I have pain below the upper left cheekbone area. I would describe it as a dull, swollen ache feeling that is there all the time. I've had this pain since 2005. I've tried to figure out the source of the problem but to no avail. I had a root canal done in 2006/2007 (don't remember exactly) and I had hoped that maybe the cause was the tooth. However, the pain lingered and I've pretty much been living with the pain all these years. I went to different doctors but no one knows what's going on. Now recently, I went back to a dentist who claims to see signs of infection at the top of this old root canal. This is tooth #14. They are suggesting for me to clean and re-do the root canal.

After reading these posts by Bryana, I'm wondering if I should get the tooth extracted rather than re-doing the root canal. Basically some questions:
1) How likely is the pain I've been having all these years due to this possibly infected root canal? I mean if I've had an infection all these years, wouldn't it have gotten extremely bad by now? In other words, is it possible for this root canal infection to persist at a steady state, giving me this constant dull swollen achy sensation for all these years but not to the point where it was ridiculously painful?

2) Should I at least give the root canal option one more shot (making this the 2nd time) before considering extraction options?

3) What is the downside to extraction? From my point of view, half of the tooth is already gone from the root canal. Is there any risk or side effect from removing the tooth?

I know I'm not Bryanna, but I've had obscene amounts of dental work done.

Outside the fact anytime you have a root canal the tooth retains the infection, second time root canals have a much lower success rate. I'm missing 5 teeth (have implants) and 4 of those I attempted second root canals on and they all failed within a year. A dentist once explained that a root canal doesn't save a tooth, it just gives you more time until you lose the tooth. Root canalled teeth are incredibly brittle, so they break easily, and often times there is a crack in the root they can't see on an X-ray.

If you don't replace an extracted tooth, the other teeth usually shift to fill the space-unless it's a back molar, and the opposing teeth get longer because there is nothing to oppose it.

I don't know the answer on if the infection can cause the pain long term, but I would guess yes.

Hi pdne,

I am in the dental field and will answer your questions in bold type.

<<<1) How likely is the pain I've been having all these years due to this possibly infected root canal? I mean if I've had an infection all these years, wouldn't it have gotten extremely bad by now? In other words, is it possible for this root canal infection to persist at a steady state, giving me this constant dull swollen achy sensation for all these years but not to the point where it was ridiculously painful?>>>

THERE IS MOST LIKELY A CORRELATION. YOU HAVE PRACTICALLY DRAWN A MAP FROM YOUR TOOTH TO YOUR CHEEK BONE. THE INFECTION PROBABLY HAS GOTTEN WORSE OVER THE YEARS BUT IT'S OBVIOUSLY FINDING WAYS/AREAS TO DRAIN. IF IT HAS INVADED THE SINUS, THEN THE SINUS COULD BECOME ENLARGED AND THEN DRAIN.. ENLARGED AND THEN DRAIN. THE MAJOR CONCERN HERE IS... AND THIS IS GOING TO BE A BIT ALARMING..... YOUR BRAIN IS ONLY 3-4 INCHES FROM THE ROOTS OF YOUR TEETH. TOOTH INFECTIONS CAN CAUSE BRAIN ABSCESSES AND THE SYMPTOMS OF THESE INFECTIONS MAY OR MAY NOT BE SEVERE. SO THIS IS NOTHING TO TAKE LIGHTLY OR TO ALLOW TO GO ON MUCH LONGER.

2) Should I at least give the root canal option one more shot (making this the 2nd time) before considering extraction options?

IT IS THE TOOTH THAT IS CAUSING THE CHRONIC INFECTION. A SECOND ROOT CANAL DOES NOTHING TO ALTER THE INFECTION INSIDE OF THE MICROSCOPIC CANALS NOR WILL IT ALTER THE INFECTION THAT HAS NOW SPREAD TO THE BONE. THE PROCEDURE WILL HOWEVER CAUSE ADDITIONAL INFLAMMATION AND TRAUMA TO THE TOOTH AND SURROUNDING BONE. IT MAY ALSO PUSH BACTERIA FURTHER PAST THE APEX OF THE TOOTH AS THE FILES AND REAMERS ARE SHOVED UP INSIDE THIS WEAK AND FRAGILE TOOTH.

3) What is the downside to extraction? From my point of view, half of the tooth is already gone from the root canal. Is there any risk or side effect from removing the tooth?

