Root Canal Question
 

Here's a situation:

Tooth root canaled three years ago. In January some discomfort for a day, fistula developed. No discomfort; just a little sensitive to toothbrush. X-rays show nothing except small dot in center of tooth. Root canal retreated. Three weeks later permanent filling. Two months later either a new fistula, or the old one, is draining. What is, given the above facts, most likely causing the infection, and the fistula to keep draining?

:Wave-Hello: Welcome robertw.

Someone will be along to help.

Hi robertw,

I am in the dental field and can offer you information here.

It's simple, the tooth is infected and will continue to be infected irrelevant of how many times you have it root canaled. There are several reasons for this however the easiest to understand is that every tooth has many many hundreds of tiny canals called accessory canals or dentin tubules that contain nerve tissue. These canals are microscopic, very curvy and connect to other tiny canals and vessels. During the rc procedure none of these tiny canals are accessible. Therefore the nerve tissue that resides inside of them cannot be removed and it becomes necrotic and diseased causing the tooth to be chronically infected.

Also the fistula that has formed is from the infection which has proliferated beyond the tooth into the bone or further. The fistula is the end or opening of a burrowed tunnel from the tooth through the bone out through the gum tissue. This burrowed tunnel is called a tract. The bone surrounding this tract is diseased and deteriorated. So now the jaw bone as well as the tooth is infected.

Every dentist is aware of these canals and knows there is no access to them. Patients should be informed of this prior to consenting to the procedure. Root canals are performed to attempt to allow a person to "retain" a diseased tooth for an undetermined amount of time. Root canals as well as apicoectomies cannot anatomically "cure" the disease that resides inside of an infected tooth.

The only attempt at curing the infection is to remove the source of the infection which is the tooth and the diseased bone around the tooth.

I'm sorry if you were not informed of this information prior to consenting to the root canal procedures.

Thank you for your reply and information. My question is, the root canal worked for three years. Then developed a fistula. The root canal was retreated and the fistula either came back or developed a new one within 2 months. Why did the retreatment fail so soon and shows no sign of infection or fracture on x-rays? What does this indicate?

robertw,

The root canal only appeared to work for three years simply because you did not have any obvious symptoms of the chronic infection until the fistula appeared. The appearance of the fistula indicates a long standing infection as the bacteria takes times to burrow through the bone.

All root canaled teeth contain necrotic diseased nerve tissue inside of those tiny canals that I mentioned in my previous post to you. Because symptoms of a problem were non existent or delayed does not indicate that this tooth was not diseased.

The second root canal procedure temporarily reduced the inflammation as some of the decrepit tissue inside of the large canals was removed. The reason it was temporary is because the diseased tissue is still residing in those tiny canals as well as in the jaw bone along the fistula tract.

This tooth may or may not be fractured. Most of the time tooth fractures do not show on dental x-rays as they are only a 2 dimensional image. Again due to the limitations of the radiographic images some infections will not appear until they have proliferated way beyond the tooth and surrounding bone.

That small dot in the center of the tooth that is seen on the x-ray will actually be larger clinically and it indicates decay or tooth rot which has occurred from the infection. That area is no longer hard as it should be it is soft and mushy from the infection.

I know you want to believe that your tooth was okay for three years. But the truth of the matter is that tooth has been infected the entire time. We all want to go by symptoms as they are what alerts us to a problem. However, most dental problems have little to no symptoms until the problem has progressed. Similar to heart disease or diabetes.... symptoms are not always present until the disease has progressed.

I know this news is not pleasant to learn but I hope that this information has been helpful to you.

QUOTE=robertw;1077761]Thank you for your reply and information. My question is, the root canal worked for three years. Then developed a fistula. The root canal was retreated and the fistula either came back or developed a new one within 2 months. Why did the retreatment fail so soon and shows no sign of infection or fracture on x-rays? What does this indicate?[/QUOTE]

Hi Bryanna, I couldn't find other way to contact you, can you tell me what do you think of my number 14 X-ray thanks.

Number 14 X-ray after and before root canal
 

Hi, Brianna can you tell me what do you think of my X-ray tooth 14. Thanks

Hi tricia,

Thanks for posting the x-ray.

Tooth #14 is root canaled and there are several things showing on the x-rays.

1) The tooth is diseased and irrelevant of how many times it is root canaled it will continue to be diseased.

2) The pre op xray shows that the bacteria had proliferated beyond the tooth into the bone around the apex (root) of the tooth.

3) The post op xray shows that the same infection is still present in the bone and has possibly communicated with your sinus.

4) It also appears on the post op xray that you are developing a deep pocket at the distal portion of the tooth. This area is in between #14 and 15.

5) During the rc procedure it appears that the dentist perforated the apex (root tip) during instrumentation. That small thin white line at the end of the tooth that kind of looks like a sail indicates either a piece of gutta percha material or a glob of liquid filling material was pushed through the perforation into the bone and possibly into the sinus.

