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Thanks for replying Bryanna. I can clearly see that the palatal root is filled past the apex after you mentioned it. I'm surprised that the second dentist I consulted did not even bring it up! He was only concerned with the distal root not been filled to the apex. You mentioned that although both these things are unhealthy, they are a typical occurrence...So in your opinion, would most dentists consider this root canal a success or failure? Also, regarding the infection around the root tip of the distal root, I'm aware that the tubules would always be infected, but is there something that can be done (like taking antibiotics for example) to get rid of the visible infection in the xray?
My tooth is reacting to hot liquids at times. Also, it's still sensitive to touch. A few days back, the gums from my wisdom tooth to this tooth got quite red and painful but seem to be getting better now. Could all this be because of the infection at the root tip? The second dentist I consulted tapped my tooth 3 times with a metal instrument but I did not feel any pain or sensitivity.

Quote:

Originally Posted by Bryanna (Post 1189347)

JamesSmith,

Thanks for posting the xrays.

The recently root canaled tooth is #14 (using the Universal numbering system), your upper left first molar. The xray is of mediocre quality, but here is what I see:

1) The dentist instrumented and placed gutta percha in all 3 visible canals in the 3 large roots.

2) The distal root, the short one furthest to the right, is NOT filled to the apex (end) with gutta percha. There is also an infection around the root tip. Possibilities: this area of infection may have been present prior to the rc OR she may have perforated this root during the procedure. In which case the disinfectant and/or bacteria was pushed into the bone beyond the tooth. Although it is not healthy and it can become progressive... it is typical to see infections around the roots of rc teeth.

3) The palatal root, this is the longest root in the middle, appears to be filled past the apex. Meaning the root tip was perforated during the procedure and although there is currently no obvious mass of infection (like at the distal root) the same perforation issues concerning the disinfectant and bacteria are possible. Also the gutta percha that was pushed into the bone is a chronic irritant. Again, it is not a healthy scenario but a typical occurrence.

4) The center of the tooth where the pulpal chamber was is now a large open void. Although this is unfavorable, it is commonly seen in rc teeth. This void substantially weakens the integrity of this area of the root system. Putting a post in this tooth could result in a fractured root and/or a perforation of a root. This area will be prone to decay irrelevant of how well a crown were to fit over it.

Regarding the lower tooth.... you could be getting referred pain.... the ligament could be inflamed and at times it's less inflamed than others .... or there is something else going on with this tooth that you are unaware of. It would have been good to take an xray of that tooth.

Extracting this tooth would leave an open space that ideally should be filled with a replacement. If not, then the molars behind it will drift towards the open space. How far or how oddly they will drift, no one can tell you that. Sometimes the drifting of a first upper molar is not very bothersome especially when it has 2 healthy adjacent teeth.

I know again.... I'm delivering unpleasant news to you. Please consider all of the information as only you can decide as to what you feel is in your best interest for the long term.

Bryanna

JamesSmith,

<< I can clearly see that the palatal root is filled past the apex after you mentioned it. I'm surprised that the second dentist I consulted did not even bring it up! He was only concerned with the distal root not been filled to the apex.>>

TWO REASONS WHY HE DIDN'T MENTION IT:

1) ALTHOUGH A PERFORATED ROOT TIP IS A HUGE CAUSE FOR CONCERN, IT IS A TYPICAL "OOPS" FREQUENTLY SEEN AND NOT JUDGED UNTIL THE AREA SHOWS SIGNS OF INFECTION.

2) HE IS CAUTIOUS AS TO WHAT HE INFORMS YOU ABOUT REGARDING ANOTHER DENTISTS WORK.

THE SHORT FILL IN THE DISTAL ROOT IS SOMETHING HE CAN "COMMENT" ON AS THIS COULD BE THE RESULT OF A CALCIFICATION IN THAT PORTION OF THE ROOT. MEANING THAT PORTION OF THE CANAL MAY BE CONGENITALLY CLOSED OFF NOT ALLOWING INSTRUMENTATION TO GET IN. I DOUBT THAT'S WHAT THE CASE WITH THIS TOOTH, BUT IT IS POSSIBLE.

<< You mentioned that although both these things are unhealthy, they are a typical occurrence...So in your opinion, would most dentists consider this root canal a success or failure?>>

IT'S A TYPICAL, MEANING FREQUENT, BUT GENERALLY ACCEPTED OUTCOME BECAUSE THE ONLY ALTERNATIVE IS TO EXTRACT THE TOOTH. THAT MEANS DUE TO THE ANATOMY OF OUR TEETH AND THE NECESSITY FOR ALL BODY PARTS TO REMAIN VITAL, THE RC PROCEDURE IS A FAILED PROCEDURE TO BEGIN WITH AND IT IS IRRELEVANT OF HOW WELL IT IS DONE, THE TOOTH WILL REMAIN INFLAMED AND DISEASED.

