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This missed diagnosis caused him a lot of pain

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Hello Dr. Hall,

I have recently gone though what felt to me like a dental nightmare! I would appreciate any advice that can be given.

Situation: My #19 tooth (lower left 1st molar) started to feel pain to cold foods and beverages and the tooth was sensitive to the touch. I went to an “advertising” dentist and he did an exam and took x-rays. His diagnosis was that I have all my wisdom teeth and 3 are impacted but one is showing and should be pulled (could be pushing on a nerve). He also said that fillings should fix the issue.

I had the fillings done and two days later my mouth started really hurting. Went back to the dentist and he corrected my bite by adjusting the filling. He gave antibiotics and suggested over-the-counter pain meds. That didn’t help so he then again suggested getting the wisdom tooth pulled. I told him the source of the pain felt deeper and not close to that wisdom tooth.

I got the wisdom tooth pulled and continued on the antibiotics. It felt like things were getting better but I guess once I stopped taking pain meds and the antibiotics ran their course the pain was back with a vengeance. My mouth started swelling and the pain was unbearable. I went to the dentist again. He gave me antibiotics again.

Early the next morning I went to the ER and they could see that I had an abscess. I went back to the dentist again and he referred me out to an endodontist. They couldn’t see me for several weeks so I went back to the oral surgeon who did the wisdom tooth. He agreed that there was an abscess infection and recommended that we pull that tooth. My anger comes from me specifying that the #19 tooth was the source of the original pain and I had to pay for several visits to the dentist, ER, and oral surgeon before the correct procedure was done and the pain eliminated. Is there any legal recourse for a situation like this?

– Jason from Texas

(See Dr. Hall’s answer below.)


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Jason,
You’re telling me a story of gross incompetence, a true dental horror story. And yes, I would call what was done to you to be dental malpractice. Based on what you are telling me, your dentist made serious diagnostic and treatment mistakes at every step of the way. If I were you, I would demand that this “advertising” dentist pay you not only for the extra visits to the oral surgeon and ER, but also for the cost of an implant and a crown to replace your missing first molar, or you will see a lawyer who will add pain and suffering damages to your claim.

Here’s a list of the mistakes he made.

First, at your initial appointment, with pain in the tooth to cold, you clearly have an inflamed pulp and he should have told you that a root canal treatment could be needed. Add to that pain to touch, and you have a high likelihood of needing a root canal. Bacteria had gotten into the pulp of the tooth, causing inflammation, and probably had begun to spread to the area around the root tip of the tooth, which would make the tooth sensitive to touch. It is puzzling to me why, with these symptoms, he would begin talking to you about your wisdom teeth.

At your second appointment, he continued with gross misdiagnosis. You have a new filling repairing what was undoubtedly deep decay, and he is adjusting the bite? The prescription for antibiotics seems to suggest that he suspected an infection in the tooth, but I’m wondering why again there appears to be a complete lack of knowing what to do. If he had missed this at the first appointment, surely he should be able to see it now. If he doesn’t like doing root canal treatments he should have referred you to an endodontist (root canal specialist) at that point. And antibiotics for a tooth infection? Since they can’t get inside the tooth, antibiotics will never completely cure a tooth infection. They only keep it at bay while waiting for treatment to be completed.

At the third appointment when you now have swelling, this should have been crystal clear to the dentist. But you just got antibiotics again. How did your dentist pass these courses in dental school about tooth infections?

It took the ER to tell you that you had a tooth infection, and when you told that to your dentist he referred you to an endodontist. Okay, your dentist doesn’t want to do root canal treatments. But he should at least know how to relieve your pain. With swelling in the jaw, the pulp of your tooth is dead, and if he had simply drilled an opening into your tooth, that would most likely have immediately relieved your pain.

