Hello,

Two months ago my crown fell out of my mouth, a crown that I have had for ten years (front upper tooth) . I never felt any pain from my tooth under the crown and had no problem with it until it fell out. I needed to get a crown 10 years ago because my root filled toth broke. I went to the dentist after the tooth fell out and he took some X-rays and told me that there was some infection and that he would need to take out the old root filling and put a new one. He put calcium in it after the root canal, after that I got some pain in the tooth and got some antibiotics and the pain went away but instead I started to get pain in the lower front tooth. The dentist ended up rootfilling the lower front tooth as well after he found a filling in it that had been leaking. Anyways, the pain in the lower front tooth finally went away but came back after several days, a sensitive pain, not a bad one, the dentist finally finished the root filling process with the lower tooth and still it is sense
tive with a little pain, one week after the final visit. Then suddenly I started to feel pain in my upper front tooth AGAIN (the little pain in the lower tooth is there as well). The pain feels like a sinus pain, I am not in pain when I chew on it, it just feel like an irritation, it is like a pain in my chin or something, I have been taking antibiotics but they have not helped. I have got holes in my teeth in the molars and sometimes the pain mooves from the front tooth to them.
Have you got any idea what could be the problem. I have been reading that an infection in a rootfilled tooth can never go away and it is always better to remove the tooth and get an implant? I also want to ask if the dentis could maybe take a look at this by openning the crown or will he have to remoove the crown in order to see what is going on?When the dentist finished working on the upper front tooth and put the old crown back in place he saw nothing wrong with it an nothing strange in the x-rays as well.
Thank you and I hope you can help :-)
My best regards

Hi annikasamper,

The problem is that once a tooth becomes infected or it is root canaled, the tooth remains infected. Some rc teeth hurt and others won't because if a tooth has made a path in the bone for the bacteria to drain, the inflammation will be temporarily reduced which means less physical pain ...until the path closes over. A draining infection is serious and does not alter the fact that the tooth remains infected. It does not matter how many times a tooth is root canaled... or how many times the rc tooth is crowned.... or what it used to disinfect it..... or what the canals are sealed with... or how many times an apicoectomy is done.... the only way to cure the infection is to remove the source of the infection which is the tooth.

Dental infections may not show up on an xray until they are large enough or pronounced enough to be picked up on the 2 dimensional film. So by the time a dentist sees it on the xray, the infection has already been present for quite some time.

There really is no way to "open a crown" to evaluate a tooth. Yes, some dentists will drill into the biting surface of a crown in an attempt to gain access to the large canals and perform a root canal. However, the view is minimal at best and there is never any access to the tiny canals that will continue to harbor infected nerve tissue. Cutting into a crown will ruin the integrity of it and compromise the stability of the crown. The bacteria and germs from doing the root canal cannot be completely removed from underneath that crown after the procedure and this is one reason why people often end up with a decay underneath the crown of a root canaled tooth.

Do you have a treatment plan with your dentist that includes all of your teeth?? Because it sounds like you have several dental problems and your dentist may be just patching you up here and there. It is not ideal to be patched up because not only will there always be issues with the patch up but the other problem teeth will eventually hurt too.

Bryanna

Dear Bryanna,
Thank you so much for you answer.
I talked to my dentist before I saw the answer from you and he told me to wait and see, he said that because I donīt have a pain when I "knock" on the tooth it is not an infection. I have pain but the pain is like someone has been trying to pull the tooth out of my mouth, some kind of an irritation that leads to my chin. The dentist wants to do some kind of a root operation if the pan does not go away...My other teeth that have got holes in them, they will be fixed, I just have not had that done, I am afraid as well. Do you think I should see another dentist and is it , like you said, the infection could be there although I donīt hava a pain when I knock on my tooth with my fingers?
Thank you again.

HI annikasamper,

Most dentists will not tell their patients that root canaled teeth are infected. If you skim through many of the previous posts on this forum, you will see countless people with that same concern.

You do not have to have pain at all for the tooth to be infected. So it is irrelevant where you feel the pain or if you feel pain. Every tooth has many hundreds of microscopic canals that are not accessible therefore they will continue to contain dead, infected nerve tissue. This simply means that irrelevant of what is done to the tooth, the tooth remains infected. The infection will eventually spread to the bone because it cannot contain itself within those tiny canals indefinitely. From your description, the infection has already spread to the bone and that's why your dentists is talking to you about doing the surgery.

The surgery he is talking about is called an apicoectomy. To be truthful, this is a barbaric surgical procedure in which the dentist removes a piece of the bone above the root of the tooth, does a root canal procedure from the top of the tooth down, somewhat plugs up the hole in the bone with either a mercury filling or cement and then sutures the gum closed. This procedure does nothing to alter the infection inside of the tooth. It will however cause more inflammation, more pain and permanently ruin the integrity of the bone. Many dentists do not even recommend this procedure anymore because it serves no purpose.

I am sorry to give you this bad news. I am sorry to say that many dentists fail to inform their patients about the truth about root canaled and infected teeth.

It is your choice whether you want to wait and see what happens. But understand that even if the tooth feels better, it doesn't mean the infection is gone. It means it is draining which can affect your systemic health.

I know this is not an easy thing to deal with and I do wish you the best.
Bryanna

Thank you again dear Bryanna. I have been getting sinus infection for the last years, always taking antibiotics to cure it and it always comes back, maybe, as you said that is because of the infected old tooth. One question in the end, if I have the tooth pulled out and have an implant, do you think that the pain in my sinus area will wanish, will I have some problems with the implant? And one more.....I have been having constant shoulder pain, thought it was musclular pain but maybe this is all because of the infected front tooth?

