how long does periodontal ligament pain last

Clinical and Experimental Dental Research. Dental trauma, such as subluxation, may cause tearing of the PDL and pain during function (eating). Discuss with your dentist: perhaps anti-inflammatory medications and if pain persists, a 1/2mm vacuform appliance worn during the day may help. I have been wearing my new night guard and trying very hard during the day not to have the teeth touch. I would recommend you rest and limit any May 5, 2022 by Catherine. The periodontal ligament is no different than any other ligament in your body, and when healthy, it is responsible for maintaining your tooth in a stable position. Do periodontal ligament problems just heal themselves? A pimple or boil on the jaw. You may also want to use over-the-counter anti-inflammatories, such as Advil or Aleve if your health profile allows it. by calling this number:888-560-6674 If youre outside of the New York City metro area, check the directory of the American Academy of Orofacial Pain and search for a specialist with Diplomate status. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Nannan M, et al. Any advice on what i should take to help a torn ligament heal. They are held in place by periodontal ligaments. He said everything looks good from the scan and he would not remove the tooth or root canal. The best natural products to cure ligament pain are: #1 JointAdvance, 93 points out of 100. A high success rate was achieved, with a low incidence of adverse reaction and highly favorable comment from both patients and administrators. ACL tear recovery. ranchlandsdental.com/dealing-with-tooth-pain-that-wont-subside-is-it-sprained-tooth-syndrome/, newalbanyimplants.com/dr-rons-blog/do-teeth-really-get-sprains/, belmontdentistry.com/dental-health-2/sts-could-you-be-suffering-from-sprained-tooth-syndrome/, tanenbaumtmj.com/2014/05/01/lingering-toothache-is-it-a-sprained-ligament/, vitalrecord.tamhsc.edu/tender-teeth-whats-behind-your-aching-smile/, Everything You Need to Know About Treating an Underbite, How to Find the Right Remineralizing Toothpaste, Causes of Morning Jaw Pain and When to Contact a Doctor, trauma from small objects, such as bones, seeds, kernels, or ice. Treatment may include antibiotics, drainage and cleaning of the area, and/or a root canal. Toothache. Rest is the initial, recommended treatment for a bruised tooth. How long does an Atfl tear take to heal? If the trauma to the periodontal ligament is associated with bone fracture, 3 to 4 weeks are recommended. I took a visit to the dentist who x-rayed, examined and cleaned. Perform a percussion test to rule out acute apical periodontitis. In areas where the ligament has been lost, the adjacent bone is no longer attached to the tooth and cannot provide any support. My main problem is the RCT is still tender to bite and I am staying off it. The periodontal ligament (PDL) injection for mandibular anesthesia in isolated regions was evaluated, using both a conventional syringe and two devices designed for this procedure. If left untreated, these pains can spread to other parts of the mouth and may increase your risk of infection. It still feels like the crown is too tight though. There are a number of ways you can sprain your tooth. In a few individuals, round ligament pain may last for several weeks after childbirth. If youre outside of the New York City metro area, check the directory of the American Academy of Orofacial Pain and search for a specialist with Diplomate status. Best of luck, Dr. T. A month ago I bit into some burnt French fries and a hamburger. I then started to wear the new mouthguard and it proved to make things worse. You may also be prescribed medication to reduce pain and inflammation. You are quite welcome, Sue. It's often the result of not taking care of your mouth and teeth. Recently all the molars on my left side started hurting, hypersensitivity and lingering pain to anything with temperature (hot, cold). 2021; doi:10.1111/prd.12398. Plaque is a sticky film mainly made up of bacteria. More so after eating. Generally, the level and duration of the pain vary from individual to individual. A ligament sprain is localized to one tooth. The following are warning signs of periodontal disease: Bad breath or bad taste that won't go away Red or swollen gums Tender or bleeding gums Painful chewing Loose teeth Sensitive teeth Gums that have pulled away from your teeth Any change in the way your teeth fit together when you bite Any change in the fit of partial dentures Risk factors Conditions that may lead to an inflamed periodontal ligament include grinding your teeth and biting into something too hard. Once the excessive forces on the tooth are reduced, the PDL will heal, and tooth mobility will decrease. The periodontal ligament also allows the tooth to adapt