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Hello Dr. Backlund,

I am currently recovering from a root canal retreatment and am a likely candidate for an apioectomy on this tooth as well.  So far my recovery is taking a longer route--9 days since the procedure, with only 3 days on clindamycin, but still increased swelling.  Yesterday my endodontist made a small incision in my gum to release the pus and fluid that had built up.  I understand all of this to be within the normal range of healing, especially since I'm only in day 3 of antibiotics, and am still hoping that I will soon be over the hump and healing well.

In the meantime I began reading online about this type of infection.  I appreciated finding your very supportive and professional responses to several root canal patients.  I would like you professional opinion on a piece of information I found on a different health website that stated that this type of infection cannot be completely cured by a root canal retreatment or an apioectomy, but rather these procedures can only knock back the infection in order to retain the tooth, which will still be infected because the microscopic canals cannot be cleaned out.  It is suggested that keeping this long-term, even if lower grade, infection puts stress on the immune system and can compromise the jawbone and make replacement of the tooth complicated in the future.  The recommendation is that the tooth be removed and all infection cleared.

Please give me your professional opinion on this statement, and/or your opinion on when an infection at the end of a root canal should move to pulling the tooth.

Thank you in advance for your generous offer of time in responding to the questions on this site.

Sincerely,
Sue

Answer
Hi Sue,

WOW....sounds like you are really going through it. No wonder you are starting to consider other options and have fears for the long term. I'm happy to try to help here as you are not alone in a situation like this. Unfortunately, I see several patients each year with similar problems/complications.

When a root canal fails, it is often due to problems with the original root canal such as inability to seal the end of the tooth or problems cleaning out the contents of the root. Over time, that can cause an infection to simmer and result in the kind of problems you are encountering. The first step always is to try to redo the root canal. This can also stimulate the healing process which can cause pain & swelling, as you have found out. Ultimately, the goal is to stop any bacterial products from continuing to come out of the tooth into the bone so healing will occur. Once this has stopped, then your body will heal anything left and the tooth will be fine.

There have been many articles, usually from more holistic web sites, that talk about this infection never going away and seeding your body with bacteria that will cause problems in distant parts of the body, like brain abscesses and heart problems. In practice, we just don't see this happening. Once the source of the infection is dealt with, which may require an apicoectomy like you talked about, healing will occur, and the tooth will function normally. An apicoectomy will seal off the end of the tooth that can't be cleaned by going through the top of the tooth.

Extraction is certainly an option as that will eliminate the problem tooth, but also introduces new issues about how to replace the tooth, assuming it's in a location where replacement would be desirable. The options would be an implant or a bridge. Both can be good procedures, but could cause new problems. As a general rule, it is always better to keep your natural teeth if possible and use the other options when it is no longer possible.

I know I'm rambling a bit, but hopefully I'm giving you a little insight. One last comment...if root canals really didn't solve the problem, then all the patients I see each year would be coming back with new infections. The success rate in root canals runs about 93-97% successful. We recall our patients at 6 months to evaluate healing and have very good results. There are some patients who don't heal and need apicoectomies and some of those eventually loose the tooth, but that amounts to 1 or 2 a year. We try to give patients honest evaluations and chances of success, but when you are healing with the human body, there are no guarantees.

I hope this helps. If you have more questions or if I didn't specifically address your concerns, please write back. You are dealing with an important issue and really need to feel that you are making the right decisions as you move forward...not easy when your swollen and in pain.

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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