Dear Bryanna, I was going through the other posts and I am convinced that you will be able to help me out. The story started in may this year when I went to my dentist to have my teeth scaled/cleaned. At the time I had this issue of food getting stuck in my no 3 tooth (I think that's the number -the first molar on the upper left) . I was under the impression that it was a cavity of some sort and could be cleaned and filled.
There was absolutely no pain in the tooth either while chewing or while tapping. Just the food getting stuck. The dentist had a look, drilled into the tooth and said that it was a borderline case, and there was some decay, so a root canal had to be done. I asked them about just filling in the cavity but he said that if they do that there will be some pressure buildup in the tooth which will eventually cause a lot more pain(there was none in the first place) and that the RCT was the only way out. So I decided to get the RCT done.

Spread out of a couple of days he cleaned all four of the canals (during the cleaning one of the canals was bleeding , but he decided to carry on with the filling of the canal anyway as he said it was a small cut..I don't know if this is important but I thought I'd mention it anyway). Once the RCF was complete a temporary cap was placed on the tooth. Now there was a constant pain in that tooth when ever I tapped it or while trying to bite on anything hard. Generally the pain would not be there constantly, but only when tapped. They put me on a course of antibiotics.. Nothing worked.
They kept waiting to see if it settles. Finally when the permanent crown came in they fixed it with temporary cement. He said I had to get used to the permanent crown , so I might as well fix that instead of the temporary. The pain persisted , so they decided to retreat. He first retreated the mb1 and mb2 canals. They put in some medicine twice and each time we waited for a week . nothing happened. Filled it up with an enormous amount of filler(I couldn't count how many of those Gutta sticks were pushed inside and split)..

He said sometimes by filling up the canal the pain subsides..Waited for some time , but nothing happened. Well then they called in an endodontist who saw the whole bunch of X-rays taken (10-12) and said everything looked fine. But he decided to retreat the distal and parietal canals. To do this he had to remove the permament porcelain crown which was fixed with "temporary cement" . Well this permanent crown had come of easily on past occasions,in fact it kept popping off and I had to go back and get it fixed. But this time it refused to budge.. The tried all sorts of ways..banging it really hard( if my tooth hadn't cracked until then I'm sure it must have) .

The crown didn't come off. So the decided to drill through the crown and retreat the two remaining canals.. That was 20 days back.. As of today the pain is still there when I tap and when I push on the tooth from the side near the cheek. It is also there when I initially bite on something hard. Normally there is no pain. Just in the above two instances..the pain is not unbearable , just there and frustrating and annoying. Now he says they have tried everything possible and day after he is going to cut out the permanent crown and leave the tooth off the bit and fill it with permanent cement.
He is also starting another course of antibiotics..augmentin or copox(not sure..he said he would let me know). Anyways he say if the pain dosent stop they will have to extract the tooth..

Now this is my concern..firstly the pain was not there before the RCT. then the pain is only there when I Tap of push on the tooth(none while releasing the pressure). Third, the pain in minor,mostly an irritant, but its there nevertheless.
Would really appreciate any advice.. Have begun to think it might me that the jaw bone itself got infected during the procedure
Thank you

So sorry to hear of your tooth troubles.
I work for an endodontist and you story is not the norm at all!

Has anyone has checked your occlusion? Surely they have.

I believe you should get a third opinion from another endodontist. There are a number of things that it could be - the occlusion, a cracked tooth - which by the way, did the endodontist use a microscope?, there could be an auxillary canal, the canals could be under-filled.

A good endodontist should be able to give you at least an idea of what's going on and you should not have continued pain.

I so hope you are able to find a resolution and save this tooth.

Hi yoba,

Here is what I think has happened. The area that was packing food was decayed and when the dentist drilled into it he either found the decay to be near or in the pulp OR he found an exposure into the pulp as he was removing the decay. That is why he proceeded with the root canal procedure.

The bleeding from a canal during the root canal indicates vitality. This means that this canal still contained live nerve tissue. However his reference to it having a "small cut"... makes me think he perforated the tooth with a sharp file and cut in to the bone. This would meant that the tooth has been perforated and the bacteria has an easy path into the bone. It also sounds like he made lots of effort to plug up this perforation with all that gutta percha!! That's like putting a band-aid over a broken bone... it just doesn't work.

It concerns me A LOT that he medicated the tooth twice..... he may have packed it with a cotton ball soaked in formocresol or some other highly toxic. chemical. He would do this to try and kill off the live nerves inside of the large canals. There is also no way to remove this toxin from the tooth which means you are breathing and ingesting it constantly.

You have been through a lot with this tooth. I am afraid that most of it may have been unnecessary. The tooth could have been in trouble prior to him drilling into it... but honestly, based on what you have written here everything he did just made it that much worse. The endodontist was not about to go against the original dentist so that is why he re treated it. He too just made things worse.

The truth of the matter is this...... you will never know if that tooth only needed a filling or not. Your dentist was eager to rc the tooth....and get that crown on there..... possibly for the $$$$. The tooth has been traumatized over and over again... it is at least partially non vital. Irrelevant of how many times you root canal a tooth with or without the use of a microscope.... the tooth will remain infected because there is no access to the infected nerve tissue inside of the tiny dentin tubules (microscopic canals). The tooth may or may not temporarily calm down as you take this antibiotic. But it will flare up at some point all over again.