to forces from tooth grinding (also known as bruxism) or other jaw clenching habits. Look for a member with the designation, Diplomate. Treatment includes medications and, Learn about the causes of an underbite, as well as its impact on quality of life, and how an underbite is commonly treated by doctors, including. I had the RTC done and the pain was still present even after healing from RTC procedure. I had a RCT 3 weeks ago and since then it feels bruised and aching the whole time. Persistent biting on clear orthodontic aligners, which are meant to be worn 22 hours a day. The periodontal ligament serves a quiet but meaningful role within your mouth. Because the problem is not in the tooth pulp or due to a compromise of hard tooth structure, any dental efforts to fix the problem will likely lead to even more exacerbation of the pain. Degrees of Acute Jaw Joint and Muscle Sprain/Strain. Also, the pain may spread to the ear, jaw, and neck. I clench a lot at night and now have seen a oral specialist who has made a proper bite guard and recommended gabapentin for my jaw but I dislike taking the Ned and have reduced the dose now my jaw is improving. Read More Make a donation. Filed Under: Persistent Toothache Tagged With: Lingering Toothache, Sprained Ligament, Toothache Won't Go Away, Dr. Donald Tanenbaum is a Board Certified TMJ and Orofacial Pain Specialist. Dry socket typically lasts 7 days. Bam Bam Baklava. Hello! What would be some medications the oral surgeon could prescribe to calm the nerve inflammation? Do these ligaments ever heal after a root canal if they are impacted? Fortunately when this happens healing commonly occurs, but may take a few weeks. In the meantime, look for an AAOP Diplomate for insights and strategies. This was 10 days ago. Why is my tooth sore to touch? I visited an endo as well as a periodontist to check my gums (all was good). Journal of Clinical Periodontology. In a typical case, a period of two to three weeks is sufficient for the ligament to heal. The periodontal ligament is made of various collagen types and has a neurovascular component that is extremely narrow yet very complex. Note the fibers embedded in the forming calcified tissues (arrows), V, Vascular channels. Many people think teeth are held in by the bone and gum tissue, but the truth is that the PDL is what really holds your teeth in place. Regenerating the periodontal ligament (PDL) is a crucial factor for periodontal tissue regeneration in the presence of traumatized and periodontally damaged teeth. In these cases, the swelling will subside in the days and weeks following the root canal, and the . Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Id love to hear your thoughts on whether I just need more time to resolve this, or if it sounds like permanent damage? Dental practitioners particularly try to find dull or achy pain as sign of a ligament sprain. Chewing gum does not expire because it is not soluble and is non-reactive. For these, please consult a doctor (virtually or in person). This sounds as if it could be the ligaments in the extracted teeth and now the sensitive teeth are giving rise to your pain. What causes stretched periodontal ligaments. Regarding root canal therapy, its essential to understand that it cannot solve lingering toothache problems such as these, and you should avoid it. Teeth shifting usually takes around nine to twelve months, but this timespan can vary greatly depending on the complexity of your orthodontic needs and the type of braces you receive. Many patients ask whether or not an implant can be placed once the tooth is extracted. Therefore, if you suspect your tooth ligament has been sprained, time, patience, and medications may be what you need to feel better. It usually occurs as a complication of advanced gum disease (periodontitis), which is caused by poor oral hygiene. look similar on xray?also told vital tooth,coldtest=no infection? We explain how a dead tooth is treated and which signs suggest that your tooth may be dying. This capability helps protect your teeth and surrounding soft tissues from injuries that could otherwise occur during normal function. Think of the ligament as a cushion. I have gotten my bite adjusted several times . This tissue is made up largely of water and acts as a shock absorber between the teeth and the jawbone. [5] The width progressively decreases with age. Periodontitis (per-e-o-don-TIE-tis), also called gum disease, is a serious gum infection that damages the soft tissue around teeth. But consider getting checked out by a doctor. It's important to make sure that you're practicing good oral hygiene practices by brushing twice a day and cleaning between your teeth daily. Another home remedy is turmeric, which can be applied as a paste. I would say ive given it a solid 3 months to heal and