Expert: Gary Backlund, DMD, MSD - 7/19/2009

Question
QUESTION: Hi
My front tooth had a root canal about a month ago...All was fine but 2 weeks later I started to feel pain in the tooth. It wasn't so bad. I thought the bite  was off so did the dentist. So we  went ahead with the crown and post. Well the pain is still there. I am not sure what is causing my pain. When I touch it it feels like I am getting a small shock pain. That is the only way to explain it. The back of the tooth where the gum line would met the tooth I can feel a small separation ands it sore back there.I also feel pain when I push on the upper gum in the front of the tooth

Before I had the root canal my dentist put me on antibiotics as he said i had all the classic signs of an infection. Is it possible I still have the infection. I go back for the crown on July the and I am scared out of my mind. It took al the courage I gad to get this root canal done. Please help.

thank you for your time
Gin

ANSWER: Hi Gina,

I'm sorry you're going through all this. Yes, it is certainly possible you still have an infection and maybe the root canal is not working, Obviously, I can't help there since I can't examine you. Root canals should feel like any other tooth in your mouth. When that is not happening, there is a problem. I would suggest that you ask for a referral to an endodontist for a 2nd opinion before you go back for the crown.

Hope this helps.

Gary Backlund DMD, MSD

---------- FOLLOW-UP ----------

QUESTION: Hi Again

I went back to Dentist today. He thinks it maybe the bite or me grinding my teeth at night. I am not aware i do this, but i might..... He took the bite down.

He took no x rays, told me he saw or felt no infection.

After doing that I still feel the pain. How long does it take for the pain to go away after he fixed the bite. Right way or a few days?


I go back July the for the crown.

He said he still would like to put the crown on. I said I don't think we should do it with pain. He said he would put it on but not permanently.  If i still have the pain he will sent me to a speciality dentist.

He did mention a crack. But how do I know I have a crack?
How do you test for that?

If i have a crack what then? This is my front tooth.

Would you put a crown on permanently or temporary if a patient still had pain?


Many thanks for your help...

ANSWER: Hi again Gina,

If it truly is your bite that is the problem, it would take several days for things to feel better. What is important is that you slowly feel like things are getting better. It's hard to put a time on how long, since everyone and situation is different, but you should notice improvement as each day goes by.

Cracks are VERY difficult to diagnosis. They can't be seen on X-rays and don't have a particular set of symptoms. Usually you do a good exam, measure how the gum is attached to the tooth and get a good history of pain & previous treatment, etc. Then put it all together and try to make the call. It is hard for us specialists even. Should your tooth be cracked, you may end up losing the tooth.

In our office, we usually don't suggest putting on permanent crowns, even temporarily, if the patient is having pain. We like to know why they are in pain and figure out what to do about it.

Good luck. Let me know what you find out.

Gary Backlund DMD, MSD

---------- FOLLOW-UP ----------

QUESTION: Hi Again Dr. Backlund ( fail root canal tooth number 8) root canal done 6-4-09

I went to a  regular dentist for a second opinion who took and xray and thought he saw a small crack he gave me the picture and I took it to a endodontist.

I went to a highly recommed Endodntist (sp). He felt around , poke , asked question and took and x ray and said he said he saw no fracture. I cried like a baby. I was so happy.. He did say he saw a black/gray area which he thinks is inflammation. He suggest we do a re root canal.   He told me it would take two visits.  We are going to wait a month to see if the inflammation gets better or goes away. I already have had the inflammation for 5 weeks and it has not gotten any better or any worse....So  I ask

Can you see inflammation on an x ray?

OR is the dentist putting together with what i said and what he saw and the x ray picture?

Does inflammation show up as gray/black on and  xray?

How long does one wait for inflammation to settle down?

Is 10 weeks enough time?

Have you had any cases where patient come in and say its not so much pain but discomfort/sensivity and feels like tin foil on the tooth and it gets fixed after a second root canal?

After the first visit for the re root canal, and after the Novocain wears off, will that pain have gone away?

I should feel no pain after the first trip to the dentist for the re root canal?

do you think this re root canal will solve my problem?

How does one get inflammation inside a root canalled tooth/

Was it not cleaned out properly?

Any thing I should be asking the dentist before he does the re root canal. I am paying out of pocket for this  re root canal which is costing me about 1600.00 does that sound like a lot.
Sorry for all the question but I am so nervous when i go to the dentist and to have a failed root canal makes me even more scared.

Thank You for your time
Gina

Answer
Hi Gina,

Let me try to answer some of your questions...some I can't since I can't examine you.....

Can you see inflammation on an x ray?

Not really. What you see is changes in bone density. Inflammation is a process, like having a cold. You can only see the results of inflammation...bone changes.

OR is the dentist putting together with what i said and what he saw and the x ray picture?

This is more likely. The point is, you only have 3 choices...live with the problem, extract the tooth, or treat it with a new root canal or root end surgery.

Does inflammation show up as gray/black on and  Xray?

Not inflammation, but bone density changes do.

How long does one wait for inflammation to settle down?

Every patient is different...you can't put a time on it

Is 10 weeks enough time?

I would think so, especially if you're not getting any better.

Have you had any cases where patient come in and say its not so much pain but discomfort/sensitivity and feels like tin foil on the tooth and it gets fixed after a second root canal?

Yes

After the first visit for the re root canal, and after the Novocain wears off, will that pain have gone away?

There is no way to know this. Sometimes it takes time to heal.

I should feel no pain after the first trip to the dentist for the re root canal?

Not necessarily. When you redo the root canal, the goal is to change things at the end of the tooth so you will heal. Sometimes that change can cause pain and/or swelling. It doesn't usually occur, but it is possible

do you think this re root canal will solve my problem?

I have no way of knowing that, but what are your options?

How does one get inflammation inside a root canalled tooth/

I can't answer this either since I can't examine you. It would be a good question for the endodontist.

Was it not cleaned out properly?

Once again, without seeing an xray, I can't answe that. Another good question for the endodontist.

I think at this point you really need to trust the endodontist. Remember, you don't have many options. You can ask all the questions you want, but they may just make you more terrified if you get answers like I gave you, truthful and maybe not promising a perfect result. In the end, the real question you need to ask and answer is "what are my options?" Trust in your endodontist is your best answer, I think.

Hope this helps.

Gary Backlund DMD, MSD