And finally, with a raging infection and toothache, referring you to an endodontist who couldn’t see you for two weeks—that is the last straw. So now we have a combination of gross misdiagnosis with indifference to human pain. Based on what you are telling me, you have a great malpractice case here. I’d be tempted to go directly to a lawyer, but I think the nice thing to do would be to first give your dentist a chance to simply pay for all the extra treatment required. That would include everything you have spent so far plus the cost of replacing this missing first molar. When that tooth is missing, the tooth behind it will tend to tip into the space, and the tooth above will drift down, really messing up your bite and possibly leading to later TMJ disorder.

Sorry for all your pain and hoping you get this resolved,
Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Dentist injured her tooth removing the retainer

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Dr. Hall,
My 18-year-old daughter had her lower permanent retainer taken off 3 weeks ago. She had been wearing it for almost 3 years after having braces for 18 months. During the removal, tooth #25 was injured and it is now receded and slightly grey. It is painful for her to bite anything with it and hurts when she wears her removable retainer when water gets under the retainer. Her dentist took an x-ray—which looks fine to me, but based on doing a cold test he thinks her tooth is dead or dying and recommends a root canal. The endodontist he recommended does not use the GentleWave technology. She is leaving for college in 2 weeks and wants to follow the dentist’s recommendation but I am hoping the tooth is just bruised and inflammed and can recover. Would you wait on doing a root canal or is there an alternative to heal the tooth?
Thank you!
Caprice from South Carolina

I found your website searching for tooth root x-ray.

(See Dr. Hall’s answer below.)


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Caprice,
I have a direct answer to your question first, but then I have a couple other concerns that I’ll get to.

First, for the direct answer: no, if a tooth is dying or dead there is no other way to heal it other than a root canal. The problem is that since the inside of the tooth is a very confined area with no space for the living tissue to swell or to bring in antibodies to fight an infection, once it becomes diseased the only solution is to remove that tissue, which is what a root canal treatment is.

But I have a couple of other concerns about your daughter’s case, and an additional point.

My first other concern: I’m really curious about how this tooth was injured in the process of removing the retainer. I’m guessing that this must have been a fixed retainer that was bonded to the teeth but still, removing it should be a fairly routine procedure. Your dentist, of course, would be liable for the damage to the tooth and should be paying for the root canal treatment.

Next, I’m concerned about the diagnostic skills displayed here. You are saying the dentist thinks the tooth needs a root canal. If you’re meaning that the dentist is unsure of the diagnosis, that leaves me wondering. The tooth suffered some trauma after which it has begun right away to turn gray and is sensitive to biting and sensitive to cold. That’s enough right there for a definitive diagnosis of a dying tooth. And then the x-ray will show definite signs of a diseased pulp, if the dentist has sufficient diagnostic skills to properly read the x-ray. So I’m hoping you’re just using soft language and not telling me that the dentist is hedging on this diagnosis. If your dentist is unsure, I’d get a second opinion, maybe from an endodontist.

I’m not getting strong feelings of competence about this dentist of your daughter’s. I’m hoping there is more to the story here to explain these possible lapses.

Finally, you have no requirement to go to the endodontist your dentist recommends. Even if he is paying for it, you can find an endodontist on your own. This new GentleWave technology is attractive and is getting good reviews in the dental literature. If you want to find an endodontist who uses this technology, you’re within your rights to go looking.

I’m sorry for what happened to your daughter’s tooth, and wish her well.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Diagnosing a sensitive tooth after a new filling

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Dr. Hall,
I wanted to get your opinion on a pain I am having after the filling on my molar was replaced two weeks ago (a silver filling was replaced with composite filling)

Here are my symptoms:
*moderate pain when chewing
*very mild sensitivity to cold
continuous moderate pain starting up in the evenings after dinner…
*I started taking 400mg Ibuprofen around midnight if I couldn’t sleep from the discomfort, and that really helps.
*In the mornings I have no pain.
(My wife, who is a doctor, suggested I take ibuprofen continuously to reduce possible inflammation. Started that today.)
*In the evenings, continuous mild pain and discomfort around my left jaw and tonsil.
*very slight tingling and numbness in my lower left jaw and chin, kind of like when anesthesia is almost completely worn off

So my question:

