AboutGary Backlund, DMD, MSD Expertise I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.
Experience 25 years practicing as a specialist
Organizations American Association of Endodonists, Past President Washington State Association of Endodontists.
Question QUESTION: In January 2008 I had a root canal on my left molar (2nd from the back). The Dentist informed me that after the treatment that a piece of one of the instruments had sharred off in the canal but I should have no problems from this at all. All was well until the I went back to the Dentist to have the temporary filling removed and replaced with a composite filling. I started having pain in the tooth. Went back to the Dentist on three seperate occasions and he informed be that the tooth was "off" and that he needed to adjust the tooth. He did so but I continued to have pain for months. I contacted his office and he informed me that there was nothing that he could do for me I need to see an Endodontist.
Went to see a well respected Endodontist and he took xrays put me on Menderol and told me that it appears that the bit if off and that there is inflammation. After a week on the medication and two weeks off the pain came back and was uncontrollable. I contacted his office again and went in and he did another set of xrays and stated that it appears that there is a branch off of one of the roots that did not get cleaned at the initial root canal. He recommended a apicoectomy. I had this completed the first of June and was put on Mederol and an Clindomycin for a week. After two weeks again the pain has returned. I contacted the Endodontist and he checked the tooth again. At this point I had facial swelling as well as pain in the tooth and a low grade fever. He conceeded to put me on Clinadamycin again. He stated that the root was near the sinus cavity and that when he did the apicoectomy that the infection had "eaten" away the bone below the sinus cavity and that infection was in this area again. That was why I was having the swelling. This was on a Monday. By Friday, 4 days of antibiotics, still no relief. I contacted his office and they put me on a another antibiotic to take with the Clindamycin. I went back the following Tuesday for a follow-up. The facial swelling had gone down but still was having an "aching" sensation in the tooth. Now I will say that when you apply heat to the face it helps. When you apply pressure to the area in which the apicoectomy was completed, it helps. The back inner right side of the tooth is still sensitive as well as the outher front side of the tooth, actually between the teeth. There is sensitivity between and is noticed when I am flossing.
I have gotten to the point that taking OTC medication does not help and I have a constant ache in that tooth with sensitivity to the front outer portion of the molar as well as the back inner side of the molar. Could it be that not only the root canal failed but the apicoectomy failed as well? Am I looking at possibly losing this tooth? What would you recommend at this point? Will it just take "time" for the tooth to heal. According to the Endodontist the bone is healing back very well.
I look forward to hearing your opinion.
Thanks
Liz
ANSWER: Hi Liz,
I'm sorry to hear all this is going on. Sounds like you have really been through it! First my disclaimer....since I can't examine you or know all the specifics of your situation, it is hard for me to give you specific advice about your problem. I can, however, give you some general advice.
Pain & swelling after an apicoectomy is not unusual. In most cases it only lasts for a few days and is not severe. In some cases there can be a pretty acute reaction that can last even 7-10 days. In your situation, things have gone way beyond what would be considered normal post-op problems. It is hard to know what exactly is causing all these problems. It could be the apico is failing too or there could be a crack in the tooth. In either event, your continued pain does not make the long term outlook good and you may need to have the tooth removed to finally get comfortable.
As for how long to wait, that's a very personal decision. After all you have been through and the amount of time that has passed, if you are not seeing daily improvement, then I'm not sure what to wait for. Sometimes you just need to do what's necessary to get better.....and in your case it probably means extraction. You won't really cause any problems by waiting but I'm not sure what you will gain either. I guess I would vote for extraction.
Sorry for the bad news. Write back if you need more information.
Gary Backlund DMD, MSD
---------- FOLLOW-UP ----------
QUESTION: Thanks Dr. Backlund. I will note that the Endodontist did state that there were no cracks in the tooth. He said that when he performed the apicoectomy when using the microscope he did not note any cracks in the tooth and that the overall conditiion of the tooth looked good. Could it be that the aching that I am feeling is from the "lack of bone" that was there below the sinus cavity as well as the procedure itself is creating.
The pain that I am feeling when I bite down on the back of the tooth is sharp. Could this be there is another canal that branched off the root at the back causing this pain that the Endodontist could not see when he performed the procedure or are all roots exposed? Or could this be from the bite being off still?
I appreciate your honesty and I have been feeling lately that extraction is a great possibility. I would rather save the tooth if at all possible. My question would be if extraction is the case, I would consider having a post put in but according to the Endodontist the root was in the sinus cavity, which from what I have read, this will could cause an array of problems when extracted and based on my past experiences it would probably happen to me. So with saying this, could a post be put in place, if so how?
Also could a retreat on the tooth either apico or root canal clear the problem since I am still having pain in the rear of the tooth? I know I have alot of questions but 8 months of this with no relief is enough to drive a sain person crazy.
Thanks again for your time
Liz
Answer Hi again Liz,
First, just because the endodontist didn't see a crack during the surgery doesn't mean there isn't one. he/she was only looking at the very end of the tooth. The crack could very well be in the upper 1/2 of the tooth...the part that sticks out of the gum and is just into the bone. These cracks can be very difficult to see. When you have sharp pain on biting, this is a classic symptom of a cracked tooth. You can test yourself....bite on the tip of a pencil eraser just on the tooth. Bite firmly and then release quickly. Try it in different areas of the tooth surface. If you have pain when you release...more than when you bite....you may have a cracked tooth. It is highly unlikely that your problem is due to the lack of bone because you have been having this problem for a long time. Another canal is always a possibility, but that should have been noted during the surgery, so I doubt that's an explanation either.
As for what to do now, I would not suggest any more treatment unless the endodontist would do the surgery over again at no fee and you want to go through it again. I think the chances for you to ever have a comfortable tooth are very low...sorry.... As for the post, I assume you're talking about an implant. The amount of good bone is critical for implant success. You would need to wait for healing to do an implant...they aren't placed at the time of extraction. Usually oral surgeons or periodontists do these. You might want to get a consult before you make your final decision. Even if you aren't a candidate for an implant, it would still be possible to do a bridge.....certainly a better option than living with pain.
