Dentistry/root canal

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Question
About 6 years ago I had to have a root canal on one of my molars on the top left side.  Things went well, and I thought all was well.  About a year ago the tooth started hurting again.  I went to my dentist and from there he sent me to an endodontist.  The endodontist said that I had lots of infection, because the root canal was not done correctly the first time (my regular dentist did it the first time).  The endodontist did a retreatment and put me on a course of antibiotics.  I took the meds and gave it some time to heal.  It still hurts! It has now been 3 months since the retreatment.  I have had sinus trouble in the past, so I thought maybe that's what is wrong now.  I went to my ENT, and he did a scan which showed that my sinuses were fine.  It is the tooth.  Even on the CT of my sinuses the infection of that tooth shows up.  He said the roots are super long.  I don't know what to do.  I don't want to go back to my dentist, because I don't feel like he is treating the problem correctly.  AND since the endodontist didn't get the problem fixed, I don't know what to do or what other options I have.  I don't want them to pull the tooth! Advice?  I know a very good oral surgeon that I have considered contacting, but don't know if I should or if I should go back to the endodontist. Advice?  I will not go back to my dentist, so I need to find a new one of those as well.

Answer
Hi Jennifer,
This presents a difficult problem often seen unfortunately.  A lot of general dentists choose not to use the benefit of specialists (like endodontists), despite the fact that research shows that endodontists have a 25% higher success rate with root canals over general dentists.

Anyhow, with your case.  In order for the bone to grow back around your tooth after the root canal retreatment:  it often takes close to 6 months for that to be seen on a radiograph.  And if it was a big lesion (like you describe), it could take upward of a year.  However, your symptoms should be subsiding much sooner.  So, my natural question, is the pain the same level as when you first went to the endodontist, or is it getting better, just slowly?

If it's progressively getting better, I would followup with the endodontist in 3-6 months, so he/she can compare the size of bone defect to when you first had the retreatment to ensure that it is healing.  If the pain level is the same, I would follow-up with the same endodontist...sometimes with largely infected teeth, an additional procedure:  an apicoectomy, which is a minor surgical procedure to improve the seal between the tooth and bone, can be done if necessary and will help you to save the tooth.  The endodontist should be able to advise you on that; and may advise you another general dentist to see.  It's important to followup with a good general dentist, that you trust, because the root canal is only going to be as good as the permanent crown/filling is since that's what protects against reinfection.

Most oral surgeons may be more bent on extracting the tooth, since that's what they do all day.  I would recommend seeing the endodontist to help you save the tooth and since they understand the healing process after a root canal better.  

Best of Luck,
Ketan Amin, DMD
Austin Center for Endodontics (Root Canal Specialists)
Austin Center for Endodontics

Dentistry

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Ketan Amin, DMD

Expertise

Graduating from Harvard School of Dental Medicine, I received a broad understanding of both medicine and dentistry. I continued my training at New York University, as a dental specialist in endodontics, which concerns root canal therapy, related surgeries, as well as diagnosing and managing various forms of pain occurring in the head and neck

Experience

Dentistry; Specialist in Endodontics (Root Canal Therapy).

Organizations
American Association of Endodontics American Dental Association American Academy of OroFacial Pain

Education/Credentials
Harvard School of Dental Medicine-Doctorate in Dental Medicine (DMD) New York University College of Dentistry-Certificate, Endodontics

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