The Cosmetic Dentistry Blog

Hi Dr. Hall,
I am writing because I could use some expert advice and I am impressed with your posts. 

I just finished a two month course of treatment where #14 was a retreated root canal and #15 was first time root canal. Anyway – there had been a sizeable black area in the bone above 14 before the RC but 14 had been asymptomatic for years. It was only when 15 needed a root canal due to a large filling that 14 “woke up”. 14 had no pain until 15 had the RC. After the two root canals, 15 resolved pain but #14 didn’t. Both teeth were re-medicated 4 times over a two month period before root canals were finally completed today. #14 is still tender and painful just to rub my tongue on it. Endodontist is highly skilled with excellent reputation and says the #15 looks great and #14 has no signs of fracture visible using microscope from inside and no sign of fracture on xray. The gutta percha did not ‘ooze’ out of filling on xray so Dr. says this bolsters evidence of no fracture. He did say the ho! les at bottom of root were larger than normal but he said that was from original root canal 20 years ago. He said that he ostensibly ‘corked’ the holes by pushing the filling material through the root openings past the tooth (which I can see on post treatment xrays). He said any excess will be reabsorbed over time. The dark shaded area above #14 appears a slight bit reduced as compared to xrays one month ago but the Dr. says that may just be angle of xray. The black area is like an 8mm pocket in the jaw (it is not surrounding the tooth’s root as would be the case with an abscessed tooth root.)

Question: My endodontist can not offer any explanation for pain in #14 other than effects of bone loss over the years due to that slow growing pocket of infection. Should I request an antibiotic to try to see if this pain is possibly from infected ligaments around the tooth now that the inside of tooth has been treated and retreated and remedicated for two months? Will the dark area on the x-ray – if it is bone loss – eventually regenerate into bone? If the black area is infection, will it reinfect the teeth? What to do? The endodontist said if it really bothers me then extract the tooth but if it were his mouth – he’d said he’d try to save the tooth. My problem is the pain is wearing me down and I have lost almost 20 lbs in 2 months from not being able to properly eat. I fear that unless we know the problem – extraction might not even be the solution. What do to? At! my wit’s end. Should I get antibiotics? Dr said to delay seeking restorative crowns till pain is resolved but not sure how long to wait. Any thoughts would be greatly appreciated.
Thank you
Nan from New Jersey

Dear Nan,
I’m not going to be able to tell what’s wrong with your tooth from here, but from what you’ve told me it sounds like your endodontist is careful and caring. Too many of them give up on a tooth too early as a way to protect themselves, and it impresses me that he’s willing to stick this through and try to save your tooth. Everything you’re saying he is telling you makes sense to me.

The black area on the x-ray, once everything is healed, will fill in with bone over a period of months. And it appears that the infection isn’t spreading. Even if it does spread, it is highly unlikely that it would infect other teeth.

If an antibiotic makes the pain go away, then, yes, that’s a great indication that the pain is from an infection and not, say, from a nerve that is acting strange, or from stress on the tooth, so that could be worth trying.

If there is pain when you chew, you can have your dentist reduce the tooth so you don’t hit it at all and this should help.

And I would agree with your dentist. While he is in favor of trying to save this tooth, if you get to a point where you just don’t want to monkey with it any more, then you can have it extracted. But you would definitely want to know that it is this particular tooth that is causing your problem. Sometimes pain can feel like it is from one tooth but it is really referred pain and the source is somewhere else. I have had patients swear that a lower tooth, for example, was the source of their toothache, when it was actually an upper tooth.

Dr. Hall

related links:
Read more about root canal treatment and failed root canals.
Read more about pain after root canal treatment.

