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Medical Forum / General / Dentistry / September 2005Tooth Pain
About two months ago I had a root canal on the next to last back molar. This was done by my dentist in one visit. For several days after that I had what felt like extreme soreness on that tooth whenever I applied any pressure. However that finally went away. Surprisingly I had the same soreness/sensitivity at the last molar right next to it which continues intermittently through today. If I press the gum with my finger below that tooth it feels very sore to the touch and generates much more discomfort than simply applying pressure to the tooth itself. Pressing the inside of the gum generates no soreness. Have gone back to the dentist and comparing x-rays now of that tooth to one taken just prior to the root canal you can detect a shadow line around the bottom of the root. He believes that I now need a root canal on that tooth. The only reason I have doubts is because I have never experienced this type of tooth pain before and wanted to be sure before having yet another root canal. I also have a question about root canals in general. I have had two in my life the first one nearly 20 years ago. At that time it was done in three visits and I recall no further pain after the initial or the follow up visits so I was surprised how much pain I had after the second which was quite unpleasant. Is that common and does it have something to do with the method used today? So the question, is this type of pain consistent with the root going bad? If not what should I be asking the dentist or should I be seeking a second opinion? On that latter note short of word of mouth is there anyway to determine who is a good dentist? Just read earlier posts on picking a dentist so forget rehashing that topic. > About two months ago I had a root canal on the next to last back molar. This > was done by my dentist in one visit. [quoted text clipped - 27 lines] > On that latter note short of word of mouth is there anyway to determine who > is a good dentist? I cannot tell you that the tooth needs root canal or not. However, these symptoms are totally consistant with an abscess and a tooth requiring root canal. There has been a definite movement toward doing root canal treatments in fewer visits. Most root canals can now be done in one visit. Part of this is the new rotary instrumentation, which makes cleaning of the canals quicker and easier. Part of it was a mountain of evidence that multiple visits (and culturing of canals which used to be done routinely) did NOT lead to better results. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Surprisingly I had the same soreness/sensitivity at the last molar right > next to it which continues intermittently through today. If I press the gum [quoted text clipped - 5 lines] > taken just prior to the root canal you can detect a shadow line around the > bottom of the root. He believes that I now need a root canal on that tooth. It is difficult to comment on this case without further info, like diagnostic tests done before root canal was performed on that tooth, to ensure that the tooth was the culprit, as well as x-rays of both teeth taken before and after the root canal. Maybe both teeth were infected, but only one showed symptoms at the time of the root canal. Maybe the tooth worked on was the wrong tooth, and the tooth behind it was the culprit. Usually a dentist should cut down the tooth having the root canal so that the patient doesn't bite into it, which would cause sensitivity after a root canal. Or maybe the dentist extruded debris from the inside of the canal to the outside of the root inside your jawbone during the root canal, which can lead to temporary sensitivity after the root canal. Usually the dentist should have detected the "shadow line" around the other tooth if his x-rays taken during the root canal showed both teeth. Maybe the sensitivity on the back tooth is due to a residual infection on the tooth that had the root canal. But basically if the pain on the root canal tooth goes away, things will be okay, as long as all the canals in the tooth were cleaned and there were no perforations in other roots in the molar tooth. > The only reason I have doubts is because I have never experienced this type > of tooth pain before and wanted to be sure before having yet another root [quoted text clipped - 4 lines] > quite unpleasant. Is that common and does it have something to do with the > method used today? Suprisingly, dentists don't seem to know why exactly some patients feel a lot of sensitivity temporarily after a root canal, even if the root canal was done with textbook perfect results. Sensitivity after a root canal done properly can be due to the patient biting down on the tooth after the root canal, or can be due to debris being pushed out the end of the root during the root canal (a common event). It could also be due to the root canal filling forcing the tooth infection outide the tooth, where it might temporarily swell up and make pressure at the root end of the tooth, causing sensitivity. the sensitivity would go away once the body's immune system came in and destroyed the remaining infection. > So the question, is this type of pain consistent with the root going bad? If > not what should I be asking the dentist or should I be seeking a second > opinion? it can be a good root canal and still give this kind of pain. but also the dentist might have worked on the wrong tooth or accidentally failed to clean out one of the canals in the molar. can't tell in this case without full info. > On that latter note short of word of mouth is there anyway to determine who > is a good dentist? Not really. Some dentists market themselves well, others are liars. some are competent but poorly marketed. others are competent but not meticulous enough to do a good job. others are burned out. dentists who are university instructors may be slightly better than average but this may be hit or miss. This profession is not as scientific as it should be. It is influenced mainly by gurus who usually are right but not always, who often don't admit it when they are wrong. experience is a plus, at least 5 years would be nice. but one is not too young to be competent or too old to be incompetent. However, it is fairly easy to evaluate root canal cases to see if they are properly or improperly done, just bring a record of x-rays taken before and after root canals, as well as record of diagnostic tests, to another dentist, especially a specialist root canal doctor (endodontist) and you will probably get a clear answer about if it was done right or not.
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