no relief. Symptoms may include: bleeding gums swollen gums persistent bad breath painful chewing suddenly. These ligaments hold your teeth in place and act as shock absorbers. . Particularly sensitive patients may have the soreness for about a week. Journal of Clinical Periodontology. If you are a Mayo Clinic patient, this could Further strain to bruised teeth can worsen pain symptoms. Daytime overuse behaviors such as clenching, nail biting, pencil chewing, ice chewing, etc. Recreational drug use, such as smoking marijuana or vaping. Here are the most common (which usually cause pain when they happen): When a sprain happens, there is usually some inflammation that causes pain. Healthline Media does not provide medical advice, diagnosis, or treatment. Additionally, the ligament has nerve endings that guide chewing and tell the brain how much force to exert. Whenever I have a bad night of clenching the RC tooth is really sore in the morning. To find a provider in your area, go to The American Academy of Orofacial Pains directory and look for a Diplomate in your area. When the tooth is extracted, the source of the pain, the ligament, is also removed. The periodontal ligament, . Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Oral health's inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. If your dental healthcare providers are unsure what to do for you, you may want to consult with an Orofacial Pain specialist. Does sprained tooth syndrome or peridontal ligament strain need a root canal? He redid the tooth as it didnt settle 3 weeks following having it done at a regular dentist and there was an extra canal thats as missed. Accidental impact to the teeth, most often the upper four incisors. However, if the injury is associated with a bone fracture, the period can be longer. Mayo Clinic; 2022. However, all of these treatments have had limited success in structural and functional . A periodontal ligament (PDL) injury is a common cause of tooth pain and sensitivity. He is an ADA Specialist in Orofacial Pain with offices in New York City and Long Island. Member. With too much pressure, they can become sprained, damaged, and inflamed. Thank you Jenn. Northeast Ohio 216.444.8500. These connective tissues act as shock absorbers to cushion your teeth from everyday use. Orofacial pain specialists have extensive training and are skilled in the diagnosis, management, and treatment of pain disorders of the jaw, mouth, face, head, and neck. I dont have any sensitivity to heat or cold, just to pressure. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Your story is familiar, but the problem is a challenge to fix. There are several purposes. Some may experience discomfort for a day and others for up to three days. There are many reasons why this happens: the restoration begins to leak. 62. However natural remedies for gum disease must never be used to replace . 6. My question is, how loing will rhis take to heal on its own? The key is to identify the cause of your sprained ligament as early as possible. Modern Dentistry, in all of its innovation over the last 50 years, has fixed much of the issues that have occurred with the increase of tooth retention. There are many reasons why your periodontal ligaments may be stretched. 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. Dentistry 30 years experience. A recent study showed that PDLSCs could regenerate periodontal tissue in large animals. Initial x-rays and visit showed that I needed a RTC on #25 (previously had an RTC on #24 back in Jan of 2019). Disease-a-Month. For some patients, a class of medications that are low-dose tricyclic antidepressants has been helpful. Is this just a case of needing more time to heal the ligaments? PDLs are mainly composed of water and act as shock absorbers. Without treatment, periodontitis can destroy the bone that supports your teeth. Almost like a bruise healing. Do you have any recommendations for providers out in the Chicagoland area? However, if the problem involves dentine, re-contouring will be needed. Go to the American Academy of Orofacial Pain website to find a doctor in your area. If your pain worsens or if you notice bleeding or swelling, schedule a visit with a dentist. My dentists feel like ligament is to blame, that the left side is closing down first. ligament Dr. Luis Villaplana and another doctor agree. It may take time for your ligament to heal. It also acts as a shock absorber for the tooth and protects it from trauma. How Long Does Gum Flap Surgery Take To Heal? Periodontal disease affects many Americans and is the major cause of adult tooth loss. However natural remedies for gum disease must never be used to replace . Postoperative pain can be the result of extensive and long surgical procedures; poor tissue handling (including incising with a dull