[robertw]

Here's a situation:

Tooth root canaled three years ago. In January some discomfort for a day, fistula developed. No discomfort; just a little sensitive to toothbrush. X-rays show nothing except small dot in center of tooth. Root canal retreated. Three weeks later permanent filling. Two months later either a new fistula, or the old one, is draining. What is, given the above facts, most likely causing the infection, and the fistula to keep draining?

[Kitt]

Welcome robertw.

Someone will be along to help.

[Bryanna]

Hi robertw,

I am in the dental field and can offer you information here.

It's simple, the tooth is infected and will continue to be infected irrelevant of how many times you have it root canaled. There are several reasons for this however the easiest to understand is that every tooth has many many hundreds of tiny canals called accessory canals or dentin tubules that contain nerve tissue. These canals are microscopic, very curvy and connect to other tiny canals and vessels. During the rc procedure none of these tiny canals are accessible. Therefore the nerve tissue that resides inside of them cannot be removed and it becomes necrotic and diseased causing the tooth to be chronically infected.

Also the fistula that has formed is from the infection which has proliferated beyond the tooth into the bone or further. The fistula is the end or opening of a burrowed tunnel from the tooth through the bone out through the gum tissue. This burrowed tunnel is called a tract. The bone surrounding this tract is diseased and deteriorated. So now the jaw bone as well as the tooth is infected.

Every dentist is aware of these canals and knows there is no access to them. Patients should be informed of this prior to consenting to the procedure. Root canals are performed to attempt to allow a person to "retain" a diseased tooth for an undetermined amount of time. Root canals as well as apicoectomies cannot anatomically "cure" the disease that resides inside of an infected tooth.

The only attempt at curing the infection is to remove the source of the infection which is the tooth and the diseased bone around the tooth.

I'm sorry if you were not informed of this information prior to consenting to the root canal procedures.

Originally Posted by robertw

Here's a situation:

Tooth root canaled three years ago. In January some discomfort for a day, fistula developed. No discomfort; just a little sensitive to toothbrush. X-rays show nothing except small dot in center of tooth. Root canal retreated. Three weeks later permanent filling. Two months later either a new fistula, or the old one, is draining. What is, given the above facts, most likely causing the infection, and the fistula to keep draining?

[robertw]

Thank you for your reply and information. My question is, the root canal worked for three years. Then developed a fistula. The root canal was retreated and the fistula either came back or developed a new one within 2 months. Why did the retreatment fail so soon and shows no sign of infection or fracture on x-rays? What does this indicate?

Originally Posted by Bryanna

Hi robertw,

I am in the dental field and can offer you information here.

It's simple, the tooth is infected and will continue to be infected irrelevant of how many times you have it root canaled. There are several reasons for this however the easiest to understand is that every tooth has many many hundreds of tiny canals called accessory canals or dentin tubules that contain nerve tissue. These canals are microscopic, very curvy and connect to other tiny canals and vessels. During the rc procedure none of these tiny canals are accessible. Therefore the nerve tissue that resides inside of them cannot be removed and it becomes necrotic and diseased causing the tooth to be chronically infected.

Also the fistula that has formed is from the infection which has proliferated beyond the tooth into the bone or further. The fistula is the end or opening of a burrowed tunnel from the tooth through the bone out through the gum tissue. This burrowed tunnel is called a tract. The bone surrounding this tract is diseased and deteriorated. So now the jaw bone as well as the tooth is infected.

Every dentist is aware of these canals and knows there is no access to them. Patients should be informed of this prior to consenting to the procedure. Root canals are performed to attempt to allow a person to "retain" a diseased tooth for an undetermined amount of time. Root canals as well as apicoectomies cannot anatomically "cure" the disease that resides inside of an infected tooth.

The only attempt at curing the infection is to remove the source of the infection which is the tooth and the diseased bone around the tooth.

I'm sorry if you were not informed of this information prior to consenting to the root canal procedures.

[Bryanna]

robertw,

The root canal only appeared to work for three years simply because you did not have any obvious symptoms of the chronic infection until the fistula appeared. The appearance of the fistula indicates a long standing infection as the bacteria takes times to burrow through the bone.

All root canaled teeth contain necrotic diseased nerve tissue inside of those tiny canals that I mentioned in my previous post to you. Because symptoms of a problem were non existent or delayed does not indicate that this tooth was not diseased.

The second root canal procedure temporarily reduced the inflammation as some of the decrepit tissue inside of the large canals was removed. The reason it was temporary is because the diseased tissue is still residing in those tiny canals as well as in the jaw bone along the fistula tract.

