I had a root canal in December 2012 on a back lower molar, and have had non-stop pain since then. I've had a full re-treatment, and some additional treatments (that I don't fully understand) since then, and nothing alleviates the pain, which manifests as gum and jaw pain, sometimes radiating to the ear. Recently, a new dentist thought pain might be caused by an adjacent tooth, and so last week I had a root canal on that tooth as well. I am already worried that this tooth is about to go down the same path as the first one.

I have read some posts here which advocated extractions of root-canaled teeth. I have reached the point of pain and frustration where I am willing to consider this, but my question is why do none of the dentists I have been working with (2 dentists and 2 endodontists) not recommend this? They seem to oppose it on the grounds that they cannot see anything wrong with the tooth, or the root canal work; they say I could possibly be extracting a tooth without solving the underlying cause of the pain. But what else could this pain be? They have mentioned neuralgia (I guess TN) but have not given me a way to rule this out? Is there some definitive way to rule out TN before extracting the tooth?

I was more inclined toward extraction before the second root canal. Now I am worried that I will have to lose both teeth and get implants that I don't want and can hardly afford. But, more than anything, I want this pain to go away before it gets even worse. I'm worried that there's an infection underneath or in this tooth, but I don't understand why no one can see it. Can it really be the case that there is no empirical way to prove the tooth is bad (except by removing it and starting to feel better), and there is ALSO no way to prove that it is TN or something else. I'm at the end of my rope and cannot find an endo or dentist who can tell me anything definitive.

Is there a specialist in this sort of thing, and if so, how can I find them?

Please help!

Also wanted to add that I have an appointment with a periodontist tomorrow to see if the problem I am having with the original root canal is in my gum. Every dentist I have seen keeps warning me that I could remove the tooth and still have the problem, so trying to rule out as much as possible beforehand. Just wondering if anyone has any opinion on whether it is better to have an extraction performed on a root-canaled tooth by a periodontist or an oral surgeon. The receptionist told me when I made the appointment for the periodontist that they do extractions, and that people are "amazed" by the difference in the quality when done by this periodontist.

As I am not sure whether I can have (or want) an implant, I am just curious about the best way to go about having an extraction. So far, it seems, I have made really bad choices. I would love to get some input on how to move forward with this.

Hi sadie,

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

Dentists are taught to "save" teeth with root canal procedures. Unfortunately, the term "save" only indicates "retain" ... not cure. And every dentist is very aware of this fact. However, rarely will a dentist go into that explanation with a patient because endodontics is a very lucrative procedure and one that they don't want to give up.... and also dentists know that most people do not want to have their teeth extracted. So the game of endodontics is played until the tooth is so abscessed that there is no alternative.

You mentioned "some additional treatments". Did you have apicoectomies done on either of these teeth??

Without any doubt all root canaled teeth are infected as there is no access to the tiny canals that contain dead nerve tissue. So irrelevant of how many times the tooth is root canaled or apicoed.... these canals will always be diseased. There are many other things that occur in the bone surrounding these infected teeth which cause pain to develop that is often misdiagnosed as some form of neuralgia.

Infected teeth can cause or contribute to various nerve conditions in the jaw bone, some temporary and some permanent. This is one huge reason why infected and/or root canaled teeth should not be "retained" for any length of time. Most dental problems pose little to no symptoms until the problem is severe. So it is never wise to gauge a tooth infection by the limitation of symptoms.

It is without question wise to assume that all root canaled teeth have bacterial problems due to the anatomical structure of the tooth prohibiting access to the countless tiny canals preventing the tooth from being sterilized or curable.

I feel terrible that you had that other tooth root canaled as the original rc tooth was probably the source of your pain. To remove one of them simply means you have not dealt with the problem in its entirety. Unfortunately, you are not alone in this travesty. I wish dentists would inform their patients of the risks of keeping infected teeth.

The decision to remove or not remove these teeth will be yours and you may have to do some searching to find an oral surgeon to do it. You can consult with someone who is a member of the IAOMT organization as these practitioners have a clearer understanding and are more forthright in providing information to their patients.

Bryanna

Thank you so much Bryanna for your continued presence here and help with this subject. Do you know where I /we can find a professional who knows about bone infection and just treats them. I am again fighting with yet another oral surgeon who refuses to go there. The one person I knew who was able to help and heal me retired...Mostly he was tired of fighting with oral surgeon also. I would any where on the west coast.


