Hi all, I got my first RCT done 10 years ago on the lower jaw left premolar and although it got infected shortly afterwards, it settled down eventually and I got it crowned. My dentist initiated my second RCT on the upper left molar number 26 this November (2015) and since then the nightmare has started! My dentist cleaned out the infection and killed the root in the first sitting, prescribed painkillers and told me to come back after a week. A few days later, I felt extreme pain in the tooth and could not sleep for 3 days! I went back to my dentist and she said it was because of a reaction to the disinfectant used to clean the canals. She prescribed augmentin antibiotic along with pain killers and told me to come back after a week. The pain reduced a bit, but it was still bothering me so I went back to her and she realized that one of the canals had not been cleaned out properly. She then recleaned the canals and the pain went away. However, the sensitivity remained. A week later, she filled the canals with gutta percha and sealed the tooth with a temporary filling. She wanted me to come back after a week for the post and core filling, but I told her that I wanted the tooth to settle down and for all the sensitivity to go away and then continue. It's been almost 2 weeks since then. The tooth sensitivity has increased and even the molar next to it is quite sensitive. Also, the tooth on which this RCT tooth is biting on in my lower jaw has become sensitive also! They are reacting to touch both with my tongue and finger! What could the problem be?

Hi JamesSmith,

I am going to re post some of your post and reply in bold type. Makes it easier to follow.

<< I got my first RCT done 10 years ago on the lower jaw left premolar and although it got infected shortly afterwards, it settled down eventually and I got it crowned.>>

There are several reasons why root canal therapy cannot cure an infected tooth but the easiest reason to understand is because it is not possible to remove all of the nerve tissue and sterilize the tooth. Your symptoms may have calmed down with this upper tooth, but the tooth itself is not healthy. Crowning the rc tooth does not alter the bacterial status of the tooth. It is more like putting a hard blanket over it to help prevent the fragile tooth from cracking when chewing on it.

<<My dentist initiated my second RCT on the upper left molar number 26 this November (2015) and since then the nightmare has started! My dentist cleaned out the infection and killed the root in the first sitting, prescribed painkillers and told me to come back after a week.>>

Again, the nerve tissue cannot be removed entirely. Some teeth will act up right away, while others won't. Also, the dentist did not kill the root of the tooth. The root system is still intact in the jaw bone. She scraped out visible nerve tissue from inside the root system. The tooth may still have partial vitality because not all of the nerves can be removed. Sometimes the remaining nerves flare up and cause pain, other times they become necrotic and may or may not show symptoms of infection until sometime later.

<< A few days later, I felt extreme pain in the tooth and could not sleep for 3 days! I went back to my dentist and she said it was because of a reaction to the disinfectant used to clean the canals. >>

A reaction to the disinfectant?? Did she perforate the tooth with the disinfectant? If she did, then bacteria and inflammation can build up around that perforation. You should find out if she did that because that problem can lead to complications involving the nerve bundles that reside in the bone surrounding that tooth.

<<She prescribed augmentin antibiotic along with pain killers and told me to come back after a week. The pain reduced a bit, but it was still bothering me so I went back to her and she realized that one of the canals had not been cleaned out properly. She then recleaned the canals and the pain went away. However, the sensitivity remained.>>

It is possible that she missed a visible canal and/or perforated the tooth. The number of visible canals (one to four depending on the tooth) are significantly less than the many hundreds of non accessible microscopic canals.

<< A week later, she filled the canals with gutta percha and sealed the tooth with a temporary filling. She wanted me to come back after a week for the post and core filling, but I told her that I wanted the tooth to settle down and for all the sensitivity to go away and then continue. It's been almost 2 weeks since then. The tooth sensitivity has increased and even the molar next to it is quite sensitive.>>

This indicates vitality in the tooth as well as inflammation in the accessory canals. Also, the tooth is intricately connected to a live periodontal ligament which becomes inflamed from the infected tooth. The inflamed ligament can literally push the tooth down from the original position causing the tooth to hit the lower tooth too hard. An inflamed ligament can cause pain, sensitivity, soreness, etc.

<< Also, the tooth on which this RCT tooth is biting on in my lower jaw has become sensitive also! They are reacting to touch both with my tongue and finger! What could the problem be?>>

This may be due to the inflamed ligament as I stated above. Both the rc tooth and the one it is biting against will become sore as both of their ligaments become inflamed.

An xray should help determine if there was a perforation of the tooth during the rc procedure... it can also help determine an inflamed perio ligament... and also infection if it is large enough to be seen on the 2 dimensional xray.

Bryanna

Thanks Bryanna. I made an appointment with my dentist for next week. Assuming it's an inflamed perio ligament, how can it be treated? Also, assuming the tooth got perforated, how can it be treated?

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