Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 28, 2017

I want to avoid getting a crown on my front tooth, after a root canal


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Hello Dr. Hall,
Back in May 21st I had my front upper tooth knocked out. It was put back in, bonded and set back into place. I had a root canal done on it as well. I’m noting that the color is slightly off (more yellow) than the rest of my teeth. My dentist said that I would probably have to get a crown after my last visit, but looking online I see that a crown for a front tooth may not be a good idea. How can I preserve the whiteness of this tooth without needing a crown? Thank you for your time.
– Joseph from Staten Island, NY

Joseph,
You’re right. A crown on a front tooth, while it strengthens it against chipping, actually weakens the tooth against lateral stresses. So if you have a heavy bite at all, it is at greater risk of breaking off.

After a root canal treatment, a tooth tends to discolor. But that discoloration can be greatly lessened by cleaning out the inside of the crown from any root canal filling materials such as gutta percha or cement. If it is starting to discolor already (four months after treatment), the dentist has left some of those materials inside the visible part of the tooth.

Here’s what I would do.

Go to one of our recommended cosmetic dentists in Manhattan, Queens, or New Jersey, and have them clean out the inside of the crown. Since the tooth has begun to discolor already, it would be a good idea to have them do internal bleaching. Then you could have them fit the tooth with a fiberglass post inside and seal the opening, and you should be good for several years before it starts to discolor.

Then, when it discolors, I would just have them do a single porcelain veneer to correct that. This would require a fair amount of expertise in appearance-related dentistry to match the color of the adjacent tooth, but I’m confident that any dentist we list would be able to get that to look great for you.

Oh, one other thing. Since this is a replanted front tooth, you want to have it x-rayed again to make sure you don’t have any external resorption. It’s possible that your body could be eating away at the root. That happens sometimes with these replanted teeth. Be sure to find that out before you invest much money into this tooth.

And just a comment about your dentist. It looks like he or she did a nice job of saving your tooth—did all the right things, and is probably an excellent dentist. But these demanding aesthetic problems are over the head of the vast majority of general dentists.

I hope this is helpful.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 16, 2017

I have a titanium allergy and think I have a titanium post in my tooth


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Dr. Hall,
I have recently been diagnosed with a titanium allergy. I have two crowns on my left side, upper and lower. I have various odd symptoms that have been addressed with my dentist. They have been checked out and I’ve been told everything “looks” fine. The dull ache surrounding my upper remains. I’m wondering if I have a titanium post and if this is possibly contributing to this dull ache and possibly other unexplained ailments throughout my body. Where do I go from here?
– Jennifer from Kentucky

Jennifer,
Titanium allergy used to be considered very rare, but with the increasing use of dental and orthopedic implants, which almost always use titanium, there are increasing reports of titanium allergy. The MELISA Medica Foundation, which conducts the MELISA test for metal sensitivities, estimates that as many as 4% of the population could be allergic to titanium. However, this test has been criticized as generating false positives, and my guess would be that titanium allergy is less prevalent than that.

Titanium is a very biocompatible metal, apparently due to its high corrosion resistance. Given this corrosion resistance, I would not think that the presence of titanium in a post inside of a tooth would affect tissues outside of the tooth, but I guess that would be possible. If you want to investigate that, I would just go to the dentist that put the post in your tooth and ask if it is titanium. Your dentist should have a record of the type of post that was inserted. I will add that there should only be a post in your tooth if the tooth has had a root canal treatment.

Metal posts are often used in root canal teeth to help retain the buildup that is placed in the tooth and the buildup in turn helps retain the crown on the tooth. For many years, stainless steel posts were the standard. Stainless steel contains nickel, and it is estimated that 10 to 20% of people are allergic to nickel. It was assumed that this wasn’t an issue, because the post was sealed inside the tooth and not in contact with living tissue. Then, about 30 years ago, it was discovered that corrosion products from the stainless steel could leach through the teeth and many dentists, including me, switched to using titanium posts.