From these xrays it is not possible to determine if the infection and filling material has gone into the sinus. But it is quite possible. This tooth is very close if not into the sinus. It is also possible that you have a cyst surrounding this tooth as well.

The only way to attempt to cure this infection is to have the tooth removed by an oral surgeon. The bone and possibly the sinus would need to be surgically debrided at the time of the extraction.

Thank you again.

Root canal not filled
 

Hi Brianna, I.m also new in this forum and I see your knowledge and experience you give to the people, we'll going to the point, I have total 2 root canals, in #6 and in#8, dentist says 8 looks all ok but 6 the canine has the round ball of infection on top and I fill a little fistula inside my nostril that grows when I have 1 or 2 times a week like a one day cold (like an allergy attack) with sniffing, mucus, headache, etc and that little fistula grow little more and comes down after, but now I'm having itchy nose and eyes every morning for several ours, etc
So the dentist said the rc wasn't done right it wasn't filled, that can be corrected and that the out side of the toot, with the root, doesn't communicate with the inside tubules so he can redo it right for the infection to desapear.
I understand with you that the only way would be extracting the toot but can you give me your opinion of what the dentist believes? If I take out my canine would my lower face look unsimetric? (I Have a bridge between 6 and 8)
After about 9 years that start this problem I'm really tire and sick of it, can you please give me your advise? Thank you so much. Dan.

Welcome danieldemaree. :Tip-Hat:

Brianna will be along to help.

Hi Dan,

I am in the dental field and can offer you some information here. I will inform you ahead of time that what I am going to tell you may conflict with what your dentist has told you. I will re post some of your thread and answer you in bold type. Makes it easier to follow.

<<I have total 2 root canals, in #6 and in#8, dentist says 8 looks all ok but 6 the canine has the round ball of infection on top>>

IT'S IMPORTANT TO KNOW THAT ALL ROOT CANALED TEETH, IRRELEVANT OF SYMPTOMS OR NOT, ARE INFECTED. THEY ALL HAVE MANY HUNDREDS OF TINY DENTIN TUBULES WHICH ARE MICROSCOPIC AND THEY CONTAIN DEAD INFECTED NERVE TISSUE. THIS IS WHY ALL ROOT CANAL TEETH REMAIN INFECTED IRRELEVANT OF WHAT PROCEDURE IS DONE TO THEM.

<< I fill a little fistula inside my nostril that grows when I have 1 or 2 times a week like a one day cold (like an allergy attack) with sniffing, mucus, headache, etc and that little fistula grow little more and comes down after, but now I'm having itchy nose and eyes every morning for several ours, etc>>

IT IS NOT A GOOD THING TO HAVE THIS ON AGAIN, OFF AGAIN FISTULA IN YOUR NOSE. THIS INDICATES THE INFECTION HAS SPREAD BEYOND THE ROOT OF THE TOOTH. WHEN THE FISTULA SWELLS IT IS FULL OF PUS.. WHEN IT GOES DOWN THAT INDICATES THE PUS HAS FOUND A PLACE TO EMPTY INTO. THIS IS NOT HEALTHY AT ALL. IF YOU KEEP THIS TOOTH, YOU ARE GOING TO HAVE CHRONIC INFECTIONS IN YOUR SINUSES.

<<So the dentist said the rc wasn't done right it wasn't filled,>>

IT IS IRRELEVANT IF THE RC WAS DONE GOOD, BAD OR INDIFFERENT. IT IS IRRELEVANT IF THE CANALS WERE FILLED COMPLETELY OR NOT. THE PROBLEM IS NOT ASSOCIATED WITH THE PROCEDURE, IT IS BECAUSE THE DENTIN TUBULES ARE INFECTED, INFLAMED AND CONTAIN DEAD NERVE TISSUE.

<<that can be corrected and that the out side of the toot, with the root, doesn't communicate with the inside tubules so he can redo it right for the infection to desapear.>>

THE DENTIST IS REFERRING TO A SURGICAL PROCEDURE CALLED AN APICOECTOMY. THIS IS NOTHING MORE THAN A SURGICAL ROOT CANAL. IT DOES NOTHING MORE THAN A CONVENTIONAL ROOT CANAL AND IT DOES NOT TOUCH THE DENTIN TUBULES WHICH IS WHERE THE INFECTION IS COMING FROM. TO JUST REMOVE THE FISTULA DOES NOT CURE THE INFECTION BECAUSE THE BACTERIA IS COMING FROM INSIDE THOSE TUBULES. THE FISTULA WILL RE OCCUR AFTER THIS SURGERY AND THE INFECTION WILL CONTINUE TO SPREAD FURTHER.

