Dr. Hall:

I had a root canal treatment on tooth #14 that had an initial infection prior to the root canal. Two years later and several antibiotic treatments, a CAT scan with finally a visit to an ENT who ruled out sinus problems, my dentist still says there is nothing wrong with my tooth. But after each antibiotic treatment the pain and discomfort went completely away, but 2-3 weeks later returns....what could be wrong?

—Kathi in North Carolina

Dear Kathi,

If the dentist feels there's nothing wrong with your tooth, why were you given antibiotics? You don't prescribe antibiotics unless you believe there's a tooth infection. If your dentist is the one who prescribed the antibiotics, it indicates less than a complete certainty that there is nothing wrong.

Your reaction to the antibiotics has given helpful information. Since your tooth felt better after the antibiotics, I would say that it's likely there IS an infection in your tooth, whether the infection shows on the x-ray or not.

I'd ask your dentist to refer you to a root canal specialist for further evaluation.

I wouldn't do any more antibiotic treatments without getting the tooth fixed. What you do with repeated antibiotics without treating the underlying problem is you breed bacteria that are resistant to the antibiotics—not something you want to create in your body.

—Dr. Hall

Dr Hall,

Thank you so very much for your reply. I think I have now decided to go ahead and have the tooth pulled as I am so very afraid to try to save it at this point.



What exactly are you afraid of in trying to save it? I don't understand that.

It could be a fairly straightforward procedure to save it. Why don't you get an opinion from an endodontist (root canal specialist) and see just what would be

Taking out an upper first molar is going to do one of two things to you:

If you replace the tooth, it's going to require a dental implant or a dental bridge or some other tooth replacement.

If you don't replace it, it will cause the teeth around it to drift and become crooked and possibly ruin your bite, leading to the possible loss of other

A tooth extraction is a very traumatic appointment. From a dentist's perspective, I can tell you that there is no more traumatic procedure to a patient than an extraction, especially a molar.

—Dr. Hall

Dear Dr. Hall,

I really do appreciate your concern. No one else has shown me such compassion with this issue.

Well, honestly, I am very afraid to lose my teeth as I have all of them except my wisdom teeth. The others are in good condition as well as my gums. I never smoked and never did any type of drugs or alcohol, but also went every 6 mos to a year to get my teeth cleaned from the age of 20. I am 48.

It WAS an endodontist that said there was nothing wrong with my teeth, that he could see no cracks and no infection, but I keep getting infections. I was told that if they WERE cracked and went all the way to the root that the tooth could not be saved anyway. I am afraid of another 2 years of discomfort and repeated infections and costs on top of costs. So I have decided to go ahead and have #13 and #14 and # 3 extracted. #13 and #14 have had root canals. # 3 and #14 had a silver fillings (from 43 years ago) replaced with a white fillings January 2004. That is what started the infections in # 3 and #14. The dentist that did that procedure touched the nerve in both teeth and they became infected; #14 more than # 3, so I had a root canal in #14. I have suffered with on and off discomfort with # 3.

But, yes, I am very afraid to lose my teeth. I will have something to replace them soon after, either bridge work or a partial plate. I can't decide which will be less costly, or just more comfortable. That is how I came across your website by doing some investigating on the internet, thus leading me to send you an e-mail.

Thank you for your compassion. You are so kind with your replies.



If the root is cracked, then that is generally an unrepairable situation.

If the endodontist is scratching his head somewhat, I'd be tempted to get a second opinion from another endodontist. Especially if you're feeling that the endodontist doesn't really care.

I once sent a patient to an endodontist because of persistent toothache in a tooth that had a root canal treatment. The endodontist said that the root was cracked and he couldn't do anything to save it, and sent her back to me to take the tooth out. When I took it out, I could see plainly that it wasn't cracked at all, but there was a fourth root canal on the tooth. The canal was hidden on the x-ray, but when I had the tooth in my hand it was plain to see. This root had been missed in the root canal, and THAT was the reason the tooth was hurting. So he missed the diagnosis, and just by re-treating the tooth it could have been saved. But then it was too late—the tooth was out. But I never sent any more patients to that endodontist.

If you do have all three of those teeth extracted and money is an issue, a removable partial denture works well and protects the remaining teeth. For a bridge, they have to put dental crowns on the adjacent teeth, and then you can have trouble with those teeth.

—Dr. Hall

Dr Hall,

Thank you so very much. I WILL get a second opinion from another endodontist. And thanks for the info on the removable partial; this really puts my mind to rest for now.

—Take care, Kathi

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