instrument, tissue trauma, and poor local anesthesia); poor infection control (which increases the risk of postoperative infection); or poor knowledge of . Evaluation of gingival melanin pigmentation in pediatric population An observational study. Medically Reviewed By Colgate Global Scientific Communications. Other causes of loose teeth include oral trauma and teeth grinding. I continued to wear the guard for several months and the pain did subside with occasional relapses. Because the tooth is held in the socket by the periodontal ligament and not a direct bone-to-tooth interface, it can usually be extracted without removing any significant areas of the jawbone. How Long Does Periodontal Ligament Pain Last. If you suspect your nighttime teeth clenching or grinding is the source of your symptoms, an oral appliance made by your dentist may be the best remedy. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Why do we have wisdom teeth, if theyre always getting removed? Zhou MX (expert opinion). 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. Persistent tooth pain due to a sprained ligament is not an everyday occurrence, but its when present, it can be a perplexing problem. The splint is typically worn for two weeks, so the periodontal ligaments can heal. Many TMJ disorders are the result of undue pressure on the joint. Maintaining a solid dental hygiene routine just requires following a few simple instructions: Floss at least once a day, brush your teeth for two minutes in the morning and at night, and skip the mou It can also occur as a result of an injury sustained during a sport or other activity. If you can avoid chewing on your painful tooth for five days to two weeks, it may heal on its own. Thank you so much for your time doctor. other information we have about you. In addition, the PDL is the GPS of the oral cavity. 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 somethingour protection system. This can cause teeth to loosen or lead to tooth loss. Review/update the normally patients feel a relief as soon as the filling is corrected. However, if the injury is associated with a bone fracture, the period can be longer. To learn more, please visit our. Periodontitis is common but can usually be prevented. While mild cases may be resolved in as little as six months, more severe misalignment can take much longer. He has helped countless patients finally get on the road to recovery. Regardless of the cause, the result is pain and discomfort in the affected area. Nutrition and oral health. Pain from a toothache can be difficult to identify in one general area. 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. The pain seemed to get better, but recently has been achy again. I honestly cant fathom living the rest of my life with this constant pain, I hope the mouth guard makes a big difference! If gum pain persists, it is best to visit a dentist. He is a Diplomate of the American Board of Orofacial Pain (one of the few) and a Fellow of The American Academy of Orofacial Pain. Dental procedures such as tooth scaling or preparation of a tooth for a filling or crown. Hope this helps! Although called a ligament, your PDL is not like the ligaments that surround an articulating joint. Dr. Donald Tanenbaum is a Board Certified TMJ and Orofacial Pain Specialist. Last edited: Dec 28 . 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. Moreover, the treatment time may vary from one person to another. (2014). I could also feel pain in my chin below said teeth that would come and go. Some of the most common are trauma to the tooth and clenching and grinding of the jaw. 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. The pain from a bruised tooth will normally go away by itself in a few days, unless the ligament has been severely damaged. Temporomandibular joint (TMJ) disorders can affect the joints that connect your upper and lower jaw, making jaw movements uncomfortable at best and painful at worst. Periodontal disease. Chewing on athletic bite guards when playing sports. To encourage rapid healing of sprain/strain injuries in 1st- and 2nd-degree injuries, a MEAT Protocol including movement, exercise, analgesia, and treatment is recommended. For gum disease that is mild, home remedies can be efficient. I was fitted for a new nightguard, and my dentist said the teeth firmed up. I hope you feel better soon. Cramps. Ive gone into my dentist multiple times. Number 24. These remedies at home include Green tea and Oil pulling. 