Do you think I should have the new filling replaced to address these symptoms? Or should I wait?
– Sergio from California

Sergio,
As thorough as you have been in describing your symptoms, I still haven’t got enough information to diagnose your pain. I don’t know how big your filling is. I don’t have an x-ray. I don’t know how deep the dentist had to go in doing your filling. Nevertheless, I think I can be helpful. Let’s examine your symptoms, point by point.
• Moderate pain when chewing. A sharp pain when chewing when there are no other symptoms indicates this peculiar sensitivity that seems to come because of a bonding failure. If that happens then yes, you want to have the filling replaced with some changes in the bonding procedure. But that’s not the case with your filling. The pain is moderate and there are other symptoms. I would attribute your sensitivity to one of two possible causes. Either this is a larger filling that has changed your bite somewhat, or the ligament attaching your tooth to the jawbone has been traumatized slightly. I would expect this to get better over time.
• Very mild sensitivity to cold. This would also happen if you had a large filling, or even one that was deep, where the pulp of the tooth was irritated because the dentist had to go close to the pulp to get the decay out. This type of sensitivity is routine for silver amalgam fillings but also happens with composite fillings when they are deep. As long as it gets gradually better, it is no cause for concern.
• Continuous moderate pain in the evenings. This is a little puzzling and is of more concern. Spontaneous pain in a tooth can indicate an irreversible pulpitis, especially if it is more intense when you lie down. Again, this could have been a deep filling. But if there is spontaneous pain, it would tend to indicate that some bacteria have gotten into the pulp. This doesn’t mean that the dentist did anything wrong. The dentin of your tooth is porous, and in the process of removing deep decay, some bacteria are going to be pushed into the dentinal tubules of your tooth. If the pulp is close to the floor of the cavity, those bacteria will end up in the pulp. If it’s not too many bacteria, your tooth can recover. But if your tooth isn’t getting better by now, it’s not recovering.
• Pain in the jaw and tonsil. This wouldn’t have anything to do with the tooth. It might be related to stress on your jaw or mouth from the procedure.
• Tingling and a sense of numbness in your lower left jaw. You had an injection to numb the lower left jaw. Residual tingling would indicate that the dentist hit the bullseye with the injection – a direct hit on the nerve he or she was targeting to numb. He or she may have even nicked it slightly with the needle. The target nerve here goes to the teeth on that side of your lower jaw and also to the lip and chin. This is of no concern and will completely go away in time.
Anyway, I hope this is helpful. You have an interesting mix of symptoms, and I’m hoping it makes an interesting and helpful blog post for others. Bottom line–most of this is not of any concern. But the spontaneous pain in the evenings worries me. Pain intense enough that you have to take ibuprofen to sleep is a concern. If it has been two to four weeks and there is no improvement, I would have the tooth x-rayed by a dentist who has a high level of expertise in radiographic diagnosis–possibly an endodontist (root canal specialist)–who should look for a widened periodontal ligament space around the root tip of this tooth. If that is present, the tooth may need a root canal treatment, and it would be better to have that done before the pain gets unbearable.

– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

If the antibiotics don’t work, my dentist says he wants to pull the tooth.

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Dr. Hall,
I have been trying to find information about calcification/mineralization of a tooth. (I was told by my dentist that, on x-ray, he does not see any remaining canal in one of my molars. It is one that already has a crown. After a round with antibiotics, if I still have discomfort in the tooth he says it may need to be pulled. Without a tooth canal present, he said he cannot do a root canal. I would rather keep all my teeth. Is there an on-line site with information about this subject so that I can read and be educated?) Thank you.
– Mikala from Wisconsin

Mikala,
I’m not comfortable with what you say your dentist is telling you.

First of all, this idea that if you’re not comfortable after the round of antibiotics you need to have this tooth pulled. Antibiotics alone in treating a toothache doesn’t solve anything. Sometimes antibiotics are used as a diagnostic tool – if the antibiotics solves the tooth pain, then we know your pain is caused by a tooth infection. That would be an indication that the tooth needs a root canal treatment or an extraction. But once you stop taking the antibiotics, if the pain has indeed gone away, it will return sooner or later, because you haven’t addressed the source of the infection.

