Hello Dr. Hall,
I am 26 weeks pregnant, and I recently had a digital xray, as tooth #15 (upper left second molar) was getting sensitive. This is a tooth that had a root canal treatment before, and it also has a pile in it. The dentist said that there was an infection under the roots, and he gave me 3 options: 1. retreat the root canal 2. apicoectomy 3. extract the tooth and do an implant. I am still hesitating between 1 or 1-2 together, just to be on the safe side . He said that usually 60-70 % of the redone root canal treatments are successful, but in my case as I am pregnant what if not. As I will be soon getting in my third trimester it will be more difficult to operate. I am also worried because of the lidocaine injection, and what it might do to the baby. I know it is usually safe, category B drug, but still. My question is: 1. Does apicoectomy need more lidocain than retreating the root canal? Is the dosage bigger? 2. How fast would my dentist know if the just rootcanal would be successful? Would I feel pain in week or two if it was not successful, or not because there are no nerves in the tooth. He said he won’t know it in a year. That seems long to me, I am just talking to the redoing of the rootcanal treatment and not the apico. 3. Can apico be redone on the same tooth if it is needed? Basically if root canal would have solved the problem, having a done apico can shorten the life of a tooth if just simply cleaning up the canal would have done the trick? 4. I am also worried something may go wrong during the procedure and then I’d be in pain after and need to take drugs. Right now I am not in pain, although sometimes my tooth is sensitive. It hasn’t been lately, but I know there is no guarantee to when the infection advances and then I feel it. Thanks for your answer. Both my dentist and endodontist are basically new for me, and I wanted to have another professional opinion. I know it is not easy to answer not having the x-ray there. I appreciate it.
Anna from British Columbia
I would have the root canal treatment re-done and nothing more at this time. But I would have it done by a root canal specialist (endodontist). Specialists would be likely to have the special tools and experience that will make this treatment more predictable.
As far as the local anesthetic is concerned, you should need very little or maybe even none, because the tissue inside the tooth is dead and they will be working completely inside the tooth. Root canal surgery would require a regular dose of anesthetic. Ask the dentist to use only the minimum anesthetic required. Yes, Lidocaine is one of the few drugs that has been proven safe during pregnancy, but still, there is no need to overdo it. And another point about your pregnancy, from what you are telling me I imagine that the infection is a minor one, but it would still be better to be rid of it.
The endodontist should be able to tell right away if the treatment went well. While it is true that re-treatment is unsuccessful somewhere between 25% and 50% of the time, when it isn’t successful, it is usually because there was a difficult problem during the treatment – such as a blocked canal, a ledged canal, curves that were difficult to negotiate, or some other cause. And the endodontist will know if there were any of these difficulties. If no problems like this arose, and the endodontist feels that he or she was able to instrument the root to the very tip and got a good apical seal, the results should be fairly predictable. On the other hand, if the treatment didn’t go well, you could then make the decision to go ahead with the apical surgery (apicoectomy).
Congratulations, by the way, on your pregnancy, and good luck with your tooth.
– Dr. Hall
Read more about root canal failure.
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