About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Dentistry - 2 failed root canals on molar, question about apicoectomy
Expert: Mark Bornfeld DDS - 4/8/2009
Question Thanks for taking your valuable time to read my question. In 2002 I had a root canal on top molar #3 as a result of much pain in that area after having a cavity filled. The first root canal proved unsuccessful, and I still had continued pain in my face and tooth area. Suspecting that he missed a fourth canal, another root canal was done within the same month.
Ever since these procedures, I periodically have flare-ups of pain up and around that tooth area, with pain radiating up the side of my cheek, and into my right eye. At times it is very painful, then will subside for awhile.
I have seen my doctor, my dentist, and a different endodontist two separate times when these flare-ups became somewhat unbearable. X-rays were always taken, no abcess or infection has been detected, and they've said the tooth is "probably" fine.
To make a long story short, I'm having another flare of pain. Went to get a second opinion from a dentist who has been in the field for 30 years. He said the x-ray indicated a small area that concerned him, and it looked somewhat fragmented (and not fully sealed). He said he'd call and consult the endodontist who recently said I had nothing going on, and to discuss if an apicoectomy was warranted. He seems to think it's in a good area (if there ever was a good area for one of those surgeries!)
I am deathly afraid of having this surgery after reading about the failure rates and the fact that lots of people end up having the tooth removed later anyway. I guess you can't tell me what to do, but after having 2 failed root canals and constant intermittent pain, would you personally have the apico done, or have your tooth removed and get an implant? I know there's no magic bullet, and I could still continue to get pain, but I'm growing weary... Thanks so much for your time!
Answer Dear Nicole,
Any answer I provide would be purely speculative, because I don't have access to the relevant diagnostic information. However, it is my experience that multiple successive failed attempts to manage dental infection present diminishing probability of successful outcome with each subsequent attempt. Unless your dentist or endodontist clearly determine the reason for the previous failures, and are assured that they can prevail over that reason for failure, any additional efforts are purely a roll of the dice. You will need to determine for yourself whether you have an appetite for gambling, because that is precisely what it is.
Especially since the presence of dental infection cannot be confirmed, it is not even certain that it truly exists. Other conditions, such as a split tooth root or a sinusitis, can masquerade as dental infection in an upper tooth.
Ideally, treatment should logically follow diagnosis. What is going on here is the reverse: your dentists intend to implement a treatment, and will be gratified to infer that their diagnosis is correct if you later experience improvement in the symptoms. Although you would no doubt be gratified as well, the provision of therapy prior to diagnosis leaves you open to increased risk of unnecessary and inappropriate treatment. Unless you have reached the point of desperation, it would be better to hold out for that diagnosis first. A trip to an ear, nose, and throat specialist would not be out of order if there is any suspicion of sinusitis.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
