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Dentistry/Old Root Canals - Pain returns after surgery

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Pre surgery
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QUESTION: In February 2013, i started feeling burning/throbbing in 16 year old root canals/post/crowns #7 & 8 (pre surgery xray attached). The pain came and went constantly throughout the day and went up into my right nostril area. Old x-rays revealed that dark shadows/infections were there for many years but I had no pain and they were left alone. Last December I had both teeth apico'ed, mta retro-filled, and bonegrafts placed by an endodontist; he said the teeth had no fractures during the surgery. The area was immediately numb for a while, then slowly OK but sensitive, but now, 9 months later, the exact old pain has returned (burning/throbbing from the teeth up into my nostril area). The doctor still sees no signs of fracture. He did new xrays and pointed to the area above 7 and 8 and said the bone is filling in great with no signs of infection and that the teeth look and feel solid. He then proceed to poke around and feel the area above teeth with his finger but he could not feel anything out of the ordinary or produce pain. What do you think is happening here? Do you see any signs/symptoms of fracture in my pre-surgery xray?  Any ideas? I really do not want to go through extractions/implants for front teeth, as i can't think of having to work with a flipper and also worrying how the implants will eventually look in an aesthetic area :(

ANSWER: Its really not possible to be sure why you are having this burning sensation. If you still had an active infection, you might have had some sensitivity when your endodontist palpated the area where he performed the apical procedure, but you did not.  It is possible that your bone graft has not taken fully, but it is also possible that you have "phantom limb pain", left over from the nerves in the bone that were irritated. I would take advil and wait and see. If the feeling doesn't go away in 6 months get another consult. My concern is, that even if you removed these teeth, you still might have the sensation. I have written a short post in my blog about post root canal pain. Just copy and paste the URL into your browser.

http://lspindelnycdds.blogspot.com/2009/06/why-does-my-tooth-hurt-after-root-can

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

QUESTION: Thanks again for the response Dr. Spindel. My endodontist last week said something similar--it could be phantom pain, or even the bone grafts. It's such a deep throbbing from the teeth (and my nostril) that it's very scary not knowing why this is still happening even after so much work (and $$). It's especially disheartening to read various blogs and websites discrediting root canals, as "they are bacterial filled diseased teeth that should be removed immediately for proper healing." I hope that's not the case; I think they are wrong. The extraction/implant process sounds awful, especially for front teeth (the flipper sounds terrible).

Answer
Sounds like you should give it some more time. If implants are needed they can be straight forward. Just take you time before deciding to extract teeth numbers 7 & 8. Most root canals are successful and even successfully treated root canals can have symptoms afterwards. Giving it more time, if possible, is the most prudent way to proceed.

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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