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.
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