Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 7, 2018

Can a root canal treatment be re-done a second time?


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Dr. Hall,
I have a tooth with a root canal that has been redone once, nine years ago. the tooth is bothering me again. Can the root canal be redone more than once?
– Jodie from Ohio

Jodie,
A root canal treatment can be re-done twice, three times, whatever, but that’s not the question. The question is whether or not that makes sense as a treatment.

Root canal treatment is one of the less predictable treatments in dentistry. It is accepted that even when the dentist has done everything right, there could be a failure rate of 5-15%, maybe more if the dentist is less skilled at this procedure. Let me explain the reason for this.

The living tissue inside your tooth is the pulp. There is a pulp chamber up in the crown of the tooth and a pulp canal that conducts the blood supply and the nerve to this pulp chamber. When the pulp becomes infected, the chamber and the canal have to be cleaned out and sealed against any bacteria re-entering the tooth. The problem is that the pulp canal can have branches and twists and turns inside the tooth that can, in some situations, make it difficult or even impossible to full clean out and seal. For example, in a molar, the standard number is three canals—one for each of the three roots. But often there is a small, difficult-to-find fourth canal. Furthermore, sometimes some of the canals can split off into branches at right angles. The dentist has tiny, highly flexible files that he or she inserts into the tooth and cleans out the infected tissue. There is no way this file can be manipulated to enter a side branch that comes off at a right angle.

Now these anomalies occur in a small minority of teeth, so the large majority of root canal treatments are successful. If a root canal treatment fails, re-treatment can remedy the situation, but only in somewhere around 50 to 75% of the cases. But if that re-treatment was done by a dentist skilled in root canal treatment and didn’t work, there’s a pretty slim chance that it will work if tried again.

There is another option, and that is root canal surgery. The dentist, most likely a root canal specialist, will make an opening in the bone and cut off the root tip of the infected tooth, and probably do a small filling at the end of the tooth to help ensure that it is sealed. This is called an apicoectomy and retrofill. If a root canal re-treatment has failed, this is usually the next best option and will be successful again in somewhere around 50 to 75% of the cases. Furthermore, some roots of some teeth are not surgically accessible or are in locations that would make surgery very risky, such as near the nerve that goes to the lower jaw and lip.

Another option is extraction. This isn’t the first choice, for sure, but some teeth are simply not savable.

– 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

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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.

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

Click here to ask Dr. Hall a question of your own.

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 1, 2016

Lingering infection after an extraction

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Dr. Hall,

I had a root canal performed more than a year a half ago. At that time, the endodontist performing the procedure said there were C-shaped roots and she ‘hoped’ it worked. I was given the standard antibiotic regimen, which I followed. I was told to follow up with my regular dentist. About six weeks later I had a routine cleaning and mentioned to the hygienist I still had the same pain (referred to the tooth in front of the root canal treated tooth). The dentist was not in the office that day, she said she would have him call me after he looked at the x-ray. I never heard back from the dentist, so I assumed all was well. In December 2015, I saw my dentist for a routine cleaning. I reported I still felt the root canal was less than successful. The problem tooth was x-rayed again and showed signs of infection. I was told there was a problem and I should call the endodontist for re-evaluation. Due to holiday scheduling difficulties, the endodontist’s office prescribed Penicillin tablets and scheduled an appointment for later in in the month. I ended up having the tooth pulled on January 8, 2016 by an oral-maxillofacial surgeon. Since then I have had improvement of a myriad of symptoms: sinus symptoms and pain, facial pain, headache, ear pain. At this writing, I continue to have pain in my jaw directly under where the tooth was extracted. While the tooth socket has healed well and many symptoms have improved, I am concerned there may be simmering infection in the jaw bone. Is this possible? How best do I proceed? My faith in my regular dentist has, understandably, been shaken. The dentist who pulled the tooth did not schedule a follow-up appointment. Your opinion would be most appreciated. Thank you.

– Kellie from Missouri

Kellie,
It’s too bad you weren’t able to connect with the endodontist. A failed root canal isn’t the end of the world and most of these teeth can still be saved with re-treatment or root canal surgery. But extraction is often necessary anyway, and that’s where you are.

It’s quite rare to have a lingering infection in the bone after the extraction of a tooth. The open socket left after the extraction leaves a clear path for drainage and your body, in that case, has no trouble getting rid of the infection. Where you can occasionally get a post operative infection is in the case of a surgical extraction, particularly if the tooth is fully impacted, and the tissue is sutured closed over the extraction site. And from your description of your symptoms, it sounds like your jaw healed normally.

If There Is a Post-Operative Infection

Nevertheless, there are some cases where a stubborn infection can linger and it can require a strong dose of post-operative antibiotics to be completely rid of the infection. I would go back to the oral surgeon for an evaluation.

If that is the case, I would not go back to the penicillin, since you apparently took that over an extended period already. In the rare possibility that you have a lingering infection, that infection is probably penicillin-resistant. I would go to a strong antibiotic like clindamycin in a situation like that.
– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

November 29, 2010

Root canal tooth was fine for a couple years and now is hurting. Why?

Filed under: Root canals — Tags: , — mesasmiles @ 8:56 am

I had root canal work done some time ago on a tooth that has started hurting again. I have had no problem until now. The pain is pretty bad. I hope I don’t lose the tooth. What is the trestment for this? Your feedback is appreciated.

Thank You,
– Gail from Kansas City

Gail,
Maybe one out of every ten teeth that has a root canal treatment experiences what is called root canal failure, where the tooth doesn’t completely heal and it flares up again some later time. This is probably what has happened in your case. Root canal treatments can be tricky because it is impossible to see deep down inside a tooth, and it can be difficult to clean out all the infection in some curved, branching roots. If anything is missed, the tooth will later flare up.

The treatment for root canal failure is to either re-treat the tooth, or to do root canal surgery. This usually will need to be done by a root canal specialist, because most general dentists don’t get into this type of specialized root canal work. The object of the additional treatment is to find the source of the infection that was missed the first time and remove it or seal it off. Root canal specialists, called endodontists, sometimes say that the chances of a re-treatment or surgery working is about 50-50, but in my experience the chances are much better than that.

It is also possible that the tooth has cracked. This could also cause later problems. If that happens, the chances of being able to save the tooth are pretty slim.

We thank our advertisers who help fund this site.

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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