Expert: Frederick R. Liewehr DDS, MS, FICD - 1/25/2006

Question
Let me first THANK YOU for taking the time to read this!
On 01-14-06 I started experiencing throbbing pain in the upper left side of my mouth. This was not a constant pain. The cold wind, liquids (hot, cold or room temp) and when I turn my head upside down to blowdry my hair is when this is the most painful. I used ambesol throughtout the weekend until I was able to see my general dentist on Monday, 01-16-06. My dentist referred my to an endodontist to have a root canal performed on # 13. On Tuesday Dr. Lundgren, D.D.S, P.A. performed root canal treatment on # 13, which I paid for on that day.
Unfortunately, the work performed on # 13 did no good. I was still feeling the original pain. I spoke to the receptionist at the doc's office on Thursday to inform them that I was still hurting as before and they asked me to come in for a re-evaluation on Tuesday 01-24-06. Dr. Lundgren placed miracold on # 13 Tuesday and I still had sensitivity to this tooth. He advised me that I must have more roots in this tooth than the normal person, and he must have missed them. He was very apologetic and asked that I return on Wednesday to have the tooth finished. When I arrived at the office on Wednesday, the doc stated he was going to do another evaluation just to be safe. At that time, # 13 didnt react to the Miracold as it had the day before. He check # 12 and it was sensitive so he stated that he would perform a root canal in that tooth free of charge. He never ever gave me time to respond to his statement, he was grabbing the anesthesia to numb me when I stopped him and asked if we could discuss the situation. I asked if both teeth truly needed root canals or if he performed the original rooth canal on the wrong tooth. He said there was not a doubt in his mind both teeth needed root canals. I explained to him that I didnt come to his office to have him handle every tooth I needed work on, I came to his office because I was in pain and needed to be releived of it. He convinced me that # 12 needed the root canal and this should take care of my pain so I allowed him to perform the root canal, agreeing there would be no charge to myself or my insurance company.
Here we go again...I'm still hurting =( This doctor has now performed two root canals (one that I paid $368 for and the two crowns I now need costing $324 each) and I am still feeling like I did when I first walked in his office. I am very lost in this situation and don't know what to do. I have a friend that works in a doctors office that has advised me to call them tomorrow and request my money back and go to a different endodontist. Right now my concern is to be releived of this pain I am feeling. I feel so dehydrated because it is so painful to drink anything, even through a straw. What is your suggestion? I appreciate you taking your personal time to assist me with this matter. Thank you so very much.

Answer
Of course you understand, Sandra, that I can't really diagnose your problem without having you in my office. That being said, there are two possibilities. One is that you have pain from a nonodontogenic source, that is, not from a tooth. Your symptoms, however, especaily the cold sensitivity make this unlikely. The fact that I presume you are telling me that this is something you have only recently experienced and not had previous bouts of also points to a tooth as the source of your discomfort.
    What it sounds like is that you have what we call irreversible pulpitis, which means the pulp ("nerve") of a tooth is very sick. Most of our testing, x-rays etc. are designed to find teeth with dead pulps, not sick ones, so unfortunately this condition can be really hard to diagnose. Since you had cold sensitivity, the endodontist should have tested your teeth for cold, and presumably #13 was the sensitive one, so he did the root canal therapy. There are a variety of other things he should have done to make the diagnosis; we will assume he did those things because I don't know what he did. There is about a 50:50 chance that #13 has two root canals, and he should know that, so I would think that he looked and didn't find a second canal. If there were two, and he missed one, it is possible that you could have th symptoms you describe. In that case, he could look again and treat the canal if there was one that he had missed. I think missing a canal in a premolar should be unlikely for an endodontist.
    It is possible that you had problems in both #12 and #13, but unlikely. Why #13 was sensitive and then not sensitive with #12 becoming sensitive I cannot tell you. That seems strange to me. The bottom line, though, is that you still have your pain and need some relief.
    To be blunt, I think your friend is right. If your endodontist can't help you, then you need to find someone who can. I really wish I could be of more help, but e-mail makes a pretty poor substitute for an office examination!
    I think the best thing is to see someone else; good luck, and I hope you get relief soon.

Dr. Liewehr