<<Also, regarding the infection around the root tip of the distal root, I'm aware that the tubules would always be infected, but is there something that can be done (like taking antibiotics for example) to get rid of the visible infection in the xray?>>

THE INFECTION SEEN ON THE XRAY AT THE APEX OF THE TOOTH IS THE PROLIFERATION OF INFECTIOUS BACTERIA THAT IS SPREADING FROM THE INSIDE OF THE TOOTH. IT IS ACTUALLY LARGER AND DEEPER THAN DEPICTED ON THE 2 DIMENSIONAL FILM.

AN APICOECTOMY SURGERY, THIS IS A SURGICAL ROOT CANAL, IS SOMETIMES DONE TO REMOVE THE AREA AT THE APEX. BUT THE PROBLEM WILL ONLY RETURN BECAUSE THE TOOTH IS STILL INFECTED. ANTIBIOTICS CANNOT CURE THIS APICAL INFECTION BECAUSE THE TOOTH IS A BREEDING GROUND OF VARIOUS AEROBIC AND ANAEROBIC BACTERIAL MICROBES THAT ARE NOT KILLED OFF BY AN ANTIBIOTIC.

<<My tooth is reacting to hot liquids at times. Also, it's still sensitive to touch.>>

HOT TEMP SENSITIVITY WITH RC TEETH GENERALLY INDICATES NERVE VITALITY. THIS MEANS THAT THE TOOTH STILL CONTAINS SOME LIVE NERVE TISSUE (COULD BE IN THE DENTIN TUBULES AND/OR THE DISTAL ROOT AND/OR REMNANTS OF NERVE TISSUE IN THE LARGE CANALS) AND IT'S BECOMING NECROTIC. THE TOUCH SENSITIVITY IS LIKELY DUE TO THE VITALITY AS I MENTIONED AS WELL AS THE INFLAMMATION INSIDE AND OUTSIDE OF THIS TOOTH. IN ADDITION TO THE INFLAMED LIGAMENT AND INFECTION IN THE JAW BONE.

<< A few days back, the gums from my wisdom tooth to this tooth got quite red and painful but seem to be getting better now. Could all this be because of the infection at the root tip? >>

EVEN THOUGH THOSE SYMPTOMS SUBSIDED, THEY ARE A SIGN OF ALL THAT I HAVE MENTIONED HERE. AS THE INFECTION FINDS A PLACE TO DRAIN, YOU MAY OR MAY NOT HAVE SYMPTOMS. IN MANY CASES SIMILAR TO YOURS, THE NEXT "SYMPTOM" MAY BE A FISTULA THAT APPEARS ON THE GUM ABOVE THE ROOT OF THE TOOTH. A FISTULA FORMS WHEN THE BACTERIA FROM THE INFECTION BORES A HOLE THROUGH THE BONE AND OUT THROUGH THE GUM TISSUE. AGAIN, THIS IS ANOTHER WAY FOR THE BODY TO RELIEVE THE PRESSURE FROM THE INFECTION.

<<The second dentist I consulted tapped my tooth 3 times with a metal instrument but I did not feel any pain or sensitivity>>

THIS DOES NOT MEAN MUCH IN THE SCHEME OF THINGS. :/

Bryanna

JamesSmith,

About 6 years ago when I was working overseas in Australia, I had another major filling/restoration done on tooth #26 (number 14 in US numbering system) because of pressure/sensitivity in that area. Didn't realize it at the time, but there was already a major infection in/above this tooth/area that had been there for a very long time. About 6 months after this filling and return to the US, I had worsening and major systemic symptoms/health issues and wasn't quite sure what was going on because I didn't have "pain" directly associated with this tooth. I went to my family doctor (repeated referrals to ENT, Neurologists, etc.), general dentist, and then to two other oral surgeons with my concerns and was just prescribed augmentin, clindamycin, amoxicillin, ciproflaxin, etc. for over a year. I was always told everything was "OK". A root canal was never done on tooth #14 but instead eventually one was done on #19, the tooth directly below it because of the "referred" and increasing nerve pain and sensitivity from the tooth above it (#14). I honestly and "mistakenly" thought all along the problem was with #19. I went to an endodontist and he stated he didn't see any active infection or apparent problems with #19, but since I wanted to get rid of this jaw/nerve pain and sensitivity, I agreed to have the root canal done on this tooth anyway. Symptoms persisted and kept getting worse until finally getting a PA x-ray on tooth #14. There was a major infection/cyst above this tooth and an old root canal tooth #13. Problems with a root canal on #13 and undiagnosed abscess on tooth #14 had caused major destruction of my upper left jawbone in this area over at least 15-20 years. So I ended up having #13, #14, and #19 extracted. There most likely was never a problem with #19 (bottom left first molar) but still lost this tooth because of a failed root canal and "referred" nerve pain. (This subsequently also happened to me on an abscessed tooth #3 on the upper right and referral to #30 below). Finally with extraction of tooth #3, #13 and #14, two debridement surgeries, and removal of a retained root tip from #13 (last debridement in upper left jaw and root tip removal by a holistic dentist), I have been recovering and many of the chronic health issues I have been dealing with for years are finally resolving.