THE UPSIDE IS ONCE THE TOOTH IS REMOVED THE SOURCE OF THE INFECTION IS REMOVED. IT IS ONLY THEN THAT THE AREA CAN BE SURGICALLY DEBRIDED OF VISIBLE BACTERIA, THE SINUS CAN BE SEEN AND TREATED IF NEEDED AND YOUR IMMUNE SYSTEM CAN START TO HEAL THIS SICK SITE. THE HEALTH RISK IS IN RETAINING THE TOOTH, NOT IN REMOVING IT. REPLACEMENT OF THIS TOOTH MAY BE COMPROMISED DUE TO THE LONG TERM INFECTION DEPENDING ON HOW DEEP IT HAS SPREAD. YOU MAY NEED TO BE ON ANTIBIOTICS FOR A WEEK OR MORE AND YOU MAY NEED A SECOND SURGERY IF THE AREA DOES NOT HEAL PROPERLY. YOU MAY BE A CANDIDATE FOR A PERMANENT BRIDGE OR A PARTIAL DENTURE. YOU WOULD HAVE TO DISCUSS YOUR REPLACEMENT OPTIONS WITH YOUR DENTIST.

Keep in mind that the longer you hold onto this tooth, the more advanced the infection and the more complicated the surgery. I'm sorry but extraction is inevitable with this tooth :/

I am here to provide information that is not often disclosed by some dentists. I hope you can now make an informed decision as to what you believe is in your best interest.

All the best to you.
Bryanna

Thanks for your advice. I wanted to mention a few things to get your opinion as well.

1) First, I have no pain in the tooth itself. Now, I suppose this is due to the fact that the nerve was removed during the first root canal. So what you're saying is that there is bacteria hidden in the microscopic root canals and this is somehow leaking toward the sinus region, which is causing this dull, gnawing, aching sensation?

2) I've been dealing with this pain for many years and have been led down many dead-ends. For example, an ENT doctor I saw years back thought it was due to a deviated septum. He recommended a septoplasty, which I did, but it didn't help with anything. I just don't want to get an extraction if it's not the true cause of this pain.

What other symptoms should I have to be positive that this pain I have is due to the tooth? Again, I have no pain inside the mouth at all. The ONLY pain I have is in this area right below the left cheekbone. It's not on the surface but it feels like it's several inches inside the face. I have no pain in the gums, which somehow makes me feel like the tooth is not the cause of the pain. I mean it is possible this root canal infection and the pain are two separate things. Does it surprise you that I can have pain in the area I mentioned earlier without having pain in the gums/tooth etc..?

Also, for the extraction route:

1) Based on my research so far, it looks like a dental implant is the best way to go? (vs. dental bridge etc..) It looks like in a dental bridge, you have to shave down the two adjacent teeth, putting them at risk long-term as well.

2) Would tooth #14 be a candidate for a dental implant?

3) I'm going over some of your old posts and I see you mention the possibility of infection in the bone and such. If I extract the tooth, which let's say is the source that's incubating the bacteria, then will the remaining infection be fought out by the body and I can be pain-free after nearly 8 years?

Hi pdne,

I will answer you in bold ... easier to follow

<<<1) First, I have no pain in the tooth itself. Now, I suppose this is due to the fact that the nerve was removed during the first root canal. So what you're saying is that there is bacteria hidden in the microscopic root canals and this is somehow leaking toward the sinus region, which is causing this dull, gnawing, aching sensation?>>>

PAIN IN THE TOOTH IS IRRELEVANT BECAUSE IT DOES NOT INDICATED THE EXTENT OF THE PROBLEM. ANOTHER EXAMPLE OF THIS WOULD BE... SOMEONE MAY HAVE SLIGHT DISCOMFORT IN THEIR CHEST AND/OR LONG TERM SYMPTOMS OF INDIGESTION. TURNS OUT TO BE HEART DISEASE. DIFFERENT LOCATION OF THE BODY, SAME SCENARIO.
THE ONLY NERVES THAR WERE REMOVED DURING THE RC TREATMENT WERE THOSE THAT WERE VISIBLE.
WHAT I AM TELLING YOU IS THAT THE TINY CANALS STILL CONTAIN NERVE MATERIAL... NECROTIC, INFECTED NERVE MATERIAL. THE BACTERIA STAYS WITHIN THE TOOTH AS IT SPREADS BEYOND THE TOOTH INTO TH PERIODONTAL LIGAMENT, INTO THE JAWBONE. THE SYMPTOMS THAT YOU HAVE ARE A RESULT OF THE AREA BECOMING OVERWHELMED WITH BACTERIA AND INFLAMMATION. SOME PEOPLE WOULD EXPERIENCE SYMPTOMS IN THEIR TOOTH... YOU ARE EXPERIENCING THEM BEYOND THE TOOTH. SAME PRINCIPAL, SAME SOURCE OF INFECTION.

