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Dr. Backlund,

First, thank you so much to you and the other experts on here willing to offer your suggestions.  I had a root canal on molar (number 19) January 3rd of this year by a high qualified, wonderful endodontist.  The tooth had been experiencing spontaneous endo type pain/throbbing for about 2 months prior.  On examination, none of my teeth had sensitivity to percussion nor cold, and only the adjacent pre-molar had minor biting pain in one area.  However, tooth 19 clearly failed the heat test and all others passed.

The endodontist said that I had 4 canals, extra long, and very curved.  Procedure itself took about an hour and was completely finished in the one appointment. There was no infection present and bone looked good.

Since the root canal I have had no more endo type pain, however the tooth is now very, very sensitive to touch.  Mainly biting, chewing and pushing at either side or on top gives a pain.  The tooth does not hurt otherwise, but sometimes I get pressure/fullness in front of ear/cheekbone area as well.  It seems to hurt less in the morning but throughout the day gets more sore.  I can still brush with toothbrush with slight pain.

The thought from the endodontist is that it is inflammation and a very sore periodontal ligament from all of the work down there.  I have been back twice (first was put on more ibuprofen) and last week was given Medrol Dose pack and Clindamycin (just in case of infection because of cheekbone pressure).  We did another x-ray last week and all looked fine.  I had crown prep done on Feb. 4th so I have temporary crown on now.  Both my dentist and endodontist checked and said occlusion is fine, however sometimes I can feel the pain with my teeth together and moving side to side.  Not always though.

My questions for you:

1.  Do some people just heal very slowly from RCT trauma plus crown prep or is there a greater chance that something else is going on?

2. If I do decide just to wait it out for 6 months or so with the temporary crown (which I am fine with the chewing pain), is that dangerous if there is in fact an apical root crack?

3. Can a temporary crown stay on that long?

Thank you so much!

Answer
Hi PJ,

I'm sorry to hear you are still having trouble with that tooth...not much fun when you thought all would be over quickly & easily. Let me try to answer your questions.

1.  Do some people just heal very slowly from RCT trauma plus crown prep or is there a greater chance that something else is going on?

In most cases, once a root canal is done, there is a day or two of some tenderness. For this to go on for 2 months is quite unusual especially when both your dentists feel the root canal was done well. If the tooth is periodically traumatized, like when you bite, that can delay healing. You may need the bite checked again, especially if there is soreness when you slide from side to side or if you have any tendency to grind your teeth.

2. If I do decide just to wait it out for 6 months or so with the temporary crown (which I am fine with the chewing pain), is that dangerous if there is in fact an apical root crack?

The most common treatment for a possible crack is to place a good fitting temporary crown and leave it on for 3 months or longer to see if the tooth settles down. So your temporary is exactly what should be done. It should stabilize the fracture or crack, if there is one, rather than allow the crack to get worse.

3. Can a temporary crown stay on that long?

This really depends on the quality of the temporary crown. In most cases, staying on for 6 months is not a problem. Just make sure to clean around it well since the margins aren't as good as the final crown and you don't want decay to get started. In addition, be careful with sticky foods so the crown doesn't come off.

I hope this helps. Good luck!

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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