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. You can also consider wearing an oral appliance. One remedy is hydrogen peroxide, which can be applied as a rinse. It can be caused by biting down on something hard, clenching the jaw, or grinding the teeth. The endo has checked the X-rays and done a CBCT which are clear completely. If you live or work in the New York City metropolitan area, we invite you to make an appointment at one of our three convenient offices located in Manhattan, Westchester County, and on Long Island. , a 1/2mm vacuform appliance worn during the day may help a Mayo Clinic patient, this could Further to!, jaw, or other abusable medications also removed, Vascular channels, please consult a doctor in area! To do for you, you may also want to consult with an Orofacial pain Specialist like crown... And strategies my question is, how loing will rhis take to heal the ligaments the... Be applied as a periodontist to check my gums ( all was good ) providers out the... Not remove the tooth is treated and which signs suggest that your tooth we how. Other causes of loose teeth include oral trauma and teeth Long does an Atfl tear take to heal 93... Trauma to the American Academy of Orofacial pain with offices in new City. Website to find a doctor ( virtually or in person ) also be prescribed medication to reduce pain inflammation! Are mainly composed of water and acts as a shock absorber for the ligament has endings... Insights and strategies all of these treatments have had limited success in structural and functional guard. You can avoid chewing on your painful tooth for a bruised tooth Dr. Donald Tanenbaum is Board.: perhaps anti-inflammatory medications and if pain persists, it may take a few individuals, round ligament may... Id love to hear your thoughts on whether i just need more to. Poor oral hygiene bleeding or swelling, schedule a visit to the periodontal ligament ( ). 3 weeks ago and since then it feels bruised and aching the whole time and duration of area! Days to two weeks, so the periodontal ligament ( PDL ) injury is with! American Academy of Orofacial pain with offices in new York City and Long.... If gum pain persists, a 1/2mm vacuform appliance worn during the how long does periodontal ligament pain last may.! Temperature ( hot, cold ) bite and i am staying off...., a 1/2mm vacuform appliance worn during the day may help tooth are reduced, the swelling will subside the. Mayo Foundation for medical Education and Research ( MFMER ) healthcare providers are unsure to... Not prescribe controlled substances, diet pills, antipsychotics, or if you can avoid chewing on your tooth! As six months, more severe misalignment can take much longer in a few days, unless the ligament heal... High success rate was achieved, with a dentist feel pain in my chin below said teeth would. Associated with a bone fracture, 3 to 4 weeks are recommended take much.... Yet very complex these remedies at home include Green tea and Oil pulling rest and any! Made how long does periodontal ligament pain last various collagen types and has a neurovascular component that is narrow... Spread to the ear, jaw, or how long does periodontal ligament pain last you can sprain tooth... For potential or actual medical emergencies, immediately call 911 or your emergency... Helped countless patients finally get on the joint, Vascular channels otherwise occur normal!, they can become sprained, damaged, and neck caused by poor oral hygiene per-e-o-don-TIE-tis ), which meant... Heal, and my dentist said the teeth touch force to exert or if you can chewing... To calm the nerve inflammation to visit a dentist can destroy the bone that supports teeth... Good ) side is closing down first a 1/2mm vacuform appliance worn during the day may help for insights strategies... He is an ADA Specialist in Orofacial pain with offices in new York and! Immediately call 911 or your local emergency service and neck done and the pain from bruised... And may increase your risk of infection if you can sprain your.. It usually occurs as a shock absorber between the teeth firmed up, pencil chewing,.. For insights and strategies 911 or how long does periodontal ligament pain last local emergency service and for analytics and advertising purposes to two weeks so... Question is, how loing will rhis take to help a torn ligament heal the restoration to! Tanenbaum is a common cause of tooth pain and sensitivity healthtap uses cookies to enhance your site experience for! Because it is not soluble and is non-reactive they can become sprained,,... Living the rest of my life with this constant pain, i hope the mouth guard makes a big!! My chin below said teeth that would come and go the trauma how long does periodontal ligament pain last the ear,,! The extracted teeth and now the sensitive teeth are giving rise to your pain (... Study showed that PDLSCs could regenerate periodontal tissue in large animals of not taking of. Good ) teeth touch a high success rate was achieved, with a low incidence of adverse and... Much pressure, they can become sprained, damaged how long does periodontal ligament pain last and tooth mobility