<<<2) I've been dealing with this pain for many years and have been led down many dead-ends. For example, an ENT doctor I saw years back thought it was due to a deviated septum. He recommended a septoplasty, which I did, but it didn't help with anything. I just don't want to get an extraction if it's not the true cause of this pain>>>

MOST PEOPLE REPORT THE SAME LACK OF DIAGNOSIS AS YOU UNTIL THE TOOTH IS REMOVED AND THE ENTIRE TOOTH AS WELL AS THE SURGICAL SITE IS VISIBLE DURING THE SURGERY. THAT IS WHEN THE DENTIST ADMITS THE TOOTH WAS UNHEALTHY. ENT PHYSICIANS TEND TO BE CAREFUL AS TO ATTRIBUTING A SINUS PROBLEM WITH A ROOT CANALED TOOTH. ONE REASON IS BECAUSE THEY PRETTY MUCH ASSUME THAT DIAGNOSIS WILL FALL ON DEAF EARS AS MANY DENTISTS DO NOT MAKE THE CORRELATION. ENT PHYSICIANS RELY ON REFERRALS AS THE MAIN SOURCE OF THEIR INCOME. SO THEY TRY TO KEEP THEIR PEERS HAPPY. THOSE THAT COULD CARE LESS ABOUT THEIR PEERS TEND TO BE MORE APT TO TELL THEIR PATIENT ABOUT THE TEETH AND SINUS CONNECTION. I KNOW... THIS SOUNDS SO BAD... UNFORTUNATELY IT IS SO TRUE :/

<<<What other symptoms should I have to be positive that this pain I have is due to the tooth?>>>

MAYBE NONE. THERE IS NO "SHOULD" HAVE PAIN LIST TO DETERMINE THE CAUSE OF THE PROBLEM. EVERYONE HAS DIFFERENT EXPERIENCES WITH PAIN AND FOR DIFFERENT REASONS. SOME SYMPTOMS ARE MORE DIRECT WHILE OTHERS ARE NOT. WHAT ELSE DO YOU THINK COULD BE CAUSING THIS LONG TERM PAIN? HAVE YOU HAD AN MRI OF YOUR SKULL TO RULE OUT A TUMOR? WHEN YOU HAD THE DEVIATED SEPTUM DONE, DID YOU HAVE A SCAN DONE THEN? YOU SAID YOU HAD PAIN AND THEN THE RC DONE. COULD HAVE BEEN THAT THIS TOOTH WAS INFECTED AND THE ONLY SYMPTOM YOU HAD WAS PAIN UNDER YOUR CHEEK. WHY DID HE DO THE RC AT THAT TIME?

<<< Again, I have no pain inside the mouth at all. The ONLY pain I have is in this area right below the left cheekbone. It's not on the surface but it feels like it's several inches inside the face. I have no pain in the gums, which somehow makes me feel like the tooth is not the cause of the pain.>>>

YOU DON'T HAVE TO HAVE PAIN IN THE TOOTH OR IN THE GUMS TO HAVE AN INFECTED TOOTH. I HAVE HAD COUNTLESS PATIENTS WHO CAME IN FOR ROUTINE EXAM AND XRAYS WITH NO DENTAL COMPLAINTS.... ONLY TO FIND AN ABSCESSED TOOTH. GO FIGURE!

<<<<I mean it is possible this root canal infection and the pain are two separate things.>>>

COULD BE TWO THINGS OR MORE GOING ON AT THIS POINT. ACCORDING TO WHAT YOU WROTE... IT HAS ALREADY BEEN RADIOGRAPHICALLY CONFIRMED THAT YOU HAVE AN INFECTED TOOTH AND THE BACTERIA HAS SPREAD BEYOND THE TOOTH.

<<< Does it surprise you that I can have pain in the area I mentioned earlier without having pain in the gums/tooth etc..?>>>

NO, NOT AT ALL. IF THE INFECTION IS DRAINING INTO AN OPEN SINUS CAVITY, CHANCES ARE THE SINUS WILL FEEL SWOLLEN AND ACHY AND THE TOOTH MAY NOT HURT AT ALL.