This tooth may or may not be fractured. Most of the time tooth fractures do not show on dental x-rays as they are only a 2 dimensional image. Again due to the limitations of the radiographic images some infections will not appear until they have proliferated way beyond the tooth and surrounding bone.

That small dot in the center of the tooth that is seen on the x-ray will actually be larger clinically and it indicates decay or tooth rot which has occurred from the infection. That area is no longer hard as it should be it is soft and mushy from the infection.

I know you want to believe that your tooth was okay for three years. But the truth of the matter is that tooth has been infected the entire time. We all want to go by symptoms as they are what alerts us to a problem. However, most dental problems have little to no symptoms until the problem has progressed. Similar to heart disease or diabetes.... symptoms are not always present until the disease has progressed.

I know this news is not pleasant to learn but I hope that this information has been helpful to you.

QUOTE=robertw;1077761]Thank you for your reply and information. My question is, the root canal worked for three years. Then developed a fistula. The root canal was retreated and the fistula either came back or developed a new one within 2 months. Why did the retreatment fail so soon and shows no sign of infection or fracture on x-rays? What does this indicate?[/QUOTE]

[triciac606]

Hi Bryanna, I couldn't find other way to contact you, can you tell me what do you think of my number 14 X-ray thanks.

[triciac606]

Hi, Brianna can you tell me what do you think of my X-ray tooth 14. Thanks

[Bryanna]

Hi tricia,

Thanks for posting the x-ray.

Tooth #14 is root canaled and there are several things showing on the x-rays.

1) The tooth is diseased and irrelevant of how many times it is root canaled it will continue to be diseased.

2) The pre op xray shows that the bacteria had proliferated beyond the tooth into the bone around the apex (root) of the tooth.

3) The post op xray shows that the same infection is still present in the bone and has possibly communicated with your sinus.

4) It also appears on the post op xray that you are developing a deep pocket at the distal portion of the tooth. This area is in between #14 and 15.

5) During the rc procedure it appears that the dentist perforated the apex (root tip) during instrumentation. That small thin white line at the end of the tooth that kind of looks like a sail indicates either a piece of gutta percha material or a glob of liquid filling material was pushed through the perforation into the bone and possibly into the sinus.

From these xrays it is not possible to determine if the infection and filling material has gone into the sinus. But it is quite possible. This tooth is very close if not into the sinus. It is also possible that you have a cyst surrounding this tooth as well.

The only way to attempt to cure this infection is to have the tooth removed by an oral surgeon. The bone and possibly the sinus would need to be surgically debrided at the time of the extraction.

[robertw]

Thank you again.

Originally Posted by Bryanna

Hi tricia,

Thanks for posting the x-ray.

Tooth #14 is root canaled and there are several things showing on the x-rays.

1) The tooth is diseased and irrelevant of how many times it is root canaled it will continue to be diseased.

2) The pre op xray shows that the bacteria had proliferated beyond the tooth into the bone around the apex (root) of the tooth.

3) The post op xray shows that the same infection is still present in the bone and has possibly communicated with your sinus.

4) It also appears on the post op xray that you are developing a deep pocket at the distal portion of the tooth. This area is in between #14 and 15.

5) During the rc procedure it appears that the dentist perforated the apex (root tip) during instrumentation. That small thin white line at the end of the tooth that kind of looks like a sail indicates either a piece of gutta percha material or a glob of liquid filling material was pushed through the perforation into the bone and possibly into the sinus.

From these xrays it is not possible to determine if the infection and filling material has gone into the sinus. But it is quite possible. This tooth is very close if not into the sinus. It is also possible that you have a cyst surrounding this tooth as well.

The only way to attempt to cure this infection is to have the tooth removed by an oral surgeon. The bone and possibly the sinus would need to be surgically debrided at the time of the extraction.

[danieldemaree]

Hi Brianna, I.m also new in this forum and I see your knowledge and experience you give to the people, we'll going to the point, I have total 2 root canals, in #6 and in#8, dentist says 8 looks all ok but 6 the canine has the round ball of infection on top and I fill a little fistula inside my nostril that grows when I have 1 or 2 times a week like a one day cold (like an allergy attack) with sniffing, mucus, headache, etc and that little fistula grow little more and comes down after, but now I'm having itchy nose and eyes every morning for several ours, etc
So the dentist said the rc wasn't done right it wasn't filled, that can be corrected and that the out side of the toot, with the root, doesn't communicate with the inside tubules so he can redo it right for the infection to desapear.
I understand with you that the only way would be extracting the toot but can you give me your opinion of what the dentist believes? If I take out my canine would my lower face look unsimetric? (I Have a bridge between 6 and 8)
After about 9 years that start this problem I'm really tire and sick of it, can you please give me your advise? Thank you so much. Dan.