But if the antibiotics don’t solve your tooth pain, then that would be an indication that the pain is NOT caused by a tooth infection, and the dentist should be looking for some other explanation for the pain. It could be from nerve irritation or who knows what. In that situation, he doesn’t have a diagnosis, so proceeding with treatment would NOT be the next step. It’s like he has this backwards.

And I have a problem with the notion that because the dentist can’t see a canal in the tooth, it doesn’t have one. Especially in an upper molar tooth where there is a lot of bone around it, it can make the root canal hard to see.

If you want to try to save this, I would get a second opinion. Look up endodontists in your area. Those are root canal specialists. Or just tell your dentist that you want a referral to an endodontist. If it were me, I would look up an endodontist on my own for fear that the dentist would send me to a buddy who would simply parrot what the dentist has said.

And to explain calcification, here’s what happens. As we get older, the canals in our teeth tend to shrink. This is a natural process that can be aggravated if there is irritation in the tooth, the tooth builds up more dentin on the inside of the pulp chamber and the canals of the tooth, making them narrower and possibly harder to find. It can make root canal treatment more difficult and sometimes, in extreme cases, can block the canal. But root canal specialists should have special tools to navigate through these calcified canals.

Good luck. If you want to save this tooth, go for it.

– Dr. hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Several ways for a dentist to screw up a root canal treatment

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My husband fell on 11/29/11, while coaching my son’s basketball team. He suffered concussion, chin laceration with sutures and his front two teeth fractured. He was treated same day in dentist and ER. Dentist did not want to do any treatment for 2 weeks. In 2 weeks, tooth #8 (right front tooth) started to discolor without pain-she felt only dried blood and no treatment at that time.He was fitted for temp crowns and placed within 3 weeks.

Two months later, he had severe pain and an emergency root canal began with amoxicillin for 5 days. There was slight relief of pain for 24 hrs and then severe pain up to his nose with a cold sensation. Root canal finished one week later without pain relief.

Two weeks after that, the dentist root canaled tooth #9 (left front tooth) because she didn’t understand why there was still pain. Novocaine in place, still no relief and pain never by tooth #9?  Probable unneeded root canal.

I decided to get oral surgeon second opinion, who suggested Augmentin TID for 7 days with medrol dosepak. 5 days into meds, cold sensation resolved and tooth #9 RC completed by general dentist who then removed filling from tooth#8 and my husband felt pain free for 1st time in 3 months! However, it returned at 50% within 24 hours, but cold sensation gone. I am a NP and I spoke with a pharmacist friend who said you will often see rebound pain with medrol dosepak quick tapers? He recommended a 2 week taper of prednisone with abt in place now that canal is open and can drain possibly? What would be recommended next step? My neighbor thought maybe tooth fractured at gum line? The dentist says she sees black spot on x-ray, but thinks it is nothing? My husband has been tortured for months without any pain control offered and is a teacher and is suffering. Do you think this tooth should have been root canalled immediately when it turned dark or 2 months later? Would that have saved the tooth and torture he is living? Do you think tooth could be saved? Should he need extraction, would you recommend implant next to permanent crown or bridge?
– Kathleen in New Jersey

Kathleen,

When tooth #8 (your husband’s right central incisor) started to discolor two weeks after the traumatic injury to the tooth, it clearly needed a root canal treatment. The nice thing about doing the root canal treatment at that time is that there is less chance of post-operative complications since infection would not have settled in yet – it would be just a matter of cleaning out the dead tissue, maybe leaving the tooth open for a couple of days as a precaution against flare-up, and then sealing it. I cannot for the life of me understand what your dentist thought was going on inside this tooth. Dried blood?? If there is dried blood in the tooth, isn’t it pretty clear that the tissue inside the tooth is dead?

