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You are here: Experts > Health/Fitness > Dentistry > Dentistry > root canal
Expert: Gary Backlund, DMD, MSD - 11/5/2009
Question
QUESTION: Hello,
I had a root canal 13 days ago on an anterior tooth (#8). Before having the procedure done, two different endodontists told me they thought #8 and an adjacent tooth (to my right of #8) might need a root canal. At any rate, I'm still having pain in #8. It is somewhat sensitive to touch -- even pressure from my tongue. Accidently knicked it with my knuckle last week and it throbbed for more than an hour. I can chew a little with it, but have been avoiding it. Taking ibuprofen -- 800 mg, 4x a day and vicodin when needed. It does not hurt all the time, but I'm constantly aware of it. On the other hand, it seems like most of the pain from the initial root canal has gone away. But, I can't say that my symptoms on #8 are better than before the root canal. Another endodontist looked at the post-RC x-ray and said the root canal was well done. My endodontist has mentioned 2 possibilities for persistent pain: microfracture (it was most likely a trauma to the mouth that occurred last month that precipitated the need for the root canal) or residual inflammation near the bone.
My questions: 1) should I wait another week (making 3 weeks) before getting an evaluation w/an oral surgeon;
2) can an oral surgeon non-invasively diagnose whether there might be residual inflammation or a microfracture;
3)what's the probability of a microfracture? Nothing has shown up on the x-ray and I know my endodontist performed the RC under a microscope;
4) is the procedure to remove residual inflammation likely to damage/fracture the tooth?
Thanks.
ANSWER: Hi Julie,
I'm sorry you're going through all this. You situation really doesn't have an easy answer. It's hard for me to diagnosis your situation since I can't exam you, but maybe I can at least try to explain a few things and, in the process, answer your questions.
I guess my first concern would be the fact that the root canal didn't really seem to improve your symptoms. That makes me suspicious of the tooth next to #8 and possibly referred pain. Microfractures are certainly a possibility anytime trauma is involved. They are also VERY hard to diagnosis and to see. If your endodontist used a microscope, I would think he/she could have seen fractures if they were apparent. I'm not sure seeing an oral surgeon will improve the chances of a correct diagnosis. Did they tell you how the oral surgeon would evaluate for microfractures? Most oral surgeons I know don't have the equipment or experience to make that call.
Since you are on antibiotics and have no signs of infection, I think we can rule that out. When they talk about residual inflammation, what they are really talking about is irritation. If that's the case, then perhaps a week of anti-inflammatory drugs might help. In my practice, we use naproyxn, Aleve, for this. I would suggest trying them, if you aren't allergic, to see if you get any relief. Take a weeks worth...it won't hurt and might help your situation.
As for a procedure to remove inflammation, did they tell what they proposed to do? Usually, anti-inflammatory drugs are indicted and in some case, surgery on the end of the root. That would not cause a fracture or damage the tooth. It would involve cleaning out the bone and cutting off a small piece of the root to inspect it and place a filling in the end to seal it. It's a fairly routine procedure and takes about 1 hour under local anesthetic in our office.
I know I really don't have answers for you. As I started out saying, you have a difficult problem. You just need to take one step at a time to prevent being over treated. Rule out the other tooth, try the naproxyn, make sure your bite is OK and not causing any irritation and move on from there.
I hope this helps some. Good luck!
Gary Backlund DMD, MSD
---------- FOLLOW-UP ----------
QUESTION: Hi Doctor,
Can a cat scan or MRI diagnose a microfracture? Also, my endodontist didn't seem to think a crown was necessary for my front tooth. Is an uncrowned anterior tooth more prone to fracture? Presuming (hoping) I recover from this root canal pain and there is no microfracture, should I always avoid biting into crusty bread or apples?
Answer
Hi again Julie,
Microfractures are VERY difficult to diagnosis. MRIs are being used in some places to help with diagnosis. However, they are not 100% either. If it finds a fracture, that would certainly help, but if no fracture is located, what does that mean? That you don't have one or it just couldn't be detected? Any if you do have one, then what?
As for a crown, since front teeth "incise" when they chew, as opposed to "crush" like back teeth, strength is not as big a factor so we don't usually suggest crowns. However, you are right, anytime a root canal is done, the tooth is weaker. In your case, it sort of depends on if you have fillings in the tooth and how big they are....it's a judgement call usually. In a tooth with no fillings and a small hole in the back to access the root canal, I would not suggest a crown. You should be able to function on the tooth normally.
Good luck!
Gary Backlund DMD, MSD
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