Expert: Frederick R. Liewehr DDS, MS, FICD - 2/12/2006

Question
Dear Doctor,

Last year I had a root canal on my left back molar which was overfilled. Even before I had the crown put on I was having a pulling, burning and soreness in the tooth. Once the crown was put on it made my discomfort even worse, it felt like my tooth was enlarged.

Went to several specialists who found nothing wrong with the tooth. After two months of misery I had the tooth extracted but the same conditions remained and seemed to jump to the next tooth.

I would like to know if the excess material could be causing all my problems as I do not want to have another tooth extracted.

Is there a surgical procedure to remove the filling material and who would I see to perform
the surgery.

Thanks in advance for your help.

Answer
I can't help you with this without seeing you, Linda. We in endodontics are very critical of ourselves, and we hate it when we extrude the tiniest bit of material through the apex out into the bone, even though with a patent apex technique this is inevetible. We usually make a point of telling our patients that this is the case, because we are conscientious and think they should know. In general, though histologically this may produce some microscopic inflammation, it generally does not harm. The real problem occurs when the bacteria are not cleaned out of the root canal, or there is continued leakage.
    There are rare cases where a lot of material has been extruded, say, into the sinus or into the mandibular canal. This would be obvious on a radiograph, and I am certain one of the dentists would have advised you of this.
    Your symptoms, particularly the "pulling" and "burning" pain, and the pain that moves to a different location sound more like non-odontogenic pain, i.e. pain that is not coming from your teeth. For a variety of reasons, including referral, you may think that your teeth are the source of the pain, but they may not be. These sorts of pain can be extremely difficult to pin down and cure. Unfortunately many dentists do not recognize them, and the end result is that patients have many root canals and extractions done that do not help their pain.
    My suggestion is that you seek help at a pain center, if you have one in your dental school. Dentists are trained and used to pain that is caused by teeth and cured by dental procedures, so they are often not particularly good at diagnosing and treating nonodontogenic pain. A pain center would have people who are used to managing these sorts of things. Good luck, and I hope you get an answer soon.

Dr. Liewehr