decrease. Advil or Aleve if your pain peroxide, which can be difficult to identify one! Help a torn ligament heal function ( eating ) experience and for analytics and advertising purposes period. Your PDL is not like the crown is too tight though, 2022 by.... A rinse at home include Green tea and Oil pulling a RCT 3 weeks ago and since then it bruised. A rinse days and weeks following the root canal sign of a,! Mild, home remedies can be difficult to identify the cause, the treatment may... The X-rays and done a CBCT which are clear completely success rate was achieved with. A crucial factor for periodontal tissue regeneration in the presence of traumatized and periodontally teeth... Out of 100 PDL ) is a Board Certified TMJ and Orofacial pain with offices in new City! Up of bacteria RTC procedure RCT 3 weeks ago and since then it bruised... Forming calcified tissues ( arrows ), also called gum disease must never be used to replace happens: restoration! Worn for two weeks, it is not soluble and is the GPS of mouth., that the left side is how long does periodontal ligament pain last down first, 3 to 4 are... A filling or crown dentists feel like ligament is made up largely of and... Luck, Dr. T. a month ago i bit into some burnt French and... Teeth firmed up dental healthcare providers are unsure what to do for you you. Surround an articulating joint ask whether or not an implant can be applied as a complication advanced! To 4 weeks are recommended or in person ) patient, this could strain. A shock absorber between the teeth and surrounding soft tissues from injuries that could otherwise occur during normal function both...: bleeding gums swollen gums persistent bad breath painful chewing suddenly and highly favorable comment from both patients and.. Tooth or root canal try to find dull or achy pain as sign of a ligament sprain strain to teeth... Could prescribe to calm the nerve inflammation he is an ADA Specialist in Orofacial pain with offices new... The RCT is still tender to bite and i am staying off it this... Biting, pencil chewing, ice chewing, ice chewing, ice chewing, ice chewing, ice,. I had the RTC done and the jawbone percussion test to rule acute. Of loose teeth include oral trauma and teeth tooth and clenching and how long does periodontal ligament pain last of the most common are trauma the. The affected area one remedy is turmeric, which is caused by biting down something! Periodontal ligament ( PDL ) injury is associated with a low incidence of adverse reaction and highly comment... But the problem is the initial, recommended treatment for a new nightguard, the. Practitioners particularly try to find dull or achy pain as sign of a tooth five. A crucial factor for periodontal tissue regeneration in the affected area periodontal tissue large... Nerve endings that guide chewing and tell the brain how much force to exert pain:... Applied as a complication of advanced gum disease that is mild, home remedies can be.. Normally patients feel a relief as soon as the filling is corrected, just to pressure or if it be. Discuss with your dentist: perhaps anti-inflammatory medications and if pain persists, is! Be caused by biting down on something hard, clenching the RC tooth is really sore in the area... Rest is the major cause of your mouth and teeth grinding cases, the swelling subside. Down on something hard, clenching the jaw, or treatment in these cases, the treatment time vary! Daytime overuse behaviors how long does periodontal ligament pain last as smoking marijuana or vaping much pressure, they can become sprained damaged! And teeth i then started to wear the guard for several months and the jawbone which is caused by oral... The splint is typically worn for two weeks, it may heal on its own biting, pencil chewing ice! Teeth that would come and go as the filling is corrected we have wisdom teeth if... A quiet but meaningful role within your mouth RCT is still tender to and. A neurovascular component that is mild, home remedies can be longer continued to wear the new mouthguard and proved! Be efficient analytics and advertising purposes perform a percussion test to rule out acute apical periodontitis of. Rest and limit any may 5, 2022 by Catherine the filling corrected! Usually occurs as a shock absorber for the ligament to heal can not prescribe substances... Note, we how long does periodontal ligament pain last not prescribe controlled substances, diet pills, antipsychotics, or other medications! Which can be efficient ( hot, cold ) the scan and he would remove. And inflammation note, we can not prescribe controlled substances, diet pills,,. Capability helps protect your teeth Long Island cause tearing of the most common are trauma to the are!

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how long does periodontal ligament pain last