I know this is not at all what you want to hear. The bottom line is this... based on the radio-graph it has already been confirmed that your tooth and the area above it has infection. Your choices of retaining an infected tooth are to leave it or re treat it with another rc or apico. Any one of those choices will not cure the infection or alter the prognosis other than the bacteria will continue to multiply and spread further. I'm sorry that seems so cut and dry... but that is the reality of the situation. I wish there was a way to cure an infected tooth... but it's just not physically possible.

Bryanna

Pdne,

<<<1) Based on my research so far, it looks like a dental implant is the best way to go? (vs. dental bridge etc..) It looks like in a dental bridge, you have to shave down the two adjacent teeth, putting them at risk long-term as well.

A DENTAL IMPLANT MAY BE RISKY SINCE THE INFECTION YOU HAVE HAS BEEN LONG STANDING... SINCE 2005..?? THE BONE MAY BE TOO COMPROMISED TO HANDLE AN IMPLANT. THE SINUS WOULD HAVE TO BE THOROUGHLY CHECKED ALSO BECAUSE IF THERE IS A PROBLEM THERE THAT WOULD HAVE TO BE REMEDIED PRIOR TO THE PLACEMENT OF THE IMPLANT OR YOU COULD END UP WITH THE SAME PAIN THAT YOU HAVE NOW.
TO DO A BRIDGE, YES YOU HAVE TO CUT DOWN AT LEAST TWO OF THE ADJACENT TEETH.... DEPENDS ON THE HEALTH OF THOSE TEETH AS WELL.

<<<2) Would tooth #14 be a candidate for a dental implant?>>>

IT WOULD BE AN AWESOME SPOT FOR A DENTAL IMPLANT PROVIDING THE BONE AND SINUS WERE HEALTHY.

<<<3) I'm going over some of your old posts and I see you mention the possibility of infection in the bone and such. If I extract the tooth, which let's say is the source that's incubating the bacteria, then will the remaining infection be fought out by the body and I can be pain-free after nearly 8 years?>>>

GREAT QUESTION? NO ONE HAS THAT ANSWER :/
IF YOU REMOVE THE TOOTH, YOU REMOVE THE SOURCE OF THE INFECTION.
THE AREAS WHERE THE INFECTION HAS SPREAD TO NOW BECOME A SEPARATE ENTITY FROM THE TOOTH AND THEY NEED TO BE DEALT WITH. NOT ALL INFECTIONS CAN BE ERADICATED COMPLETELY. SOME LINGER AND BECOME A CHRONIC PROBLEM. THAT IS WHY IT IS RISKY TO PLACE A DENTAL IMPLANT IN AN AREA THAT HAD A LONG TERM INFECTION. OTHER TIMES THE INFECTION WILL SHOW UP IN A DIFFERENT SPOT FROM THE ORIGINAL AREA BECAUSE THAT IS HOW BACTERIA TRAVELS IN THE BLOOD STREAM.

Bryanna

<<WHAT ELSE DO YOU THINK COULD BE CAUSING THIS LONG TERM PAIN?>>

I wish I knew but I've had so many claims over the years that I'm cynical these days. It wasn't just the septoplasty...I saw a dentist and he said it was probably the tooth and so I did the root canal and still had the pain afterwards. At the time, I concluded that the tooth wasn't the problem since I just had the root canal and my tooth didn't hurt and I believe the x-rays were clean. A TMJ specialist said the pain could be muscular in nature and probably due to clenching at night, so I had a night-guard done. Strangely enough, I found some relief from wearing the night guard but no idea how that would alleviate the infection, unless of course I was clenching and also infected at the same time.

<<HAVE YOU HAD AN MRI OF YOUR SKULL TO RULE OUT A TUMOR?>>
Yes, I had a MRI done twice many years ago when this first started happening. They both were negative.

<< WHEN YOU HAD THE DEVIATED SEPTUM DONE, DID YOU HAVE A SCAN DONE THEN?>>
Yes, I really felt I was misled at the time into getting the septoplasty because I was grasping for a solution. I had a scan done and the septum was slightly deviated. But since I was complaining about "pain", I guess the doctor felt compelled to provide an answer and I was willing to try it if it meant being pain-free. The scan didn't show anything else at the time.


