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Medical Forum / General / Dentistry / April 2007Root canal - follow up to my prior post(s)
I had my last of 5 RC sessions on a single tooth two weeks ago. It was done on a lower 2nd premolar that had been painful off and on for 2 months prior, and that had one filling that was just replaced, but the replacement filling didn't help any (after waiting a month to find out). The endodontist charged me $1300 and said the outcome might not be good because of the tooth having two intertwined canals. I was in the chair with my mouth open for at least 4.5 hours. At the end of it, the guy finished it off with a permanent core filling topped by a temp filling. He said a post would not be needed, but to go back to my dentist in 3 - 4 weeks for a crown. Ultimately he told me he was pleased with the result which I was glad to hear. So, now it is two weeks later and I still have a fair amount of discomfort and mild pain, both when chewing on that side - though carefully - and throughout the day and night. Basically, it never feels pain free. The first week it seemed to be gradually improving, but then got worse. My question is how long is reasonable to expect to be in some pain? I see there have been lots of posts about root canals lately, and I've read that it might be a bit painful for several weeks. At what point do I declare this RC a failure? Although there doesn't seem to be any outward sign of an infection, would it be worth taking antibiotics to kill a possible low grade infection? Finally, can I assume that I would be foolish to put a crown on a still painful tooth? >I had my last of 5 RC sessions on a single tooth two weeks ago. It >was done on a lower 2nd premolar that had been painful off and on for [quoted text clipped - 3 lines] >be good because of the tooth having two intertwined canals. I was in >the chair with my mouth open for at least 4.5 hours. Seems like a long time and many sessions to me. Must have been a very difficult one. > At the end of >it, the guy finished it off with a permanent core filling topped by a [quoted text clipped - 12 lines] >read that it might be a bit painful for several weeks. At what point >do I declare this RC a failure? Certainly not yet ! Perhaps get your dentist or endodontist to relieve the occlusion (bite). > Although there doesn't seem to be any >outward sign of an infection, would it be worth taking antibiotics to >kill a possible low grade infection? Yes, that is often helpful. Residual infection >Finally, can I assume that I would be foolish to put a crown on a >still painful tooth? I generally wait until a tooth is mostly assymptomatic. (largely pain free) before making the crown. If there is a crack in the tooth however, I tend to crown earlier rather than later. A temp crown can be helpful in this regard, to help deter further splitting, and can be an aid in diagnosis. > >I had my last of 5 RC sessions on a single tooth two weeks ago. It > >was done on a lower 2nd premolar that had been painful off and on for [quoted text clipped - 43 lines] > in this regard, to help deter further splitting, and can be > an aid in diagnosis. Well, I called the guy, and spoke to his assistant first: she said that there can be some pain for several months! If I am in that category, this is gonna really suck... Then I spoke to the endontist. He said that the root canal turned out perfectly, and it wouldn't make sense to try to redo it. He didn't have an explanation for why it seemed to be getting better than got worse. He didn't think there was an infection, but was willing to put me on antibiotics anyway (perhaps just to appease me). One complication that he did mention was that if the tooth was indeed cracked (he didn't see any crack during the RC) and the pain did not eventually go away, the only option would be to have surgery (to do what I'm not sure) or to have the tooth pulled - neither option I am keen on. So how is it that a cracked tooth can cause pain even after the root has been removed? The tooth itself can't be hurting anymore right? Would the crack somehow aggravate the periodontal ligament? I was getting a bit annoyed with the guy because he seemed unwilling to even consider the possibility that he may have done something wrong or even suboptimal during the procedure. One thing I noticed was that he seemed to have to apply a lot of downward pressure when inserting the permanent composite filling on top of the RC work. Not sure why that would have been necessary, unless the composite was setting faster than he was working... I suppose he could have cracked the tooth himself, but aside from that, could too much pressure have done some other harm or messed up the RC? John. > I was getting a bit annoyed with the guy because he seemed unwilling > to even consider the possibility that he may have done something wrong > or even suboptimal during the procedure. One of the reasons why I will have my recent root canal checked out by a different endodontist than the one who originally did it.. On Apr 13, 2:51 pm, "grube...@gmail.com" <grube...@gmail.com> wrote: > > I was getting a bit annoyed with the guy because he seemed unwilling > > to even consider the possibility that he may have done something wrong > > or even suboptimal during the procedure. > > One of the reasons why I will have my recent root canal checked out by > a different endodontist than the one who originally did it.. I thought of that, but to what extent would you have another endo check it out? It would be easy enough to have him take an x-ray and examine it for problems, but if he found nothing unusual, would you have him start drilling? Depends on the exact symptoms, physical presentation, x-ray image, previous history, etc.  