AboutBenjamin Schwartz, D.D.S. Expertise I can answer a range of questions in dentistry, ranging from cosmetic dentistry, fillings, root canals, and comprehensive treatment. Specifically, my fields of interest are in CEREC technology, Invisalign (Invisable braces), and Endodontics (root canals).
Experience
Licensed and full time general dentist. Treated over 200 Invisalign patients and have placed numerous CEREC restorations.
Website and Office Information: ProDent NY
Organizations
American Dental Association
Member of the Academy of General Dentistry
New York State Dental Association
CEREC Doctors
League of Dentists
Publications Schwartz Benjamin, Boczko Fae, McKeon S. Oral Care For The Elderly. Perspectives in Gerontology December 2006
Education/Credentials New York University College of Dentistry - D.D.S.
Woodhull Medical Center, 1 year post-graduate residency program - GPR
I received a root canal last summer of 07 in my hometown, but wasn't able to afford the crown. My plan was to save up money while in college and then pay for the crown the following summer. However, soon after going back up to college (which is in a different state from where I recieved the root canal) I went to a local dentist and he took some x-rays of my tooth. He detected some decay and told me that the root canal was getting infected again. This would have been only 4 months after I recieved the procedure. Now its almost been a year and I've yet to have the time to go back home. I've made an appointment to go see the dentist who performed the procedure and I will be finally going be home in a week or so.
My Question is, is it normal for a tooth without a crown to get infected only after 4 months of a root canal procedure? I was told that I could wait 6 months to a year to get the crown done, so I didn't think that it any problems would occur before then. Now I feel like I just wasted thousands of dollars, and might have to deal with the price of a retreatment + crown, which would be nearly impossible at this point. What should I do? I also recently signed up for dental insurance, but I can't get covered for any big procedures until a year later. Is it safe to wait a year to do the retreatment? Right now the tooth is bringing me absolutely no pain and I am not feeling any odd sensations in that area.
Any help would be great.
Thank you,
Jen
ANSWER: Hi Jen,
To answer your question; yes, a tooth can get re-infected after a root canal, even if it's only within 4 months.
Allow me to elaborate..
A root canal is usually performed to clean out any and all infection inside the tooth. Once the inside of the tooth is made as sterile as possible, a filling material is placed inside the tooth, to give it a 3-dimensional fill, to seal it off, so that no bacteria can get back inside.
However, it is also equally crucial that the top part of the tooth be sealed off. If either of these areas, be it the root of the tooth, or the top of the tooth be exposed, then new bacteria can get back inside and re-infect the tooth.
The reason you may not feel pain, is because there is no nerve in the tooth, so the tooth doesn't feel anything. However, it can be that down the road, when the bacteria travel out of the root into the surrounding bone, then you will start feeling intense pain.
Some doctors like to retreat any root canaled teeth that have been open for a while, before starting definitive treatment. The reason for this, is that they don't want to make you an expensive crown, only to have to drill through it and redo the root canal in a year, thus destroying your nice new crown.
Let me ask you, the temporary filling the doctor put in the tooth last year, did it fall out? Or, is it still solidly in place?
If it fell out, and the tooth has been exposed to everything that goes on inside your mouth, then you most likely will want to have it re-treated.
However, if the restoration is still intact, and on the xray there is no noticeable lesion, here is what I would suggest;
I would have the doctor prepare the tooth for a crown, and make a GOOD fitting temporary crown. Wear this temporary crown for about 6 months. At that time, if there is no pain, and no radiographic appearance of infection, then I would go ahead with the permanent crown. If, however, there is pain or infection, I would opt to retreat it.
Please let me know if you need any more help.
---------- FOLLOW-UP ----------
QUESTION: Hello,
Thank you for the information. To answer your question, the temporary filling has never fell out, and the x-ray that was taken 4 months after the procedure showed a dark shaded area in the gum underneath the tooth that received the root canal. In which the dentist at school (who didn't specialize in root canal therapy) had stated that it was most likely decay.
Can you elaborate on what you mean by a "noticeable lesion"? Also, when you state that I should try wearing a temporary crown for 6 months, does it mean that the tooth may heal by itself?
Also, I don't know if you are able to answer this. But is it common for dentists to offer some sort of financial help in this situation? The dentist that took a look at the tooth near my school said that since the root canal was performed not even a year ago, I should try and see if the dentist that performed the therapy could help me financially instead of charging me the full price of a re treatment + a crown. I guess I'm just wondering if it would be unreasonable for me to ask for a "discount" or some sort of financial help for this situation.
When decay (ie; bacteria) get into your tooth, they usually travel down the pulp along the root. Once there, they then spread into your bone around the tooth. If left untreated, it can form an abscess, which is an infection that spreads from your bone into your gums.
The dark area in the gum on the xray is most likely the infection in the bone. After a root canal is completed, it can take up to 1 year in many instances for this to heal up and appear normal again (if at all).
A noticeable lesion, refers to the dark area around the root of the tooth. If it is smaller, or the same size as before the root canal, then I would go for the temporary crown. If it is larger, then it most likely would mean the infection has spread.
>Also, when you state that I should try wearing a temporary crown >for 6 months, does it mean that the tooth may heal by itself?
Kinda. Since the filling is intact, the dark area around the root may be healing. However, it can take a while for this to appear on an xray (since it takes a long time for bone to form).
So, by wearing a temporary crown, in case the tooth does need a re-treatment, you won't need to destroy a new expensive crown. You can take off the temporary, and redo the root canal.
Or, if at 6 months, the dark area is smaller, and there is no pain, then you can go ahead with the permanent crown, and hopefully not have to worry about needing the root canal re-treated.
I hope this made sense to you.
Please let me know if you'd like me to elaborate more in this.
Benjamin
---------- FOLLOW-UP ----------
QUESTION: Hello Dr. Schwartz,
So you are stating that the dark area in the x-ray might be a healing infection from the decay before I recieved the root canal? So then, there is a possibility that it might not be a new infection? If so, that puts me a little more at ease.
But is it still normal for the gums to bleed in that area if there is no new infection when I floss?? This doesn't happen anymore, but 4-6 months after I recieved the procedure, I would bleed in the gums whenever I flossed in that general area.
Also, could there also be a possibility that the dentist who performed the procedure missed a root? or didn't clean the root thoroughly?
Thank you once again for taking the time to answer my questions. I've been anxious to get home and have been desperate to get some opinions and answers in the meantime. You've been a great help!
Jenica
Answer Hi Jenica,
Yes, the dark area might be healing, as opposed to a new infection. I can't say this for certain, but there is a possibility of that.
The gums bleeding can be due to a host of factors. It can be due to a large temporary filling, inflammation from the procedure, etc. However, since they are not bleeding now, that is definitely a good sign.
And yes, there is always the possibility that a canal wasn't cleaned out thoroughly during the procedure.
Again, make sure to discuss all options with your dentist. No need to rush into anything if you don't feel comfortable with it. Your dentist is just looking out for what's best for you.