And I don’t understand why there was a prescription for amoxicillin and for only 5 days. So if I am understanding this treatment sequence correctly, the tooth was opened and the amoxicillin started. I can’t tell from what you are saying whether the tooth was left open during this time or not. But then the amoxicillin ran out, and AFTER that, the root canal was completed – in other words sealed. Doing it this way, there would be a fairly substantial risk of flare-up. Once a root canal tooth is sealed, there is no longer any pathway for drainage for any infection that may be there. And a five-day course of amoxicillin would not be enough to completely wipe out the infection. In fact, amoxicillin would not be a first-choice antibiotic anyway for this type of tooth infection.

My recommended next step? See an endodontist (root canal specialist). An oral surgeon would not be a good choice of specialist to see here. And a pharmacist doesn’t have the correct training either. There is something to be said about getting a professional involved who has the specific training for this type of problem. I can’t tell by just e-mails what is happening here. But I can tell you I disagree with some of the treatment choices made by your general dentist, and the flare-up is not surprising to me at all. Doing a root canal on the other front tooth appears to me to have been a stab in the dark, and it also doesn’t surprise me that it didn’t help. And the prednisone would also be the wrong treatment if the infection isn’t resolved. And what is this about your dentist seeing a “black spot” on the x-ray but thinks it is nothing? That sounds almost grade school. Is there a continuous, intact lamina dura around the tooth? Is there a widened periodontal ligament space? You need an endodontist to look at this x-ray and read it, not someone who will try to take wild guesses at what is going on.

There should be no need to extract this tooth. None of what has happened is any indication that the root canal was not sealed properly. And even if there was that type of error here, there are several options for correcting that, short of extraction. You need the correct choice of antibiotic therapy – probably clindamycin at this point – which in most circumstances should get this to settle down in a couple of days. However, if there is a root fracture, that is a different story.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Root canal tooth still hurts after three weeks. Should we put off doing the crown?

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Dear Dr. Hall:
Exactly three weeks ago I got my 2nd endodotic treatment (root canal). The first session seemed to go well, but the endodontist had me come back for a second appointment because he suspected a fourth canal. After much digging and discomfort he did find a fourth canal on molar #14. The endo also found a crack while doing the treatment. I had pain and swelling for several days following the procedure. Now, I don’t feel the swelling, but I do feel intermittent dull pain more like in the jaw area of the tooth. Sometimes I feel a dull ache radiating to my ear. Sometimes it’s just a dull headache similar to when you have sinus pressure. I am due to go get the tooth crowned but have postponed one week to see if this goes away.

I am taking ibuprofen every 6-8 hours. Is this normal and should I give it more time to heal? Or, is this the signs of something worse happening? I know he did dig for a long time to find the fourth canal. I am only eating soft foods like mashed potatoes for fear that the tooth gets further damaged. I am so frustrated because I have been suffering with problems with this tooth for 5 months now, and no one can give me a straight answer. Last Friday, I also got an x-ray taken of the tooth, but the general dentist saw nothing out of the oridinary. That’s when he recommended I take ibuprofen and postpone the crown for a week.

Thank you for any recommendation you may have.
Cyndi from Florida

Cyndi,

That was good advice from your dentist to wait before doing the crown, but not good to wait just a week. It can take a month or more to be able to tell if this tooth is going to “make it.”

Root canal treatment can be somewhat chancy in some cases. With this tricky fourth canal and the crack the endodontist saw, the treatment may indeed not be successful.

In dental school, they made us wait 6 months before putting a crown on a tooth that had a root canal treatment. In practice I didn’t wait that long, as long as I felt confident of the result, but the point is that it can take a while for the problems to show up. If the tooth is infected, it won’t show on the x-ray until the infection has settled in, and even then, the signs on the x-ray may be subtle and beyond the diagnositic abilities of your dentist.

Before going ahead with the crown, I would ask for a green light from the endodontist. I would ask the endodontist to follow-up, either by you personally visiting his office or having your dentist send him a copy of the x-ray to evaluate.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Can you tell a cracked tooth from an x-ray?

