Dentistry/root canal

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Question
Hello,
I was just told by my dentist that I need a root canal (+post+crown) on my top front tooth(9?) she took an xray that showed abscess away from the tooth high up on the roof of my mouth. She said that maybe it was b/c of a filling I had 5+ yrs ago which "slowly leaked out." I've been to other dentists and they never mentioned anything. My only symptoms are a little sensitivity and ever since the filling my gums, exactly where the anesthesia was injected, feels a sore when I touch it sometimes & the surface feels harder. I always assumed that the pain from the needle wouldn't completely go away but always wondered if he hit something b/c the injection was far more painful than others I've gotten (felt more like drilling). Also, that tooth overlaps w/ the one next to it, is it possible that there is a hidden cavity there?
I'd appreciate any thoughts on this. Thank you!

Answer
Good day Liz,
Thank you for your question.As I always state, unless I could perform a complete clinical and radiological exam, it is really impossible to know the exact diagnosis and treatment.
However, based on your history it would seem everything you recite is not that unusual.
Your dentist has observed on the radiograph
bone damage, therefore a "dark" area that indicates pathology. This damage appears to have been caused by previous decay and a deep filling on your tooth close to the gums. When trauma to a tooth occurs from decay or fillings the pulp tissue that contains the nerves and blood vessels in your tooth become inflammed and damaged. This is when sensitivity begins and eventually the tooth dies. When this results, the body attempts to wall off this inflammed damage. This results in an inflammatory response in the bone around the tooth. This is what your dentist noted on the xray and is the hard knot of inflammed tissue and fluid you feel in the roof of your mouth. When this is injected with anesthetic it is painful because the soft tissue covering your palate is already inflammed. Your dentist didn't want to cause you pain during the treatment. Therefore, this is why it was done.Even though this damaged area appears hard, once the root canal is treated and the damaged tissue is removed inside the tooth, this inflammed knot should heal. Depending on the size and amount of bone damage, total bone regeneration will occur in 6 months to 2 years.In some instances the knot might have to be surgically drained (lanced) during treatment.If healing does not occur a surgical procedure can be performed to remove any of the remaining damaged inflammed tissue.This is usually not necessary, but can be performed to save the tooth.
Hopefully, I have addressed all your concerns. It sounds like your dentist is following good protocol in your treatment. Good luck with your follow up and hope everything works out well for you.
I wanted to add that as far as your overlapping tooth being a problem, a thorough clinical exam which includes endodontic tests and a periodontal evaluation should be performed. In this way,it could be determined if additional issues are present.

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robert block

Expertise

I would prefer to answer questions related in my specialty of Endodontics( ROOT CANAL THERAPY) I am a Board Certified Endodontist with a special interest in advanced surgical endodontic procedures. I know root canals create a lot of apprehension in patients, and they usually have many questions about the procedure. I can address patient concerns either before or after their root canal treatment. I also have re-treated numerous patients who have had previous endodontic treatment. As a result of these clinical failures,and the increase in the use of dental implants, its important patients understand the alternatives of therapy. There are often many components to treatment that interrelate the disciplines of endodontics, periodontics and restorative dentistry.Patients frequently question the importance of considering all facets in a clinical regimen. Hopefully, I would be able to educate and contribute some information from the endodontic perspective.

Experience

Diplomate American Board of Endodontics, 35 years plus private practice experience. Formerly Professor and Chairman, Department of Endodontics at US dental school. Editorial journal reviewer for the endodontic section of The Journal of American Dental Association. Serve as a reviewer on several editorial boards.

Organizations
American Association of Endodontists, College of Diplomates, American Board of Endodontics

Publications
Over 150 publications, abstracts, case reports, chapters in textbooks. J. Dental Research, J. of Endodontics, J. of Oral Surgery Oral Medicine Oral Pathology,The NEXTDDS J.For example: The Single File Approach for Predictable Endodontic Canal Instrumentation:The Wave One, THE NEXTDDS J. 4-2:13-17 Fall 2014 Non Surgical Management of an Endodontic Failure Utilizing Contemporary Technology, www.THENEXTDDS 5-1:60-63 Spring 2015 Are You Still Using Formocresol? An Update, Tn. Dent. J. 89-4:14-19 Fall 2009 Management of Endodontic Failures, Oral Surg.vol.66:711-Dec.1988

Education/Credentials
BA. DePauw University, DDS. University of Michigan, MS. Medical College of Virginia, Virginia Commonwealth University, Gen. Practice Resident, University of Connecticut, Endodontic Resident Medical College of Virginia, Virginia Commonwealth University

Awards and Honors
Numerous Awards and Honors, Edward P. Hatton Award( Int. Assoc. of Dental Research), Endodontic Memorial Research Award ( American Association of Endodontics) Outstanding Endodontic Department Teaching Award (given by dental students)Fellow American Academy of Dental Science

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