Expert: Tony Appleton BDS DPDS - 4/4/2007

Question
A couple of years ago, I had the first two parts of a root canal procedure done on the last lower right molar, due to tooth decay.  The dentist that I went to was not very nice to me at all.  He hardly talked to me through the entire procedure, and I had what he referred to as a "hot tooth", so my experience was VERY painful, until the nerve was removed.  He had to give me 10 shots of whatever numbing solution he used, directly on the nerve.  I didn't feel relief until the nerve was gone. On the second visit, he filled the tooth with that gutta percha and sealed the top and side (which had broken off prior) with a silver type filling (I think that's what it is).  While filing this down, he inadvertently cut my tongue with his drill, and kind of made a joke about it.  Of course, I didn't feel this, because of the novacaine, but I did feel it when that wore off and was sick several days after.  He told me to come back in a few weeks(?)/months(?) to have cap put on.  He said the reason he waited, was to make sure that nothing went wrong/developed with the previous procedure first.  During this time, I left my current job and was so without dental coverage.  I did NOT want to back to that dentist, because of the horrible experience I had.  When, I got a new job, I was reluctant to visit any dentists, because of that memory, and it's hard to find a dentist when you don't know which ones will have good bedside manner, etc.  It's a gamble...so of course, my own fault, I put that final most important procedure off.  I didn't feel any pain anymore, so I didn't worry about it...even though in the back of my mind I knew I should get it done.  A couple years later, low and behold, I am again without dental coverage (unless I use the COBRA continuation I was offered) and as fate would have it, the pain started.  Once in a while, in the last two years, I would feel some pain in the tooth, but it always went away after a couple of days, and I could manage it with Advil.   And of course, each time, I thought "I really need to get that cap put on."  This time is different.  I have had pain for about 5 days now, and it has gotten worse every day since it started.  Advil doesn't seem to help very much anymore. I cannot chew food/bite down on it.  It doesn't seem to react to hot/cold however.  The pain is to the point where I know something is not right.  At first, I thought "why am I feeling pain in a tooth that has no nerve?"  So, I started doing some research online, and found that teeth that had root canals done, but no crown, can have a root fracture, and/or develop an abcess near the the root.  This is probably what has happened to me.  I will need to go and have it x-rayed.  I have read that a second root canal is sometimes done in this type of instance, or if the crack is a vertical one, the tooth may have to be extracted.  I know this is my own fault for not having the cap put on in the first place.  However, I am quite nervous to have this procedure done (again), but I know it needs to be.  I need to find a good dentist in Milwaukee, WI that will be kind to me, talk me through the procedure.  I had such a bad experience before, and so am understandably nervous about going to a dentist again.  Is there anyway to relieve the pain before going?  Or are there any dentists/endo specialists that offer some kind of IV (putting to sleep) like I had done for oral surgery?  Will dentists to that for a root canal?  Anyway, I guess I'm just very scared to do this, but know it needs to be done.  I think the first step is to have an x-ray done.  It must be a fracture or infection build up, because I didn't have any pain this severe after the root canal was done 2 years ago, and now seemingly "out of the blue", the pain is constant and getting worse each day.  How long can I wait before having someone take a look at it before infection spreads to the bloodstream?  A week, a month?  My fear is that it may have already spread in the last 5 days.  I have no redness, or swelling, just extreme pain when biting down, and a throbbing pain when just leaving it alone.  Thank you so much for your help/advice.  Sorry this was super long, I just wanted to get my story out, as I have not had the best of luck in the dental department.  Thank you again!!  Melanie from Milwaukee, WI.

Answer
Hi Melanie

Wow - you certainly get the prize for the longest question!

You are absolutely right - the likeliest cause for your pain is that the tooth has become re-infected, and the other possibility is that there is a root fracture. Either way you need to see an endodontist as soon as possible.

The next question is how to find a good dentist. I completely understand why you won't go back to your previous dentist. The best way to find a good dentist is to ask friends, family and colleagues. That way you get a 'consumer' opinion and can get a pretty good idea of who is a sympathetic, skilled clinician with good communication skills (which is what you really want).

Don't worry about having the procedure done. If you have the right dentist it will be straightforward and painless. You shouldn't need sedation for what is basically a routine procedure.

Best of luck - let me know how you get on

Regards

Tony Appleton