<<YOU SAID YOU HAD PAIN AND THEN THE RC DONE. COULD HAVE BEEN THAT THIS TOOTH WAS INFECTED AND THE ONLY SYMPTOM YOU HAD WAS PAIN UNDER YOUR CHEEK. WHY DID HE DO THE RC AT THAT TIME?>>
Yes, when the pain started, I had no idea it was tooth-related. I went to an ENT first, actually multiple ENTs, and no one saw anything until the septoplasty guy. After the septoplasty, I was still having pain and I was constantly searching for answers. I went to a neurologist who said negative on nerve pain etc. Like I said earlier, I went to multiple dentists, some who said it was clenching and others just said they didn't see anything. Since it was so long ago, I can't remember exactly but when I did the RC, I believe it was during a regular dental examination and the infection showed up on the x-ray. That was when I was hoping the RC was the cause of the problem. However, it still persisted afterwards and at the time, after chasing so many dead-ends, I assumed the RC was another one.

If I had known the things you were mentioning now about the inaccessible canals and draining to the sinus, I would have been more persistent regarding the infected tooth scenario.

Will the oral surgeon be able to check the bone and sinuses for infection? Or do I need to see another doctor for that first? Appreciate any guidance on how to proceed next. Thank for your help. I've made up my mind to cancel the second root canal and get this tooth extracted.

Pdne,

Thank you for going into such a detailed explanation about this tooth situation. For me, the picture is very clear and here is why.

At the onset of the pain in your cheek, the xray showed that the tooth was having a problem. Because you did not complain of tooth pain, you couldn't get a dentist to admit the tooth was infected. <Keep in mind how I have told you how evasive dentists can be if the patient is not complaining about tooth pain.> This tooth could have been dying from having a previously deep filling in it and/or because it was fractured and/or as a result of your clenching/grinding habit the nerve became traumatized and died from the constant banging against it. All of these things are contributing factors to why a tooth becomes infected in the first place. One or more than one of them can be present. However, it only takes one of them to kill a tooth :/

So dentists were not of any help other than making you a night guard which temporarily helped BECAUSE it took the pressure off of this ailing tooth. It didn't make it healthy again because the nerve was too far gone. ENT's and others were not helping because they were finding you to be healthy. The one ENT saw a minor flaw and figured why not... let's fix it and see what happens. Grasping for answers you went along with him. But low and behold your problem was still apparent... why?... because it was a tooth problem all along.

Yes, the oral surgeon will be able to check the health of the bone and the sinus. But do NOT assume this will automatically be done. If you've read through some ..many... of these posts you will see repetitively how people report back saying their OS did not do a thorough surgery when extracting their tooth. I know, stupid.... unbelievable.... I know.... I know.

So here is where your self advocacy comes in to play... You have to be the one to express to him that you want to be sure he removes the periodontal ligament and all necrotic bone and tissue as you want a thorough debridement done once the tooth is removed. You are also concerned about a possible sinus communication so you want to be informed after the surgery if there is one, how large it is and if he had to repair it. You also want to be informed after the tooth is removed the health status of the sinus and if infected does it need intervention. Tell him you are considering a dental implant in the future if the area is healthy enough to place one. He may discuss bone grafting with you. Ask him if the site is infected or there is sinus involvement, would he still place the graft?? This is a judgement call for the OS and he will only know the real answer after he debrides the bone. But it is still good to discuss with him prior.

Most of my years in dentistry have been perio and oral surgery. I always get a kick out of an informed patient and appreciate their diligence in researching this stuff!! Some oral surgeons will take "slight" offense to a patient being so well informed.... others get their ego bruised a bit because they want you to assume they are great at what they do .... and others will say hey this is an informed patient who cares about his healthy, I'd better do a good job!

This is a tough situation for anyone to be in. The pain you have may not go away completely right away or it may linger forever. It has to do with the longevity of the infection and where it has resided all of these years. Sometimes there is permanent irritation to the facial nerves from being inflamed for so long. This is why I am not an advocate of root canal therapy even in a temporary situation because it can be difficult to eradicate the aftermath. But I also want you to know that many people seem to do really well and go on to be okay!!! So please think positively and take very good care of yourself

Bryanna

I'm not sure if the infection has spread to the bone, at least no one has mentioned that to me explicitly.

It's been quite an adventure this past weekend. I had pretty much given up on finding the cause of the pain and was mostly seeing a physical therapist for what I assumed to be muscuclar facial pain. I even had a night guard re-made recently. It was during that session that the oral surgeon said he saw something on my panoramic x-ray and suggested I see an endodontist. I saw the endodontist this past weekend and she wanted me to re-do the root canal and that led my to this website.

I really hope you're right and I can finally get to the bottom of this issue!

I have obtained copies of my x-rays and will be seeing an oral surgeon later today.

I will post them here just in case you have any comments as well. Cautiously optimistic here!

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