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Hi Sue M,

I do not personally know of anyone on the west coast. Have you tried the IAOMT organization? You would have to do a search for dentists in specific areas and then call their office and ask if they treat bone infections or if they can refer you to someone who does.

Could you try to reach the dentist that retired and ask him if he knows of someone you could go to?

Bryanna

I thought I may have finally talked my dentist into approving the extraction, but now have met further opposition from the periodontist, who thinks I would benefit from seeing a TMJ specialist before any "irreversible" procedures. Just have a couple of questions (Bryanna, I would really appreciate your help here!) before I decide to see him or get another referral:

1. Is this pain I've been feeling really caused by the biological width issue? It feels almost like teething pain (from what I can remember about teething!) and sometimes as if the gum is trying to squeeze the tooth out of my mouth. It hurts 24/7, though it does seem to feel more irritated after eating or drinking. I do think it's the reason I originally (and mistakenly) sought out the root canal.

2. If it IS pain from the biological width violation (and not, say, from the root canal per se, or from a possible fracture of the tooth below the gum line): will the extraction of this tooth solve the issue, or will the gum remain inflamed? Would taking the temporary off (temporarily) really prove that it is or isn't a biological width issue? How long would it take to work? and, if that doesn't work, and I have the extraction,would there be any complications from the gum problem if I had to get an implant in a few months?

3.Is it possible that the TMJ is actually causing this pain in my gum? It seems impossible that even as much as I clench, I am manifesting this "teething" pain in my gum. I do have many of the symptoms of TMJ, the jaw pain, earaches, headaches, numbness in the left side of my face. The soft diet has helped somewhat. Is it worth it to further delay this extraction, and seek out a TMJ specialist? (And spend even MORE money.)

4.Why does NOT ONE dentist (endo, perio, etc.) want to pull this tooth? Why does everyone suggest some other "last ditch" effort I should make beforehand? I feel like Dorothy in OZ; I have finally gotten in to see the wizard, but he makes me go chase down the witch's broomstick before he'll talk to me. I have told the last two dentists that I am ready to have the extraction, but they both have insisted I try "one more thing" before I pull the tooth. Is having an extraction really so horrible?

This is driving me crazy. I feel like that guy who was trapped under a rock by his arm and had to saw it off himself. It's as if when he was finally ready and willing to sacrifice the limb for his life, a doctor came up and suggested he instead try some massage to relax his muscle.

This tooth has been hurting me since last Thanksgiving; at this rate I will see another holiday season without any relief. I'm sure I could just find an oral surgeon online who would pull the tooth, but I'm confused about why my own dentists are so hesitant to agree that it's the best course of action. I would rather have them on board than feel that I am disregarding professional advice. (And it's not even as though these two had anything to do with the original situation.)

I don't get it.

Hang in there Sadie, wait for Bryanna to respond to you. You can also try to PM. her. You do have some real concerns and valid points. she can best direct you in this. Dentists in general like to "retain" a tooth, even if it is infected. Bryanna knows your history. She will be along. I know you are feeling like Dorthy in OZ, it is confusing for me too. I know how anxiety can work a person over. ginnie

Hi sadie,

I will repost your questions and answer in bold type.

<<1. Is this pain I've been feeling really caused by the biological width issue? It feels almost like teething pain (from what I can remember about teething!) and sometimes as if the gum is trying to squeeze the tooth out of my mouth. It hurts 24/7, though it does seem to feel more irritated after eating or drinking. I do think it's the reason I originally (and mistakenly) sought out the root canal.>>

YOU ARE DESCRIBING WHAT DENTISTS REFER TO AS A PERIO/ENDO PROBLEM. THIS IS WHEN THERE IS A PERIODONTAL PROBLEM WITH THE BIOLOGICAL WIDTH AS WELL AS AN INFECTION IN THE TOOTH. IT CAN BE DIFFICULT TO DETERMINE WHICH ONE ACTUALLY CAME FIRST... THE PERIO ISSUE OR THE TOOTH INFECTION.