The only way to prevent the infection from spreading into the jaw bone is to remove the tooth.

I'm sorry to tell you this but your dentist should have given you more information that he has. This tooth will be a constant source of bacteria. He is well aware of that.... so is the endodontist. If you decide to remove this tooth..... please go to an oral surgeon who is not affiliated with this practice... and do not let a general dentist extract it.

Please check back with us and let us know how you are doing.

Bryanna

Thank you very much for the reply. I guess my options are very limited now. They have put me on a course of augmentin, which is an amoxicillin and potassium clavulanate tablet. The dentist said if the pain reduces then they will fill up the hole in the crown with composite cement( the crown itself is supposed to have been fixed temporarily, but refuses to come off) and that's it. If it dosent improve then they will cut out the crown and leave the tooth off the bite till we decide to extract it.And no, they didn't use a microscope. I got a couple of questions:
A) is it ok to have a crown with a hole filled up with cement ( I paid a bomb for the crown) or should I ask them to cut it off and replace with a new crown

B) should I stick with the present crown, and monitor the progress . That way I case I have to get it extracted won't be paying for another crown

C) is there any way to know if the tooth is cracked. As I feel either it's infected or cracked. The were suggesting a cone beam ct scan, but were doubtful about finding anything on it.

D) is there any way to confirm the infection, apparently no dark spots show up on the x-ray

Looking forward to hearing from you all,
Thanks a lot

Yoba,

I will repost what I had replied to you as this answers all of your questions...

"The truth of the matter is this...... you will never know if that tooth only needed a filling or not. Your dentist was eager to rc the tooth....and get that crown on there..... possibly for the $$$$. The tooth has been traumatized over and over again... it is at least partially non vital. Irrelevant of how many times you root canal a tooth with or without the use of a microscope.... the tooth will remain infected because there is no access to the infected nerve tissue inside of the tiny dentin tubules (microscopic canals). The tooth may or may not temporarily calm down as you take this antibiotic. But it will flare up at some point all over again."

"The only way to prevent the infection from spreading into the jaw bone is to remove the tooth."

If the pain goes away, it does not mean the tooth is okay or healthy. It just means that the antibiotic "temporarily" reduced some of the inflammation and bacteria. But you have a chronic infection irrelevant of taking the medication. Pain and the lack of radio-graphic pathology are not the best indicators for oral infection because the bacteria inside of an infected tooth can easily spread through the tooth into the jaw bone and beyond .... without causing too much discomfort. Why? Because once the bacteria finds a way to drain some of the pressure is relieved from inside of the tooth.... thus little to no pain. However, the problem then becomes much more widespread than when it was contained just within the tooth and that is when that dark area will show on the x-ray. At this point a cone beam scan may or may not show the full extent of the infection. At which point they would just tell you to wait and see what happens.

Given the dental history on this tooth.... yes it may very well be fractured especially if he perforated it with a sharp file. It is definitely infected as I have explained previously. I know this is hard for you to understand but this is not really a question of should you keep the old crown or have them make a new one. The crown issue is no longer the problem and new or old will not make any difference.

Your dentist is putting a band aid on this as he is trying to put off the inevitable which is removing the tooth. The longer he can convince you to go along with this.... the less chance you have of him reimbursing you for the root canal and the crown. I know that sounds horrible and mean ...and I wish that I didn't have to share that with you... but this is the nonsense that occurs in many dental offices every single day.

If you are unsure of the information that I have given you about the infection within this tooth, take some time to do some research and look at evidence of what I am telling you. Google "Dr George Meinig focal infection"... and "Dr Mercola "why you should avoid a root canal".

Bryanna

Thanks a lot.. Made everything clear..I guess will go ahead with the extraction

Dear Bryanna, now the dentist suggests I go to an oral surgeon for an apicocetomy. He says maybe that will sort out the cause of infection???

Yoba,

The referral to the oral surgeon is smart.... the apicoectomy is not and here's are a few reasons why.

There is no question that all root canaled teeth are unhealthy and infected. One reason is because the many hundreds of tiny canals cannot be cleaned out which means they will always contain infected nerve tissue. The infection eventually spreads beyond these canals into the jaw bone.
Secondly like every other area of the body, teeth require blood to be able circulate through it in order to be healthy. The root canal procedure permanently cuts off the blood vessel supplying the tooth nutrition rendering the tooth non vital.

Keeping those things in mind.... irrelevant of what is done to the tooth or to the bone above the tooth the tooth will remain infected. An apicoectomy is a barbaric oral surgery that does nothing more to "cure" the tooth than the root canal procedure did. In fact the apico causes more inflammation, more bacteria and causes the bone to continually break down around the tooth.

Unfortunately, the only way to cure the problem is to remove the source of the problem which is the tooth. If you decide to extract the tooth, it would be best to have an oral surgeon do the extraction, not your general dentist.

Bryanna


QUOTE=yoba;1018510]Dear Bryanna, now the dentist suggests I go to an oral surgeon for an apicocetomy. He says maybe that will sort out the cause of infection???[/QUOTE]