also responds to medication classes that ordinary painkillers do not cover; standard analgesics and antibiotics typically do nothing here, which is usually already obvious by the time people arrive.