Could your dull ache be from a metal sensitivity? I would say that it could. I would wonder if there is any metal in the crowns you have—that is something worth checking also. There could also be a problem with the occlusion of the crowns. In any of these scenarios, everything would “look fine,” but that doesn’t mean that everything actually is fine.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 27, 2017

This is too much sensitivity – you need a root canal


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Dear Dr. Hall:
On June 26, my dentist prepared my cracked tooth number 30 (lower right first molar) for a crown. I had several problems with the temporary crown including very sore gum and pain with biting and cold sensitivity. However, since the pain was not lingering, my dentist placed my permanent crown on July 12. But it didn’t subside and in fact, it got worse. After one week, I visited him again and he took X-ray and did cold test and pressure test. He also knocked at my tooth which was not painful. My tooth was very sensitive to cold but it went away in less than 30 seconds. Also, I didn’t feel pain with pressure test although I felt pain when I bit on hard things. So my dentist said I had to wait and I had high chances to get better. He said sensitivity to pressure is normal even for 30 to 90 days. Now 10 days has passed and from my permanent crown placement, but I don’t see any improvement. Also, today I discovered my tooth is sensitive to hot food too although it doesn’t linger for a long time after the hot food is removed. I think once I realized this sensitivity with that temporary crown but didn’t care about it.
Are these reversible pulpitis symptoms? Does that heat sensitivity show my tooth nerve is dying? How long do you think I must wait before I see an endodontist?
Thanks a lot.
– Bita from Iowa

Bita,
Thanks for the clear description of your symptoms! You told me what kind of pain, what provokes it, and gave me a clear history, which makes it much easier to figure out what is going on with your tooth.
I would call the endodontist today. There are a couple of red flags here and I’d get an expert diagnosis before this tooth gets any worse. It doesn’t look good.
I don’t want to be too critical of your dentist, because I don’t know the whole story of your tooth—just what you’ve told me. But just taking what you’ve told me, some additional caution in your case seems like it would have been wise, and I’ll explain why. It also isn’t normal for a tooth with a new crown to be sensitive to pressure for more than a few days, if the occlusion is adjusted correctly.
First, you had a cracked tooth. A crack can easily involve the pulp of a tooth and by itself can cause a tooth to become infected and the pulp to die.
On top of this, you had significant cold sensitivity after the crown preparation. This could have been due to an incompletely sealed temporary crown, or it could have been due to the extra irritation to which the tooth was subjected from the crown preparation, or a combination of the two. It would have been wise to have coated the tooth with some type of desensitizing product at this point. Maybe that was done.
Also, given those two things, it would have been prudent to have temporarily cemented the crown. This is a lower first molar, so the crown would have to be made out of some strong material that could have been cemented with a soothing type of cement in hopes that it would settle down, or, if it didn’t, to allow easy removal of the crown for root canal treatment. Permanently cementing a crown is usually an additional irritation which can push a borderline tooth over the edge to needing root canal treatment.
So your dentist permanently cemented the crown and the pain got worse. Your sensitivity is headed in the wrong direction and appears that it will end up in irreversible pulpitis, requiring root canal treatment.
And now it is getting sensitive to heat. I wouldn’t go quite so far as to say that it’s absolutely certainly suffering from irreversible pulpitis at this point, but if not, it’s awfully close. The endodontist should be able to tell you for certain. There would be subtle changes in the ligament of the tooth around the end of the root that most general dentists wouldn’t see but the endodontist should.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 26, 2017

My dentist put a screw post in my front tooth

Filed under: Root canals — Tags: , , , , — mesasmiles @ 11:58 am

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Hi Dr Hall,
I just had a front right central incisor break at the gumline after getting a root canal treatment. My dentist has used a metal screw post for the temporary crown. I have a continuous dull feeling in nasal cavity area but no pain. Is the screw a good idea for this type of problem as I cannot afford a bridge?
Many Thanks,
Frank from Pietermaritzburg, South Africa

Frank,
These screw posts generally are pretty solid as far as staying in the tooth, but they are risky. They exert a lot of stress on the root. The risk is that the root will split from the pressure. Is that happening in your case and is that why you have this dull feeling in the nasal cavity (which would be where the end of the root of this central incisor would be)? That could be, but I would wait it out.

