Dentistry/root canal

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QUESTION: I had my first root canal not yet a yr ago, my dentist put a temp
filling,three months it broke returned fixed it and then again three months later it broke on a Friday so i had to wait until monday to go in to have it fixed, this time the entire filling was removed it had a odor that almost made me throw up. It was the worst odor. The tooth was always tender with small amount of swelling after the procedure was started, and I just kept telling my self it will calm down, After the last visit that was a week ago today, had a lot of swelling on that upper side where the tooth is, two days later started running a low grade temp, slept two days, had some amoxicillin just 4, took them felt better and for the first time since we began the procedure it wasnt tender, now temp is back, swellings back with tenderness this is a upper left molar second to last tooth, face hurts under eye, could this tooth infect sinus above tooth. Have no other symptoms, all started with opening the tooth again. Should I go to dentist, or doctor? And I just want to pull the tooth at this point, had enough and don't want it messed with anymore. I have to go back on 12th for perm. crown. What should I do?

ANSWER: Obviously I can't see you, so I cannot positively tell you what happened, but it sounds like you have an infected and abscessed tooth. First you should know that "temporary" fillings are called "temporary" for a reason. They need to be replaced quickly by a permanent filling. Most dentists use what is called Cavit, a paste that is probably good for about two weeks. It breaks and dissolves and allows saliva leakage. The root canal filling will not stand up to saliva, so when this happens within a few weeks or months the root canals become reinfected and the root canal treatment needs to be re-done. So, by leaving a temporary in for that period of time, you have wasted the money you spent on the root canal therapy. Additionally, if the filling keeps falling out and the tooth smells bad, it may have actually fractured ("split"). That can be avoided by placing the permanent filling and covering it with a crown. Unfortunately you did not do either. So, at this point, your are probably looking at having it extracted. You should DEFINITELY not consider a permanent crown until all the symptoms are gone, and from what you tell me, if you are lucky and the tooth is not split, that would at least require the tooth to be re-treated endodontically.

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QUESTION: First of all you made it sound like I did not do what I should have, but I go to the same office and have a check up every six months, and on each visit my dentist did look at it and made me feel it was the norm, to wait for the crown. I didn't know what should be done or when. I called his office on monday and he did not want me to come in to look at it, he just called in antibotics for me to take 4 times a day for seven days. My dentist made it sound like he wanted to wait to put the perm. crown on the tooth to make sure it was not going to flare up again, due to it being tender and the gums staying swollen. The filling did not fall out it was the temperary crown, I guess, It was the rough feeling material over the entire tooth. Im not a dentist and I do not question what one is doing, this was my first root canal, I felt something was not right is the reason I took to the internet. I dont know if the tooth is split, and xrays have not been done since he removed the nerves and packed the roots with something that had a very bitter taste. It just could not be normal to have soreness for this long. What I really wanted to know is
Could this be normal? I am not someone who does not take care of their teeth. As a matter of fact I am 46 yrs old and have only had 4 teeth worked on. I have done exactly as I was instucted. So I must assume that I need to find a new dentist. But maybe it was my mistake for calling it a filling that broke, it was the covering over the filling, and I do not know why it takes so long to do a root canal, I have wanted to get this over with from the first day it was started. I do know nobody will touch it until it is well. At this point I am thinking just pull it, which I have ask my dentist to do, but he keeps telling me he still thinks it can be saved. This tooth was filled when I was sixteen and during a cleaning the outer side chipped which then caused it to be very sensitive, he tried to repair it and it was all down hill after that. As for the smell, I did not smell it until I was in the chair and he removed the covering to replace it because it had broke. The material he put down in the root canals did not come out. I am sure I sound upset with you but I am just sick of dealing with this tooth. Again I just wanted to know if this was the norm? But from what you already stated it, and if I explained it in the correct way it sounds like you are saying it is not normal? And or get a second opinnion??

Answer
Again, I'm sorry you have had this problem, Vicki. I can't see you, obviously, so all I can go by is what you tell me. I know you are not a dentist and that you are in a sense at the mercy of your dentist, and that you are trying to relate to me what he told you (which may very well not be correct), but that is simply not enough for me to do anything more than guess on the basis of over 30 years of experience. I say in my blurb that I cannot answer specific questions about people's individual cases, but I constantly get those questions anyway. So, I try to help as best I can.

I need to make an observation here. I do not think it is responsible for a dentist who clearly does not know why you are having problems so long after the treatment (so NO, this is not normal) to refuse to see you and instead call in antibiotics. The only time antibiotics should be called in is if the doctor knows why you need them, in the case of a flare-up immediately after treating a tooth with a necrotic pulp, for example. Many months after treatment, when you are having this problem, there is something else wrong, and he needs to figure out what it is and deal with it, not give you pills that will not and can not affect what is actually wrong. I would love to see you and to solve your problem, but as that is not possible, I suggest you consult an endodontist, not another general dentist, and see what he says. Good luck.

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Frederick R. Liewehr DDS, MS, FICD

Expertise

I can answer your questions about root canal therapy in general. PLEASE DO NOT ask me to diagnose your particular problems or recommend treatment as I cannot do this without examining you and seeing your x-rays.

Experience

I am a Board-certified endodontist, former university department Chairman, teach dental residents, and have a private practice.

Organizations
ADA, AAE, ICD, AAOM, FDI, AMSUS, AAOB

Publications
J of Endodontics, Endodontics and Dental Traumatology, O,O,O, Military Medicine, Medical Bulletin, J of Dental Education

Education/Credentials
DDS, MS (Oral Biology), certificate in Endodontics

Awards and Honors
Surgeon General's "A" Designator, Fellowship ICD, Order of Military Medical Merit

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