JamesSmith,

All root canaled teeth are chronically infected for the reasons I offered you in my first replhy. So irrelevant of what is done to that rc tooth, it will remain infected.

Pertaining to root canaled teeth, the ligament becomes inflamed when bacteria overwhelms the area. Other than extraction and removal of the ligament, there is no way to alter this once it has happened. If the tooth were perforated during the rc procedure, the bacterial contamination to the jaw bone from the perforation is not repairable. The only cure is to extract the tooth and remove all of the diseased tissue, ligament and infected bone.

I am sorry to deliver this news to you. If you are curious about learning up to date information about this topic ... buy the book The Toxic Tooth by Dr Robert Kulacz.

Bryanna

Thanks for replying Bryanna. I called up my dentist and spoke about the inflamed perio ligament as well as tooth perforation. She said neither is applicable in my case and after doing the post and core and crown the sensitivity should go away. She also said the sensitivity is due to the disinfectants reacting with my bone. When I specifically told her that I'm not going to continue further with the treatment until I get relief, she advised me to take augmentin (antibiotic), 2 tablets a day for 3 days. I told her the fact that she is telling me to take antibiotics clearly implies that she knows that there is an infection! She said that that's not the case and it will help calm my tooth! Obviously what she is saying does not make sense! It seems like she knows that there is a problem but she just wants to do the post and core and crown and take my money!! I'm thinking of consulting another dentist. Even If i'm getting the tooth removed, could you advise me what to do to get some relief in the mean time? Also, the tooth below the RCT seems to be bothering me quite a bit. Some days back I had flossed and a piece of the string got stuck between that tooth and another molar. It was quite uncomfortable and when I finally managed to pull it out, the tooth hurt a bit. Now, its a bit sensitive. I'm not sure if it's the flossing or the RCT tooth that is troubling this tooth. Any advise would be appreciated. Thanks

JamesSmith,

The disinfectants used during the rc procedure should not have entered the jaw bone during the procedure unless the tooth was already perforated (possibly fractured) and/or she perforated the tooth.

A post put into a root canaled tooth actually further weakens the integrity of the tooth, pre disposes it to fracture and contributes to additional inflammation. It's like driving a nail into a splinter of wood and then using that piece of wood as a hammer. The nail is the post.. the wood is the tooth... and the hammer is the chewing forces between the upper and lower teeth. Dentists who put posts in rc teeth do so because:

1) There is an inadequate amount of tooth structure to put a crown on the tooth so they use the post as a replacement for the missing area of tooth.
2) Some dentists think all rc teeth should have posts just because the tooth is fragile and the post will give it some support. See my #1 comment.
3) Some do so for the $$.

A crown is put on a weakened or fragile tooth more or less to act as a hard shell for chewing. Crowns are also put on for esthetics or when the tooth is unable to be restored properly with a filling material. Crowns do not strengthen the tooth, they just kind of hold it together for chewing purposes.

I think the reason your dentist prescribed antibiotics may be because she is concerned about the contamination that possibly occurred during the rc procedure (which has not clearly been established and if it did occur, antibiotics would not make any long term positive difference) .... or she is suspicious of infection .... or she knows there's a lot of inflammation in the tooth and ligament and she's hoping (???) that the antibiotic calms it down just long enough to do the post and crown.

Most conventional dentists are going to side with your dentist because this is basically how they practice too. You could consult with an oral surgeon (although he would most likely be of similar thinking) about the present status of the surrounding bone of this tooth...a periapical xray and possibly a panoramic xray might be helpful. But they are only 2 Dimensional so there could be something happening that is not able to be picked up on them.

The bottom line here is this.... ALL root canaled teeth are unhealthy. Your symptoms are not uncommon and therefore are often regarded as "normal" meaning "typical". The lower tooth may be biting too hard against the upper one causing the ligament around the lower tooth to be inflamed. Taking these two teeth out of occlusion, meaning drilling away minute amounts of either tooth so they hit against each other more gently does not alter the health status of the upper rc tooth. It would however reduce the inflammation in the ligament of the lower tooth. BTW.... what is the health of that lower tooth? Is it decayed, filled or crowned?

Bryanna

Hey Bryanna, thanks for replying. I consulted another dentist. He told me that one of the canals had not been sealed fully with the gutta percha and there was some space left. He advised me to go back to my dentist and tell her to refill it. He also mentioned that he could see a minor infection and cleaning would be required before refilling it. He also said that it would not trouble me much now but in the future it would start paining and I would have to redo it then. He offered to redo it if I wanted but said that it would be a re-root canal and I would have to pay even more than a regular root canal! My dentist was previously working under a senior dentist (he now does implants only) and had an assistant to position the xray machine while she adjusted the device in my mouth. Now she has started her own practice and does not have an assistant so she has to re take xrays multiple times before getting them right! I'm very concerned about getting so much radiation! Even if I show her this dentist's xrays, and she refills it, I don't know how many more xrays she will take just to see if it's been filled properly! What would you advise?

JameSmith,

In the scheme of things it is irrelevant if she missed a canal. Re treating the tooth, filling that canal, will not change the status of the infection inside of the dentin tubules. I will post a diagram of the anatomy of a tooth so you can see for yourself just how many dentin tubules are inside of every tooth. In the diagram each brown line represents a tiny canal. These tiny canals are not accessible and will therefore harbor infected nerve tissue irrelevant of how many times or how well the rc procedure is done.

I cannot advise you of what to do. I can only offer you the information that is evidently not being given to you by your dentist to help you become better informed. Only you can decide what you feel is in your best interest.

Attached Images

dentin tubules.jpg (84.3 KB, 5116 views)

Thanks Bryanna. About my lower tooth, it has an old filling. I should have shown it to the new dentist I consulted but with all the talk about the root canal tooth, I forgot. The sensitivity keeps on coming and going. The weird thing is, If i'm feeling sensitivity in the root canal tooth, then it goes away from the lower tooth and vice versa! Assuming I decide to remove the root canal tooth, that comes with it's own set of problems like ensuring the infection is thoroughly cleaned and the ligament removed etc. I'm going to take a few days and think about all this. Also, I'm attaching pics of the root canal tooth that the new dentist took.

Attached Images

	xray1.jpg (129.3 KB, 5056 views)
	xray2.jpg (118.9 KB, 5174 views)

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