But a front tooth that has broken off at the gumline is a tough situation. Many dentists would consider the tooth to be unrestorable. There are rotational forces on a front tooth that over time can loosen the crown and/or the post. My advice would be to go ahead with the crown, cross your fingers, and hope this post and crown last a long time. My guess would be that they would fail at some point.

If you can’t afford a bridge, the budget option for replacing a single front tooth would be a flipper partial. That may be where you end up.

In retrospect, it would have been good if your dentist had placed a simple post in your tooth after the root canal treatment, before the tooth broke off.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 8, 2017

Delayed pain after a root canal treatment


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Dr. Hall,
I think your response to Patty from Kansas about increased post-root canal pain a few days following the procedure was somewhat misleading. It’s my understanding (and several resources suggest) that it is not uncommon to experience peak inflammation/pain 48-72 following a root canal, yet you advised: ‘The tooth being fine right after the second time doing the root canal but then the pain coming back a few days later, that is a particularly bad sign. This isn’t ordinary post-operative pain but a failed root canal.’
– Nan Anne from Chicago

Nan Anne,
I didn’t write what I wrote from reading research about it, but from experience and an understanding of the physiology involved. And it may not be that your reading is disagreeing with me. You didn’t say who these “several resources” were, but you did say they are suggesting that peak inflammation occurs 48-72 hours following the root canal. I think that may be true, if the pain is not treated by reducing the occlusion. The tooth hurts right after the novocain wears off but then, untreated, it feels worse the second day, maybe a little worse the third day, and then starts getting better. So the pain has peaked on the third day. That sounds about right. When there is postoperative pain after a root canal treatment that comes from simple inflammation, it will hurt right away but the pain won’t peak for 2-3 days.

But that is different from what Patty from Kansas reported to me. She said her tooth felt fine for 2-3 days after the procedure and then started to hurt again after that.

Prodded by your comment, I did revise the blog post to make it more clear that when I said she had a failed root canal, I was talking about her particular case, and I don’t mean to imply that whenever a root canal tooth begins hurting a few days later it is a failed root canal. This was her second time around, so the root canal had already failed once. I’m confident that her renewed pain was not just a simple inflammatory reaction to the instrumentation of her tooth.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 20, 2017

Tooth with a crown is sensitive to heat


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Dr. Hall,
I have several crowns, some on natural teeth some on implants. I have two crowns next to each other on top and front. The crowns are maybe 20 or 25 years old. 1 week ago I saw my dentist for a cleaning and today I woke with constant strong pain but much worse when sipping coffee warmer than room temperature. My dentist isn’t in for a few days and the pain seems to be growing to include the crown on the tooth next to it. Any ideas?
– Randy from Illinois

Randy,
I’m sorry to have to be the one to give you the bad news, but the pulp of your tooth is dying and it is going to need a root canal.

You have two of the classic symptoms of a dying tooth. Teeth can be sensitive to a number of things, and that sensitivity can sometimes come and go and may not indicate a dying tooth. But if you have strong pain that isn’t provoked, that’s an indication of a dying tooth. Adding to it, your pain is aggravated by heat–a doubly bad sign.

What happens is that an infected pulp will draw in body defenses including white blood cells. The tissue wants to swell, but being in a confined space, it chokes itself and then dies. As it dies, it can sometimes give off gasses. Any warming up of the tooth increases the pressure of those gasses and increases the pain. Cold will cause the gasses to contract and will generally provide relief in this situation.