Again thank you

Hi annikasamper,

The antibiotics were obviously not curing the sinus infection they were just subsiding the symptoms most likely because the infection originated someplace other than the sinus. And yes, infected teeth can and will cause sinus infections. However, many general dentists will not acknowledge that fact. Oral surgeons and ear nose and throat doctors know better as they treat these things all of the time.

Removing an infected tooth is the first step to curing the infection. There is no guarantee that the bone will become completely healthy after the tooth is removed because the infection has been in the bone for a very long time. But the longer the tooth is present, the more severe the infection. So it is wise to remove the tooth sooner than later.

Replacing an infected tooth or any root canaled tooth with a dental implant is a risky thing because the bone may be compromised. Implants replacing root canaled teeth have a higher failure rate for that reason. You would have to discuss replacement options with your dentist.

Regarding your shoulder..... any oral infection can travel elsewhere in the body. This is referred to as a focal infection with a systemic result. Also any time the immune system is dealing with a chronic infection, any weak area of the body will become compromised.

Bryanna

Thank you for you answer. Just so I understand something regarding an implant. I thought that was the only choice after a tooth has ben extracted? Would a "bridge" be a better choice. This is a front upper tooth or the one next to the main (two) front teeth. There is something that can be replaced isnīt it? I do not have to be without a tooth? :-) No I am just worried, I just want to know what could be the best choice if not an implant. I do not quite understand this.....
Thanks and my best regards,

Hi annikasamper,

So you are talking about your upper lateral tooth. This would be the tooth next to a front tooth. Correct?

Your long term (permanent) replacement options depend on the health of the bone as well as the health of your gums and teeth in general. So it would be wise to have a complete treatment plan that included all of your teeth not just this one.

Some permanent replacement options could be:
...A dental implant if the bone is healthy and adequate enough to hold the implant.
...A permanently cemented bridge that spanned across several teeth and would replace this missing tooth with a fake one attached to the bridge. To do this the teeth involved in the bridge would have to be healthy (not root canaled). Those teeth would be shaved down and covered by the bridge. Replacing a lateral tooth would mean that at least one central (front tooth) and the canine (the tooth behind the lateral) would need to be part of the bridge as they would serve as anchor teeth to the bridge that replaced the lateral.
...A removable partial denture which is an appliance that replaces any missing teeth in the entire arch. So if you had other teeth missing or had them removed due to extensive decay then the partial would replace those teeth as well as the lateral. This is worn for esthetics, to keep the existing teeth from shifting and can be worn when eating most foods.

The short term or temporarily solution could be what is called a flipper or small removable partial denture. It is a small appliance similar to a retainer that has a tooth on it to replace the extracted tooth. This appliance snaps into place and is removable. It is worn for two reasons. One is esthetics so that you don't walk around with a missing tooth. Two prevent the adjacent teeth from shifting towards the space.

Without xrays or a clinical view of your mouth I cannot tell you what would be the best choice for you. This is why you need to discuss your overall dental problems with your dentist, explain to him that you are concerned about keeping infected teeth and may want them removed... this way he can give you a comprehensive treatment plan that includes every thing. If you patch things up here and there you will find yourself in the dental chair more than you want to be and financially patch up dentistry always costs more in the long run.

I hope this information is helpful to you. I know this can be very confusing. If you are concerned about keeping your root canaled teeth for the reasons that I have stated, then please sit with your dentist and seek an alternative treatment plan that includes removing those teeth, replacing them and taking care of the rest.

I wish you well...
Bryanna

Hello dear Bryanna,

I have now decided to have my upper lateral tooth extracted.
I have been having this weird dull pain in that tooth or the area around it.
I want to ask you a couple of questions though before this is done:

1. The dentist tested me this morning and anaesthetized my upper lateral tooth. I had been having pain in my lower tooth and that pain almost went away after he had numbed the upposite one (refferd pain?) Could this be a proof that the upper tooth is the guilty one?

2. Do you think that when I have this two times root canaled crown tooth mooved with its roots that I will get rid of this pain?

3. Can I expect to have pain after the extraction for a long time, they are now making a temporary tooth that I have to have in my mouth for about 8 months all together.

The dentist wants do do this because he says that if he will do this apicoectomy surgery he says that he will damage the bone even more (like you said) I will probably, at any time in my life have to have it extracted, better now because of thiss strange dull pain in it and the opposite tooth.

One more thing, is it not strange that my pain in this upper tooth comes and goes all over the day and I hardly fell it during the night.
I have not got headaches, it is not a muscular problem, it is just this tooth isnīt it ? :-)

I just wanted to hear from you before the etraction will take place :-) Thanks again so much.

Sorry just adding a little bit.....Sometimes it feels like the pain is coming directly from the front lower opposite tooth but that tooth never had any problems until the root canaled old crown tooth fell out and they started repairing it....Is referred pain in opposite teeth normal,a referred pain that is going down, not up? I am just scared to have this old sick tooth restracted.
This upper lateral tooth shows no infection in Xrays and the bone is ok but it has been damaged due to this older infection.
BTW I have had most of the other holes in my mouth repaired, they were not big.

Thank you again, I am hoping for some answers soon, my tooth will be extracted on thursd. og friday.