Dr. Hall,

I was having EXTREME pain and sensitivity all of sudden in my lower left side of my mouth and I went to the dentist. She evaluated the two possible teeth (both of which were somewhat painful to cold and tapping) and stated that one of them (if not both) needed a root canal. So I went and had two root canals (#18 & #20) at the recommendation of the endodontist. Everything went well except that even after a few days, I still experienced serious sensitivity and discomfort, but in a DIFFERENT tooth (#22). I went back to the endodontist for a checkup and he confirmed that #18 & #20 were fine and to go back to my regular dentist to check #22. I am very worried that I did not need the other root canals and that they were just sensitive because of the massive filings and previous work done a few years ago. The tooth that is still hurting me (#22) has had no work done except a superficial filling (white amalgram or whatever its called) a while back. Is it possible that this tooth was the actual problem and the others were only hurting when banged or touched with cold spray because of major fillings? This tooth (#22) hurts when I tap it with my toothbrush or drink anything cold or hot, and also if cold air rushes across it. The pain is not as bad as before the root canals, but now I have less nerves to feel the pain

PLEASE advise, as my insurance is maxed out and now I feel like I have been taken advantage of with no recourse. I am using a sensitive toothpaste in the meantime and trying to avoid anything too cold or hot.

Thank you.

Melissa,
It’s hard to tell, sometimes, which tooth is causing a problem. Your diagnosis from the start was iffy – “two possible teeth … that needed a root canal.”

It could be that they both needed root canals. Your teeth shouldn’t be sensitive after dental work for more than a couple of months. But then again, maybe they didn’t. But it sounded like even your dentist who actually examined the teeth wasn’t completely sure.

When teeth get to hurting and the pain is hard to localize, the more time that goes by the more clear it is which tooth is causing the problem, or what the problem is. Eventually they abscess and then it’s usually pretty clear on the x-ray where the problem is.

I’d advise getting another opinion from another dentist.

Dr. Hall

Related links:
Pain after root canal
Read more about toothaches

Dr. Hall,
I had a checkup and was told that my back top left molar was half missing and would need to be capped. When I went back a week later to have my cavity filled in another tooth I was told that it would have to be removed. Well now I have a low pain that seems to radiate to my bottom teeth same side but when I drink something cold the pain goes away. 

So with that said would i need to get it capped or is it too late and do I need to get it removed completly?
- Jeremy from Rhode Island

Jeremy,
Sounds like your tooth needs a root canal treatment. When cold makes the pain go away, that’s a dead giveaway that the tooth is dying inside and needs a root canal.

If you want a tooth extraction, then that’s your choice. I believe in saving your teeth when you can. But your dentist should give you the option of saving it, and explain the pros and cons of doing that versus having it taken out. One of the problems in taking out one tooth is that it affects other teeth. For example, there’s a good chance that taking out your upper 2nd molar will cause you to eventually lose your lower second molar on that same side.
Dr. Hall

Related links:
Read about tooth pain after a filling.
Or tooth pain after root canal.

Dr. Hall,
I had a root canal done on my lower molar a year ago, since then I’ve had pressure sensitivity and then later sensitivity to heat that would radiate. I went back, and then my dentist decided to retreat the tooth with the thought that there may be another canal. He said there was, he packed it with some medication and a temp. filling and prescribed antibiotics and I am to go back in 3 weeks for the permanent filling. Since he did this I have had pain in the tooth, pressure…nothing to hot/cold, but I can’t chew on that side. My dentist is out of town this week so I have nobody to call. I don’t know if this is “normal” or why I am having this much pain.
- Karen in Missouri

Karen,
Your pain isn’t unusual. Post-operative pain after root canal work is common. I don’t think there’s any cause for alarm, and it sounds like your dentist did everything right, but I’m sure you’d like some relief from the pain.

Pain to pressure that develops long after a root canal treatment was completed could indicate a failed root canal. But pain to cold or heat is a strong indication of another canal being present in the tooth.

There was apparently infection in the tooth. If he cleaned it out some, it’s likely that some of the infected material was pushed out of the end of the root, and this would cause that tissue to be very irritated and would cause pain until your body resolves that. If this is what is happening, the pain could be eased considerably if the tooth were adjusted to where it doesn’t hit when you clench together. Sometimes when the bite is adjusted it provides immediate and complete relief.
- Dr. Hall