So what do you do when you have a crown on the tooth that needs a root canal? It isn’t difficult to make an opening in the crown and do the treatment through the crown. However, if I were your dentist, I would want to remove that crown and find out what is going on under it. I would also want to replace the 20-year-old crown on the adjacent tooth, because something similar may be happening to that tooth.

Why is this happening? There are several possibilities. One is that decay has gotten in under the crown. This can happen through a leaky margin that your dentist didn’t catch or maybe did see but didn’t attach enough significance to it. Another could be that the tooth has become irritated through exposed root surface.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 12, 2016

Root canal re-treatment isn’t working


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Dr. Hall,
I had a root canal re-treatment on my front tooth 3 weeks ago, by an endodontist specialist. I had the tooth checked just over a week ago and although I was still having pain around the tooth, he said that there was no swelling and it would all settle down. However, it is still very sore and sometimes the gum throbs, particularly if I am active, which surely tells me there is inflammation still. I am unable to take ibuprofen or aspirin and take paracetamol when needed.

I had gum swelling around the tooth before the root canal re-treatment, which was treated by erythromycin and this was finished about a week before the treatment was completed.

My question is what should I do next? It does not seem to be settling and I am worried if the bone around the tooth is infected and if it could spread. Should I wait more time to see if settles or see if the dentist will prescribe more antibiotics?
– Diane from Ashfield, UK

.

Diane,

It doesn’t look good for your front tooth. Your instincts are correct – after three weeks it should be feeling better. Am I correct in assuming there is no improvement in the tooth? Residual tenderness in a tooth after any root canal work isn’t that unusual, but there should at least be some gradual improvement which you should be able to notice after three weeks.

I would not do any more antibiotics. Antibiotics won’t get at the source of the infection in a tooth – they only assist your body in fighting off the infection. Yes, the tooth would feel better for a while but then when you quit taking the antibiotics, since you haven’t eliminated the source, the pain will come back and now you will have an antibiotic-resistant infection.

There is no significant risk of the infection spreading at this point. You aren’t having an increase in pain, from what you are saying, and there isn’t any serious swelling.

Something is still wrong with the tooth that wasn’t fixed with the root canal re-treatment. Re-treatments don’t always work and it appears that yours isn’t. After initial root canal failure, which you experienced, the chances for success for re-treatment are somewhere in the range of 50-80%, depending on the nature of the problem that led to the failure.

The way antibiotics were used in your case seems strange to me. You said you had erythromycin before the treatment, and this was finished a week before doing the re-treatment. That would just give the infection a chance to come back before starting the re-treatment. If antibiotics were needed, I would have started them, done the re-treatment after they had taken effect, and then continued the antibiotics for a couple of days afterward. I just mention that because it’s strange – that’s not why your tooth isn’t getting any better.

Your options at this point are limited. You could have root canal surgery, but I’m skeptical about the chances for success of that treatment in your case, since, based on what you’re telling me, your endodontist isn’t inspiring me with a lot of confidence. You could maybe try that if you get outside your UK National Health Service. Your other option would be to have the tooth extracted and then replaced with whatever options they give you in the UK.

Dr. Hall

Question and answer go here.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 29, 2016

Removing a metal post in a tooth


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Dr. Hall,
I just found out my dentist inserted a stainless steel post into my root canal tooth–my upper molar. A temporary crown is placed over it now and a permanent crown will be placed in a week. My question is can the post be removed and a zirconia or carbon post (I don’t think he does those) be put in instead? I don’t want steel in my mouth even though he said it’s encased. My ears have been pulsating since. Please tell me it’s removable!
– Linda from Brooklyn

Linda,
Yes, a stainless steel post probably can be removed, though there may be some risk involved.