<<I understand with you that the only way would be extracting the toot but can you give me your opinion of what the dentist believes?>>

THE DENTIST IS WELL AWARE OF ALL OF THE THINGS THAT I HAVE TOLD YOU HERE. HOWEVER, HE IS TRAINED TO "RETAIN" OR "KEEP" TEETH IRRELEVANT OF THE INFECTION. HE IS NOT TRAINED TO REMOVE TEETH THAT HE FEELS HE CAN PERFORM ADDITIONAL PROCEDURES ON. HE KNOWS THE ONLY CURE TO THIS INFECTION IS REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH AND THAT EXTRACTION OF THIS TOOTH IS INEVITABLE.

<< If I take out my canine would my lower face look unsimetric? (I Have a bridge between 6 and 8)>>

TEETH #6 AND 8 ARE UPPER ANTERIOR TEETH. YOU HAVE A THREE UNIT BRIDGE FROM 6 TO 8, CORRECT? ARE YOU MISSING #7? DID YOU HAVE AN ACCIDENT OR WERE THE TEETH BADLY DECAYED?

<< After about 9 years that start this problem I'm really tire and sick of it, can you please give me your advise? Thank you so much. >>

THE HEALTHIEST OPTION FOR YOU IS TO REMOVE ALL SOURCES OF THE INFECTION WHICH IS TO REMOVE THE ROOT CANALED TEETH, BOTH OF THEM. REPLACEMENT OPTIONS WOULD BE A LONGER SPAN PERMANENT BRIDGE FROM #5 THROUGH #10 OR 11. ANOTHER OPTION MIGHT BE A REMOVABLE PARTIAL DENTURE WHICH WOULD REPLACE ANY OTHER MISSING TEETH IN YOUR UPPER ARCH. DENTAL IMPLANTS WOULD BE RISKY BECAUSE CHANCES ARE YOU NOT GOING TO HAVE HEALTHY OR ADEQUATE BONE IN THE AREAS OF #6,7 AND 8.

Tomorrow
 

Hi Brianna thank you so much for your replay about the issue I'm passing trough, about the 7th toot it was taken off about 27 years ago to instal the bridge, they were perfectly healthy, not bad, just the 7th was kinda semi out of place, but I think I was stupid giving up the pressure of my ex wife on that time to fix it, I was in the playing music thing so she was telling and telling me to do it, and dentist said all was going to be ok, but years later they were decaying, so took the bridge out and root canaled and since then my health has been poor, So I'm repented now but is to late for that. I'm glad to see now this post I was waiting from you, thank very much for it, tomorrow afternoon is the day going to dentist for the RC but I won't do it so I'm taking out the toot.
Do you think in next months after new bone grows there ill be ready for implants, if this is not another new nightmare?
Do you think, even that he's saying that #8 r canal is done great, is giving me some kind of trouble, but no infection showing in the r graphs? Thank you a lot

Hi Brianna thank you so much for your replay about the issue I'm passing trough, about the 7th toot it was taken off about 27 years ago to instal the bridge, they were perfectly healthy, not bad, just the 7th was kinda semi out of place, but I think I was stupid giving up the pressure of my ex wife on that time to fix it, I was in the playing music thing so she was telling and telling me to do it, and dentist said all was going to be ok, but years later they were decaying, so took the bridge out and root canaled and since then my health has been poor, So I'm repented now but is to late for that. I'm glad to see now this post I was waiting from you, thank very much for it, tomorrow afternoon is the day going to dentist for the RC but I won't do it so I'm taking out the toot.
Do you think in next months after new bone grows there ill be ready for implants, if this is not another new nightmare?
Do you think, even that he's saying that #8 r canal is done great, is giving me some kind of trouble, but no infection showing in the r graphs? Thank you a lot

More details The little fistula that grow more and less I see is on top of the supposedly good root canal that is the no. 8 toot I think, so in no. 6 is a clear infection up going and in 8th no infection in r graph but the fistula appears in the very top, is what I see, so would you think the fistula is coming from the "good" RC? Thank you

danieldemaree,

As I have explained earlier, there is no GOOD root canal tooth. Meaning... with or without symptoms or pathology ALL root canaled teeth are infected.

Fistulas are common with root canaled teeth because a fistula is a LATE symptom of a chronic infection. A fistula occurs when the area of infection has become large, deep and overwhelmed with bacteria. Re treating this tooth with another root canal or having a surgical root canal procedure called an apicoectomy will not cure the infection that lives inside of this tooth and inside the jaw bone.

The only way to attempt to cure the infection is to remove the source of the infection which is the tooth.

I hope I was able to convey my explanation well enough and the information is helpful to you.

Two Root Canals
 

Hi Bryanna, I had two root canals done both on the second molars on the bottom teeth.

One of them developed a fistula a couple of years after the rootcanal was done. The other one has been fine and pain free. The Dentist said the fistula may be from micro fractures due to my bruxism. The fistula comes and goes on the same area.

I am 29, Are there other options than to extract the tooth with the fistula ? Thank you for all the information you have posted already.