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Is it easy for an x-ray to miss detecting a cracked tooth? I had full mouth x-rays-taken at two different dental offices within a month of each other. Neither set of x-rays detected a cracked tooth. But when I changed to another dental office and that dentist referred me to an Endodontist, from the x-rays the Endo took, he told me I had a cracked tooth that needed a root canal right away. I’m wondering why the other two dental offices missed seeing that cracked tooth in the x-rays, and am wondering if it is common for an x-ray and/or dentist to miss detecting a cracked tooth?
– Grace from California

Grace,
I would put the answer to your question this way – it is very difficult to detect a cracked tooth on an x-ray. Unless the x-ray is taken at the exact angle of the crack, it won’t show up.

I suspect that the endodontist didn’t actually see the crack, but saw some subtle evidence that suggested a crack.

I have four molars of my own that all ended up needing root canal treatments because of cracks developing in them. But none of the cracks have ever shown up on an x-ray.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Tooth still hurting after root canal treatment

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Dr. Hall,
I recently (5 weeks ago) had a root canal in my right crowned front tooth by a very highly skilled Endodontist (he used a microscope). I still experience discomfort in this tooth, (no hot or cold). If my tongue touches the tooth, when I chew food or if I slightly push on the tooth it is sensitive. Should I give this a little longer, or should I contact my dentist and advise I am still experiencing discomfort? I have already had my permanent filling put in.
– Susan from Maryland

Susan,
I can’t tell from what you’re telling me if something is wrong with this tooth or not. It’s typical for a tooth to be at least a little sensitive to pressure after a root canal treatment. Five weeks is a little long for this to be going on. But if it’s still getting better, it should be okay. If the root canal treatment caused a little swelling, which would cause this tooth to swell up a little in its socket so that you hit it first, it could take a while for that to heal itself.

If it is getting better from week to week, I wouldn’t do anything now. But when you go to your dentist for your next regular checkup, I’d ask them to x-ray this tooth and check it out, just to make sure it’s okay.
Dr. Hall

You may want to read more about pain after a root canal treatment.

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Root canal tooth is infected, and I’m pregnant.

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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.

Best regards,
Anna from British Columbia

Anna,
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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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

A broken file in a root canal tooth

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Dr. Hall,
My dentist performed a root canal today and informed me that a tip of one of the metal instruments broke off in the canal. (I actually heard it and thought my tooth had broke!) He informed me that he was not going to try to fish it out. Since it was ‘sterile’ he was just going to leave it in the canal and put the post and cap on.

Is this what he should be doing? Or will it hurt me in the long run? This doctor has become notorious for not taking a lot of time with patients and overcharging, so I am nervous.

Thanks in advance for your help.
– Connie in New Jersey

Connie,
These metal files can break off easily, and that happens to a lot of dentists. And while it is best to retrieve the broken piece, that can be difficult to accomplish and can be beyond the ability of many general dentists. If your dentist can negotiate around the broken piece and seal the apex of the tooth, the root canal treatment will probably be successful. If the broken piece blocks access to the apex of the tooth, the root canal treatment could still be successful but the chances for success are greatly diminished.

If the tooth has problems later, it could end up needing re-treatment for the root canal. Cementing a post in the tooth could possibly make re-treatment impossible, depending on how many roots this tooth has. If the dental post is to be in the same canal as the broken instrument, I’d advise you not to let him put the post in the tooth.

The safest thing would be to ask to be referred to an endodontist (root canal specialist), who should have special equipment to be able to retrieve the broken instrument and fill the root canal. Depending on your relationship with the dentist and your personality, you may or may not want to do this. However, if the post is needed to help hold the crown on and if it is in the same canal as the broken root canal file and that broken file blocks the canal, I would insist on seeing an endodontist. If your dentist doesn’t refer you to one, you can seek one on your own. Otherwise the risk of losing this tooth would be too great, in my opinion. Meanwhile you could wear a temporary crown on this tooth or a temporary filling.
– Dr. Hall

Related information:
Failed root canal treatment
Root canal surgery
Dead tooth

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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