Let me give a little background on this to frame my answer.

stainless steel dental post

A metal post in a lower molar

When a tooth is “bombed out,” needing a root canal treatment and with little tooth structure left, a dental post is often placed in the tooth. This post can serve a couple of purposes. For front teeth and premolars, it can strengthen the tooth against horizontal fracture. For molars and any other teeth, it can also provide additional retention for the crown. If there is little of the original natural crown of the tooth left, the post, anchored in the root of the tooth, will help retain a buildup in the tooth, and the buildup retains the crown.

There is a history to the material out of which the post is made. In the 1970s and earlier, stainless steel was the material of choice for prefabricated dental posts. However, in the 1980s it was discovered that even though a post is cemented inside the tooth and doesn’t come into contact with the bloodstream at all, metal ions were found to leach through the tooth and into the bloodstream. Stainless steel contains nickel, which causes sensitivity reactions in many people (see some of our blog posts on metal allergies). To guard against potential reactions as you seem to be experiencing, many dental practices, including mine, switched to titanium, which is not only very strong but the most biocompatible metal available. In the 1990s, other materials were introduced for posts, including carbon fiber and fiberglass. More recently, zirconia has been used for posts. Zirconia is a ceramic that has high flexural strength and is also very biocompatible.

So yes, you have a legitimate concern about this stainless steel post. Your dentist should get with current technology. From what you are telling me, he isn’t into any of these newer post materials, most of which have been around for twenty years or more.

Now, as to removing the post that is in there, that could be tricky and, depending on the situation, you may not want to trust your dentist to do this but may want to see a root canal specialist or another dentist who feels comfortable doing this. It depends on how deeply the post goes into the root of your tooth and how well it is cemented. It may be possible to dislodge it with an ultrasonic tip. I remember one patient I had who was adamant about removing several metal posts in his teeth. I don’t remember why his posts were so difficult to remove, but I ended up telling him that I had to drill out all of these posts and I had him sign a paper acknowledging that I had told him there were serious risks in doing this, that I could perforate the roots of any or all of these teeth, leading to the loss of the teeth. He was willing to accept those risks. The good news is that I got out all of the posts without any accidents, but I remember it was very stressful for me.

If you feel that you are experiencing a sensitivity reaction to the post, I would put a halt to the crown procedure until you can have the post removed. Cementing a crown on the tooth will only make it more difficult, as your dentist would have to start by drilling through the crown, possibly ruining the crown.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 30, 2016

My tooth was fine until my dentist worked on it


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Dr. Hall,
I went to my dentist recently and he filled a front tooth. While in the chair he stated that he saw a small crack on the rear molar on the left side, and he said it needed to be repaired. He drilled the tooth out, banded it, and filled it with composite. I called him the next day because the tooth was extremely painful. Two days after he did the procedure I was back in his office, and after a cold test he said that I needed a crown and a root canal. I had him pull the tooth. Should I pay him for the extraction when there was no issue with the tooth, before he removed half of it, other than a small crack?
– Mark from Georgia

Mark,

Nothing you told me indicates to me that your dentist did anything wrong. Yes, it’s possible, because I don’t know the whole story. But I’ve seen this sort of thing many times, and it sounds to me like your dentist did the right thing.

When you say that there was nothing wrong with this molar but a small crack, that’s not the complete story. A crack is almost always a symptom of a major underlying problem with the tooth. A tooth that is otherwise healthy will not have a small crack in it. From subsequent events, it seems clear to me that this tooth was already infected. Yes, working on it irritated it a little more and placing a well-sealed filling over the infected pulp of the tooth caused an immediate painful reaction. Had your tooth been healthy before your dentist worked on it and had merely had some accident during the procedure, your tooth would have started to get diseased and it would have taken some time for it to flare up. The fact that it was immediately painful indicates that this disease process was probably already pretty advanced.

The reason your dentist was concerned when he saw this “small crack” was that the tooth probably had a large filling in it. You didn’t say what type of filling, but almost all teeth with cracks have large fillings in them, usually amalgam fillings. The crack would probably indicate that there is some leakage around the filling, meaning that decay will be able to leak through and get under the filling.

