Expert: Steven Litwin DDS - 7/6/2009

Question
QUESTION: Hi Dr. Litwin,

  For infections on the bone, is there something called residual infection after a root canal?

What I mean is, well this may sound like an odd theory, but are there infections on the bone that while it is trying to heal, it ends up hurting more later on? In other words, the infection after the root canal does not hurt, and then it starts hurting later on. If you know something similar, please do tell. I may be completely wrong. If i don't make sense (sorry too much 4th of July cookies), then I will surely clarify.

Also I want to make sure I get this clear. An infection on the bone can cause the tooth to ache right? meaning if tapping on the tooth, the infection can still cause pain for the tooth even after a root canal, right?

I also want to get this other thing cleared up. Are root canals really responsible for bone infections? I have been told they are responsible for infection inside, but what about the bone? Are the root canals responsible for those? So if the infection is still on the bone even like months or years after the RC, would the root canal be at fault?

Ok thanks, I hope you are having a fabulous 4th of July!!!

Karrie

ANSWER: High Karrie,

Thanks for the question. A chronic infection at the base of the root of a tooth will eventually cause destruction around the bone making it seem as if the infection is on or in the bone. What is important to understand is that this type of infection is due to a failing root canal due to any number of reasons. The pain would be coming from the pressure that is being built up from the infection and not the nerve in the tooth as it had been removed previously.  Regarding the bone there are no nerves in bone and thus no pain would come from the bone. If there is pain upon tapping the tooth it is because of pressure that is transfered along the tooth to the nerve fibers in what is called the periodontal ligament (a sling that each tooth sits in within the bony socket). If after having a root canal treament there is no discomfort and then pain appears later then it may or may not be due to a recurrent infection. IF the bite is off and you are hitting the tooth prematurely or the tooth is fracture then these can cause the discomfort as well. Hope this gives you some information and wish you the best.

Steve Litwin DDS

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

QUESTION: Hi Dr. Litwin,

 So to clarify, are you saying that the root canal is ultimately responsible that the infection is still on the bone?

  I had to take some antibiotics after the root canal. My dentist is thinking of switching antibiotics. Would it be ideal, because one dentist told me that more antibiotics will not work, while another dentist said a different type might just do the trick. Another dentist told me that the immune system should of already rid of the infection already. I'm being pulled in all these different directions, and I'm not really sure where to go from here. What do you think?

ANSWER: Hi Karrie

Hang in there I know its confusing. The bottom line is this. I am assuming that the dentist had placed you on either penicillin VK, Amoxcillin, or Clindimycin any of which would be a first line attack for these type of infections. If I am correct in this and it did not work then I would certainly not try another antibiotic because there is a very high probability that the root canal is failing for some reason and the infection remains at the apex of the tooth which is in the bone. Karrie, if the original issue was an infected nerve in the tooth then the root canal should have resolved the issue. Antibiotic treatment along with root canals is only if there was drainage of infected matter when doing the root canal or if there was bleeding during the procedure. Karrie, I would not just try another antibiotic because I don't think it will work if the cause is a faulty root canal or fractured root. ALso, too many antibiotics can cause resistance to be built up to the medicine and even a possible secondary infection. I really believe that you should contact an endodontist whom specializes in root canals and have it thoroughly evaluated. Hope this helps and best of luck.

Steve Litwin DDS

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

QUESTION: I called my dentist today to ask him which antibiotic he wanted to switch to, and he wanted to switch to Augmentin, which he prescribes to a lot of patients. I was taking amoxicillin, which a lot of dentists seem to like to prescribe for antibiotics. But what is the difference between amoxicililn and augmentin?

My dentist said I don't need to go to the endodontist, and that my tooth hurts becasue of my gums and the infection. He said it's not a root fracture, because I did a bite test, and as I am biting, it's a little sensitive, but when I release there's no more pain. So, would even the smallest fracture cause pain, or does that not completely rule out root fracture?

He also said that my gums are really red, and that when I floss it should not bleed, which my gums do. So, I'm wondering what that means. But I didn't know bacteria at the gums can cause the tooth to ache like this, or is my dentist wrong? Thanks!

Answer
Hi Karrie,

From what you have just told me it sounds like the issue might be coming from a periodontal concern (gum disease). I would have a periodontist evaluate the site and depending on what he finds you may still need to visit and endodontist.

Steve Litwin DDS