IN THE FIRST PLACE, THE TOOTH HAD TO BE COMPROMISED TO WARRANT A (CEREC) CROWN... MEANING DECAYED, BROKEN DOWN, HEAVILY RESTORED, OR FRACTURED. PERHAPS IT WAS INFECTED AT THAT TIME AND THE DENTIST DID NOT DIAGNOSE IT AS SUCH? IN ADDITION TO THAT THE CEREC CROWN DID NOT FIT PROPERLY WHICH RESULTED IN A GUM ISSUE.
THAT SQUEEZING SENSATION YOU DESCRIBE IS INFLAMMATION. IT MAY BE BACTERIAL RELATED FROM THE TOOTH AND THE GUM POCKET.

<<<2. If it IS pain from the biological width violation (and not, say, from the root canal per se, or from a possible fracture of the tooth below the gum line): will the extraction of this tooth solve the issue, or will the gum remain inflamed? Would taking the temporary off (temporarily) really prove that it is or isn't a biological width issue? How long would it take to work? and, if that doesn't work, and I have the extraction,would there be any complications from the gum problem if I had to get an implant in a few months?...

IT IS MOST LIKELY FROM BOTH THE TOOTH AND THE GUM. ONE PROBLEM IS FEEDING OFF OF THE OTHER. BOTH ARE CAUSING INFLAMMATORY ISSUES AND THAT IS WHY IRRELEVANT OF WHAT YOU DO TO THE GUM OR THE TOOTH THE PROBLEM WILL REMAIN. EVEN IF IT WERE ORIGINALLY GUM RELATED..... THE ROOT CANALED TOOTH HAS NOW ADDED TO THE BURDEN OF INFLAMMATION WHICH IS IRREVERSIBLE. EXTRACTING THE TOOTH WOULD ELIMINATE ONE PIECE TO THE PUZZLE WHICH IN TURN STOPS THE IRRITATION WITH THE GUM TISSUE. BOTH PROBLEMS WOULD BE RESOLVED. ONCE THE GUM TISSUE IS HEALED AND THE INFLAMMATION IS GONE, THEN SO LONG AS THE BONE IS HEALTHY AND ADEQUATE TO HOLD AN IMPLANT... A DENTAL IMPLANT MAY BE A VIABLE OPTION TO REPLACE THIS TOOTH. THE ONE CONCERN REMAINING WOULD BE THAT THE IMPLANE IS BEING PLACED NEXT TO ANOTHER ROOT CANALED TOOTH WHICH HARBORS BAD BACTERIA THAT WILL EVENTUALLY SPREAD TO THE JAW BONE.

<<<3.Is it possible that the TMJ is actually causing this pain in my gum? It seems impossible that even as much as I clench, I am manifesting this "teething" pain in my gum. I do have many of the symptoms of TMJ, the jaw pain, earaches, headaches, numbness in the left side of my face. The soft diet has helped somewhat. Is it worth it to further delay this extraction, and seek out a TMJ specialist? (And spend even MORE money.) >>>

YOUR TMJ PROBLEM MAY BE RELATED TO MANY THINGS AND MAY NEED TO BE ADDRESSED MORE SERIOUSLY AT SOME POINT. HOWEVER IRRELEVANT OF HOW YOU TREAT THE TMJ YOU ARE STILL LEFT WITH TWO NON VITAL DISEASED TEETH. ANYONE THAT HAS A CHRONIC INFLAMMATION FROM A GUM OR TOOTH PROBLEM WILL TEND TO CLENCH THEIR TEETH TOGETHER AS A NATURAL REACTION TO A FOREIGN OR ABNORMAL ANNOYANCE IN THEIR MOUTH. SO VERY OFTEN PERIO PROBLEMS AND TMJ PROBLEMS GO HAND IN HAND.

<<4.Why does NOT ONE dentist (endo, perio, etc.) want to pull this tooth? Why does everyone suggest some other "last ditch" effort I should make beforehand? I feel like Dorothy in OZ; I have finally gotten in to see the wizard, but he makes me go chase down the witch's broomstick before he'll talk to me. I have told the last two dentists that I am ready to have the extraction, but they both have insisted I try "one more thing" before I pull the tooth. Is having an extraction really so horrible?>>>

