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

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?

hi
I have merged your threads as it is best to keep all replies together when on the same topic.

Hi sadie,

Sorry I was not able to get to you earlier today.... but I just got home from working all day.

By now you have seen the periodontist. What did he say about the health of your gums?

Ideally an oral surgeon would be the one to remove your teeth. Periodontists are also surgeons and they also do extractions.... but not nearly as frequently as oral surgeons. There are some cases when a periodontist would be preferred over an oral surgeon but they are specific cases and not the norm. The choice would be up to you.

All dental surgeons are trained to remove teeth in a manner that is thorough but at the same time cause the least amount of trauma to the bone. Unfortunately not ALL perio or oral surgeons necessarily follow that training :/

Regarding the replacement of this tooth....
It is true that when a tooth is removed, other than a wisdom tooth, the adjacent teeth will shift towards the new opening. The opposing teeth either above or below the extracted tooth will naturally gravitate towards that open space. There are some cases where this movement occurs very slowly or very little. There is no way of telling what the outcome would be.

Bryanna

Thanks Bryanna. Of course, I realize that you are not available 24/7 to answer my questions; I'm just very appreciative to get your input, and I thought (or was hopeful) that I might get a chance to do at least one extraction today, so I was worried that I had to make an immediate decision.

Instead, the periodontist said that he thought there was some violation of the biologic width of the first root canaled tooth. This tooth had a Cerec crown on it that had universally criticized by every dentist and endo who subsequently saw it. It never felt like it fit in my mouth, and in fact always seemed like it was cutting into my gum. Eventually (it was less than a year old at the time of the root canal) I sort of got used to the discomfort, though never completley. Last year right before Xmas, however, the pain welled up and instead of going to my regular dentist (not the same one who made the cerec crown), I asked for a endodontist, thinking I needed to take care of it before the holidays.

After the root canal, however, the gum swelled and wouldn't calm down. Even after they fixed the pain and pressure of the tooth itself, the gum never felt right. It is this feeling that there is always something stuck under the tooth (or that I need to floss constantly because of some invisible pressure) that has been the most troubling part of this last year. He performed some minor work scraping the gum away from the tooth (here I'm slightly fuzzy on the the details) to see if the gum can start to repair itself.

More important (at least in my mind) is that he said that thought both of my root canals may have been unnecessary. He thought it was possible that my original pain may have come from the awkward placement of the cerec crown, and that the additional pain might have originated with that as well: my bite has shifted to one side, possibly from the crown and some other dental work I had done at the same time. He suspects I also now have a TMJ issue, which makes sense to me as I have been having headaches and some numbness on that side of my face.

He wants me to wait before any further procedures (i.e, extraction) to see if his gum treatment yields any benefit and also if I get any relief from some simple TMJ exercises and treatment. I can't tell you how awful it was to learn that I quite possibly had TWO root canals for no good reason, not even as you say to "retain" the teeth. It's horrible to think I spent all this time and money AND compromised my present and future health just because I thought I needed a root canal, and I found an endodontist who agreed.

I like this periodontist and despite the pain I have been in, he did manage to persuade me to wait another couple of weeks to see if the treatment he did (and the other stuff he wants me to do) will make a difference. I realize I probably still need to have the extraction, but I am so angry at having two teeth root-canaled for no reason that it is hard to make another drastic decision at the moment. It's bad enough to have a root canal when you are facing a major abscess; in my case, the endo told me only after the fact that there was no infection, just "inflammation" of the nerve. I guess that means I killed two perfectly good (or at least, not BAD) teeth.

At least I hope I know enough now not to be talked into another root canal, ever.

I know you're going to say I still need to extract the tooth (teeth). And I'm sure you're probably right, but I am going to wait until after Labor Day, since everyone on vacation until then anyway. In the meantime, I would love to get your input on this gum issue, the biologic width thing. From what little I have read online, it does seem to match up with my pain and the sensation in my gum. Also the TMJ: I kept feeling like my bite was off, and it just kept getting worse after the root canal (especially since I couldn't chew at all on that side for the last 9 months.)

And thanks again so much for getting back to me. I feel like I spent 9 months wandering in the wilderness until I found this site. THANK YOU again! I'm very grateful for your help.

Hi sadie,

I am going to re-post some of your statements and answer them in bold type.