Not being able to see the x-ray, and not having looked over the shoulder of your dentist while he was working on your tooth, I can’t say with certainty what happened, but let me tell you what probably happened, based on my experience with many of these situations. Your dentist removed the old, leaky filling, likely with some decay underneath it. The dentin that was left between the bottom of your cavity and the pulp of the tooth was thin but intact. However, dentin is porous, and because of how the tooth reacted it appears to be clear that bacteria from the decay had been able to penetrate that porous dentin to infect the pulp of the tooth, causing it to be slightly inflamed. Working on the tooth irritated it somewhat, as it always does. Your dentist then replaced the old leaky filling with a new composite resin filling, bonded to the tooth and tightly sealed. The well-sealed filling now caused the internal pressure of the inflamed pulp to increase, which is what caused your immediate painful reaction.

I’m sorry for your sake that you had the tooth pulled when it could have been saved, but that is water under the bridge now. If it was the tooth furthest back in your arch, that shouldn’t have a serious impact on your bite, but you might eventually end up also losing the opposing tooth because it now may have no tooth to chew against and will hyper-erupt.

My recommendation to you would be to have your dentist look at your entire mouth and all your old dental work with a new set of eyes, and replace any old, suspicious fillings with new, well-sealed composite fillings, to help prevent this from happening again.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 20, 2016

The use of steroids to treat root canal pain


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Dr. Hall,
I had a root canal in May in a front tooth and serious pain following it, I was treated with antibiotics and steroids. This did not help so the dentist redid the root canal. I felt OK for 2-3 days then the pain came back. I feel a lot of pressure on this front tooth and the gum is inflamed and the root area is tender.
– Patty from Kansas

Patty,
There are some experts in root canal treatment who recently have been advocating treating postoperative root canal pain with steroids, but I disagree with that. Yes, if there is simple inflammation, steroids are an effective treatment. But the problem is that you have some dentists who don’t understand pharmacology well enough or aren’t good enough at diagnosis, and you have the treatment being misapplied, as I believe it was in your case.

Steroids block inflammation. That’s why some of these dental school professors recommend it for post-operative pain. There is irritation of the tissue around the end of the root of the tooth because the instruments used to clean out the teeth irritated it. When that happens, that tissue tends to swell, raising the tooth and causing traumatic occlusion, which only irritates that tissue more. It’s a nasty vicious cycle and Decadron, a steroid, is an effective treatment.

But the problem is that steroids also block the body’s response to infection. So when you have a post-operative infection, as you apparently did, steroids do more harm than good. And then the dentists feel that, to cover the possibility that there is infection involved, they need to prescribe antibiotics. This leads to an overuse of antibiotics and contributes to the serious public health problem of cultivating antibiotic-resistant bacteria in the population.

What I did for post-operative root canal pain in my practice, that was very effective, was that I would give a strong dose of ibuprofen at the beginning of the root canal appointment, so that it was fully absorbed by the time I was done with the appointment. This would help head off that inflammatory response. (Ibuprofen is a non-steroidal anti-inflammatory drug.) Then I would reduce the occlusion of the root canal tooth so that it didn’t touch the opposing tooth when the patient clenched together. Since the tooth would later need a crown anyway, it wouldn’t hurt to reduce it a little. That pretty much took care of any post-operative pain.

So what do you do now? The tooth being fine right after the second time doing the root canal but then the pain coming back a few days later, that is a particularly bad sign. This isn’t ordinary post-operative pain but in your case appears to be a failed root canal. In your case, this would be the second failure on this tooth. It seems that the infection here has never completely gone away, and thus the tenderness around the root comes from that persistent infection. If this wasn’t done by a root canal specialist, I would ask for referral to a specialist. The specialist may feel that he or she could solve the problem by re-doing the treatment one more time. Or, root canal surgery is fairly simple on an upper front tooth, if that’s what tooth we’re talking about. That may be required. Or you could end up losing the tooth.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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