BECAUSE THEY HAVE BEEN EDUCATED ON HOW TO RETAIN TEETH WITH LITTLE TO NO EMPHASIS ON THE SYSTEMIC CONSEQUENCES OF RETAINING THESE DEAD, INFECTED TEETH. ROOT CANALS ARE THE MOST PROFITABLE FORM OF DENTISTRY AND MANY DENTISTS WANT PEOPLE TO BE UNINFORMED AS THAT LIMITS THE QUESTIONS THEY HAVE TO ANSWER AND POSSIBLE LEGAL CONSEQUENCES.
YOUR SITUATION IS COMPLICATED IN THAT THERE IS MORE THAN ONE ISSUE GOING ON AND THERE ARE SEVERAL DENTISTS INVOLVED ALL OF WHOM ARE NOT WILLING TO DETERMINE OR DISCLOSE TO YOU WHAT CAUSED THE ORIGINAL PROBLEM. THEY HAVE SEEN YOUR PROBLEM COUNTLESS TIMES AND CERTAINLY HAVE THEIR SPECULATIONS BUT WILL CAUTIOUSLY SHARE THEM WITH YOU FOR FEAR OF STEPPING ON A COLLEAGUES TOES.

HAVING A TOOTH PULLED IS NOT USUALLY A BAD EXPERIENCE. HOWEVER IT IS NOT REVERSIBLE AND YOU HAVE TO BE SURE OF YOUR DECISION. I CANNOT EMPHASIZE ENOUGH THAT YOU HAVE TWO TEETH IN JEOPARDY, NOT JUST THE ONE SIMPLY BECAUSE THEY ARE BOTH ROOT CANALED.

Bryanna

Hi Bryanna,

Thanks so much for your reply. No, I did not have an apico on either tooth; my first dentist did not recommend it, and I had by that time already read a lot of very discouraging things online about the procedure. Unfortunately, I had not read about the general infection issues with root canals until recently, and had already undergone the second root canal.

The "other" procedures I'm referring to in terms of the first root-canal are various phases of re-treatment (including calcium hydroxide) and one procedure in which the dentist said he sterilized the tooth, using a laser. This did stop the percussive pain, but did not alleviate the pain around and inside the gum, which began right after the root canal and has continued unabated to this day.

Sometimes it's better and sometimes it's worse (which I don't really understand; why is it better in the morning?) but it's never felt like a healthy normal tooth since before the root canal. The frustrating thing for me is that for 9 months I have been telling two sets of dentists and two endos that the tooth is either fractured or infected or both, and they have kept me on a path of investigating other options (in addition to retreatments- replacing a year old crown,and now peridontal issues). I feel like I have made a serious commitment to this root canal, and not just a financial one (though that of course is SUBSTANTIAL). I have missed holidays and vacations (and funerals) and just day-to-day life waiting for this pain to subside, and the root canal to settle down. The fact that it will not EVER do this is heartbreaking to me, and made worse by the fact that my friends and family cannot imagine how I have been rendered so incapacitated by a *mere* root canal. Especially when all the medical professionals find absolutely nothing wrong with the tooth.

I have seen some of your other posts on here and I really appreciate your taking the time to respond to me. Just wondering if you have any additional insight about ruling out the other possibilities (TN, TMJ, violation of the biologic width of the tooth) so that I can convince my dentist to do the extraction. Also, if you have input about the difference between letting a periodontist (who does implants) and an oral surgeon do the extraction. Since I am seeing the periodontist tomorrow (and I would have to find a separate oral surgeon) it would be convenient to be able to schedule something with him, especially if I decide to do the implants. Or should I start searching for an oral surgeon who would be willing to do this?

Thank you again for all your help!

Apologies to everyone for this second post; still trying to figure out how things work on the site, and yesterday posted this question within another post. This is the first place I have received any answers that make sense to me after nine months of suffering with a root canal on a bottom molar, and I am hoping that an extraction will start the healing process. The question now is: who is most qualified to perform this extraction?

I have appointment later today with a periodontist (my dentist wants my gums checked out before he agrees to extraction) who regularly does extractions as part of his practice. The receptionist explained to me that they take extra care because their goal is to make the area as clean as possible so that they can do an implant. (That's ANOTHER question, actually, do I need to have the implant? Dentist seems to believe teeth will shift without it, or top tooth will grow down, or perhaps both with my luck. But I am not convinced yet.)

Anyway, I have little experience with any of this until now. I had my wisdom teeth removed years ago by an oral surgeon, and I suppose I always thought they were the only people who could/should pull teeth. But it did seem reasonable that someone who is preparing the area for an implant might do just as good a job as an oral surgeon. Opinions?