Signature/ Amatus / > On Apr 13, 2:51 pm, "grube...@gmail.com" <grube...@gmail.com> wrote: >> [quoted text clipped - 9 lines] > examine it for problems, but if he found nothing unusual, would you > have him start drilling? A RCT does NOT remove the root, it only removes the soft tissue from inside the root. If there is a crack, it can be very hard to see. A crack would allow bacteria to seep along the length of the crack, and could allow parts of the root to move and "pinch the ligament holding the tooth in place". If there is already a crack in the root, the pressure of filling the root (during RCT) can split it further, however, those cases would have progressed further anyway. Signature/ Amatus / >> >> >I had my last of 5 RC sessions on a single tooth two weeks ago. It [quoted text clipped - 75 lines] > > John. > A RCT does NOT remove the root, it only removes the soft tissue from inside > the root. Yeah, I only meant the soft tissue of course, not any of the tooth itself (other than scrapings removed by the rasps). How far down should the RC go? Use this picture of tooth anatomy as reference: http://www.doctorspiller.com/tooth_anatomy.htm I understood the RC to remove all of the tissue in red that is also within the dentin. Should it also extend into the cementum or periodontal ligament, or even the jaw bone? What if it does? Would that show on an x-ray? If it extended too far, would that cause more pain than usual? > If there is a crack, it can be very hard to see. A crack would allow > bacteria to seep along the length of the crack, and could allow parts of the > root to move and "pinch the ligament holding the tooth in place". If the crack is only above the gum line, it should cause no pain in a RC-ed tooth, right? > If there is already a crack in the root, the pressure of filling the root > (during RCT) can split it further, however, those cases would have > progressed further anyway. > How far down should the RC go? Use this picture of tooth anatomy as > reference: [quoted text clipped - 4 lines] > within the dentin. Should it also extend into the cementum or > periodontal ligament, or even the jaw bone? Depends on which year we are talking about. 20 years ago, we were prepping these short of the end. Now we prep to the tip. Some schools like to see a "puff" out the end on the x-ray image. >What if it does? Would that show on an x-ray? I am not certain what you are asking. >If it extended too far, would that cause more pain than usual? I have not seen that to be the case. >> If there is a crack, it can be very hard to see. A crack would allow >> bacteria to seep along the length of the crack, and could allow parts of [quoted text clipped - 3 lines] > If the crack is only above the gum line, it should cause no pain in a > RC-ed tooth, right? Right, but if the crack spreads........ > > How far down should the RC go? Use this picture of tooth anatomy as > > reference: [quoted text clipped - 7 lines] > Depends on which year we are talking about. 20 years ago, we were prepping > these short of the end. The end of what, the tooth I guess? > Now we prep to the tip. Some schools like to see a > "puff" out the end on the x-ray image. What does the "puff" signify? > >What if it does? Would that show on an x-ray? > > I am not certain what you are asking. I meant, if the endo rasps out too far down through the canal and into the jaw bone, say, will that be visible on x-ray? > >If it extended too far, would that cause more pain than usual? > [quoted text clipped - 9 lines] > > Right, but if the crack spreads........ >> >What if it does? Would that show on an x-ray? >> >> I am not certain what you are asking. > > I meant, if the endo rasps out too far down through the canal and into > the jaw bone, say, will that be visible on x-ray? We often take a tiny file out through the end of the root on purpose to facilitate drainage through the tooth. No big deal. And, it cannot be seen on an x-ray image after the fact. >>Depends on which year we are talking about. 20 years ago, we were prepping >>these short of the end. > > The end of what, the tooth I guess? Most dentists now use an electronic apex locator. It is easy to find the end of the root to within a few tenths of a mm. >> Now we prep to the tip. Some schools like to see a >>"puff" out the end on the x-ray image. > > What does the "puff" signify? Most techniques for filling canal spaces involve a 'paste sealer' (a type of cement) and a 'filling cone' (gutta-percha, resin, or plastic point wrapped with gutta-percha are most common). The filling point pushes the sealer along and down the canal with hydraulic forces. If the canal has been cleaned and shaped all the way, a small 'puff' of sealer will be squirted out of the apex. D >Well, I called the guy, and spoke to his assistant first: she said >that there can be some pain for several months! If I am in that [quoted text clipped - 10 lines] >what I'm not sure) or to have the tooth pulled - neither option I am >keen on. We usually get 1 or 2 per year that take a while to settle down. It is rarely more than a few weeks, not months ! Give it some time, take the antibiotic and keep us apprised. Vertically fractured roots tend to have a specific presentation, and are not that difficult to diagnose if you know what to look for. Most endodontists are very good at spotting this. |
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