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QUESTION: Dear Sir.
I have seem my dentist due to painful upper molar and have an abscess in an old root canal. I have two antibiotics which have helped some. ( It is now 6 days on the antibiotics but I still feel some pressure there). I have two questions: Are my antibiotics working or do I need others if I still feel some pressure there after this length of time? Also, and most importantly, I live in a remote location in Northern Canada. My dentist wants me to wait for the root canal for when the specialist comes up here in 2 1/2 months. He said that he could try it himself but feels I really need a specialist as my best chance not to loose the tooth. He wants me to retain the tooth because of my 'unusual' bite which would make a bridge or implant much more difficult. Can I safely wait that long? I would rather wait if I can, but am concerned about the risk of waiting so long. Thank you so much for this service.

ANSWER: Hi Mia,

I'm sorry to hear this is going on. You didn't say how much relief you got from the 6 days, but if you are significantly better, but not 100%, I would not change your antibiotics. However you may need to be on them a little longer to improve the remaining pressure feeling. If you really haven't gotten much relief, then changing the antibiotics would be a good idea.

As for waiting, it's a tough call. You won't do any harm by waiting, but a failing root canal is an unstable situation. Even if the tooth starts to feel pretty good again, you could always have another flare up. That would mean going back on the antibiotics again to simmer things down. Redoing a root canal is not easy, so it is probably best to wait for the specialist, even if it means dealing with another episode of discomfort since this sounds like a very important tooth for you.

Hope this helps.

Gary Backlund DMD, MSD

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

QUESTION: Thank you so much for your help. It is so hard to know what is best to do, especially with my remote living situation. If you don't mind, I have a couple of other questions:
First, I have had relief from the antibiotics, as I was at a point on the third day of antibiotics of thinking I should go to emergency at the hospital because of the discomfort. But then it suddenly seemed to improve and get better, but I still have a pressure/ ache throb around there.

My questions:
- If my health is seriously threatened by waiting, I could go through the expense of flying south, hotel rooms, etc. and see a specialist, rather than waiting for a specialist to come up here. I just don't have any real idea of how urgent this would be and need some perspective. Does waiting also endanger the success of the root canal, or anything else? What am I risking besides another awful flare up by waiting?

- if I go through all of this expense to see a specialist sooner; what are the chances of this being a long term fix ( will it fail in 5 years or so and it ends up coming out anyway). How successful is a re-do on a root canal? If done right is it usually expected to be a lifetime fix?

- If it is likely at all a 2nd root canal would fail then I'm in the position of having it pulled anyway, and dealing with an implant with my 'unusual bite' anyway, as well as all that expense and involvement. Should I just go straight to that option?

I greatly appreciate your help.
Most sincerely,
Mia

Answer
Hi again Mia,

It is highly unlikely that your overall health will be compromised...we really don't see that. However, if the infection were to reoccur, the antibiotics did not work and the infection was massive, you could end up in the hospital, but the likelihood of that happening is pretty remote.

Since I can't exam you or see your X-rays, I really can't help with whether this has a good long term prognosis or not. Re-doing a root canal has a lower success rate than doing it the first time. If the first one was done by a specialist, then the success rate of the 2nd try goes even lower. If it was done by a general dentist, specialists can often save those teeth.

Whether you have the tooth extracted or not is a very personal decision and one you should talk to your dentist about. Your unusual bite might really make saving that tooth important and worth the risk of a 2nd failure. I have patients all the time dealing with that decision and it really boils down to how much you are willing to spend in time and money to save a tooth. Every patient is different, but it is ultimately your call since it's you money and your mouth.

Hope this sort of helps.

Gary Backlund DMD, MSD

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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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