<<<Instead, the periodontist said that he thought there was some violation of the biologic width of the first root canaled tooth. This tooth had a Cerec crown on it that had universally criticized by every dentist and endo who subsequently saw it. It never felt like it fit in my mouth, and in fact always seemed like it was cutting into my gum. Eventually (it was less than a year old at the time of the root canal) I sort of got used to the discomfort, though never completley. Last year right before Xmas, however, the pain welled up and instead of going to my regular dentist (not the same one who made the cerec crown), I asked for a endodontist, thinking I needed to take care of it before the holidays.>>>

THERE PROBABLY IS SOME VIOLATION DUE TO THE ILL FITTING CEREC CROWN.... WHICH PROBABLY SHOULD HAVE BEEN REDONE SOON AFTER IT FIRST BECAME A PROBLEM. FOR DENTISTS TO CRITICIZE THE WORKMANSHIP BUT NOT INFORM YOU THAT IT NEEDED TO BE REDONE.... HAS MOST LIKELY COST YOU THE MISFORTUNE OF HAVING HAD TWO ROOT CANALS UNNECESSARILY.
THE PERIODONTIST DEEPLY SCALED THE POCKET BETWEEN THE GUM LINE DOWN TO THE CREST OF BONE ALONG THE ROOT OF YOUR TOOTH. THIS IS DONE IN AN ATTEMPT TO REMOVE ANY GRANULATION TISSUE THAT HAD FORMED IN THAT INFLAMED SPACE DUE TO THE ILL FITTING CROWN. THE GOAL OF DOING THAT IS TO HOPE THAT THE GUM TISSUE RECEDES AWAY FROM THE MARGIN OF THE CROWN. IF THIS FAILS, YOU WILL MOST LIKELY BE TOLD TO HAVE A CROWN LENGTHENING SURGERY TO PHYSICALLY REMOVE THE INFLAMED TISSUE DOWN TO THE CREST OF BONE.
IF THIS TOOTH HAD NOT BEEN ROOT CANALED, THIS PROCEDURE WOULD HAVE MADE THIS TOOTH <PERMANENTLY> SENSITIVE TO COLD.

<<<After the root canal, however, the gum swelled and wouldn't calm down. Even after they fixed the pain and pressure of the tooth itself, the gum never felt right. It is this feeling that there is always something stuck under the tooth (or that I need to floss constantly because of some invisible pressure) that has been the most troubling part of this last year. He performed some minor work scraping the gum away from the tooth (here I'm slightly fuzzy on the the details) to see if the gum can start to repair itself. >>>

I HAVE A SUSPICION THAT THE PAIN WAS NOT TOOTH RELATED... IT WAS GUM RELATED DUE TO THE ILL FITTING CROWN. HAVING HAD THE ROOT CANAL WAS LIKE PUTTING GASOLINE ON AN ALREADY BURNING FIRE AS IT DID NOTHING TO ALTER THE PROBLEM AND JUST ADDED MORE INFLAMMATION.

<<<More important (at least in my mind) is that he said that thought both of my root canals may have been unnecessary. He thought it was possible that my original pain may have come from the awkward placement of the cerec crown, and that the additional pain might have originated with that as well: my bite has shifted to one side, possibly from the crown and some other dental work I had done at the same time. He suspects I also now have a TMJ issue, which makes sense to me as I have been having headaches and some numbness on that side of my face.>>>

WELL THERE YOU GO! THAT IS EXACTLY WHAT I AM SAYING... IT IS THE ILL FITTING CROWN THAT WAS YOUR ORIGINAL PROBLEM. SO AT THIS POINT THE CROWN STILL FITS POORLY, THE GUM IS BEING CHOKED BY THE POOR FITTING MARGIN ON THE CROWN AND THE TOOTH HAS BEEN ROOT CANALED. I KNOW YOU ARE FOCUSED ON THE GUM ISSUE, BUT THAT IS TRULY ONLY ONE ASPECT OF WHAT WILL LIKELY TURN INTO A CHRONIC TOOTH PROBLEM. I'M TELLING YOU THIS SO THAT YOU ARE MINDFUL OF THE SHORT COMINGS OF ANY OTHER TREATMENT RECOMMENDATIONS TO DEAL WITH THE "GUM PROBLEM".
IF YOUR OTHER DENTAL WORK IS NOT FITTING PROPERLY AND IS CREATING A TMJ PROBLEM.... THAT MAY MEAN THAT YOU HAVE TO REDO YOUR DENTAL RESTORATIONS BEFORE THE BITE BECOMES SO BAD THAT YOU START HAVING ADDITIONAL TOOTH PROBLEMS DUE TO THE POOR BITE.

You can only make one decision at a time. I am hoping that your gum irritation subsides..... but in the long run I think you realize that it would just be a temporary thing due to the bacteria contained in root canaled teeth.

I have seen your exact situatuon countless times...... it always breaks my heart to see people go through unnecessary dental work and pain because of crappy dentistry. One of the dentists that you had seen along the way (the endodontist especially) should have been more truthful with you and said hey..... go back to the guy who did the cerec and get him to redo it.

I am just so sorry you are going through this. Just try to stay positive and please be mindful that spending more money to treat the gum issue is not going to solve the overall situation.

Bryanna

Hi Sadie, I just wanted to say I am sorry you are dealing with this pain. I know it is hard that your friends and family don't get how much pain can be caused by the tooth but know that there are many others in the same position as you and we get it!

I am finally getting a root canal tooth extracted tomorrow at noon after having 2 dentists and a root canal specialist tell me they want to keep treating it. The pain and cost are just not worth it in the end. I hope you get things sorted soon!