I have a toothache

March 21, 2007 3:21 PM

My tooth hurts . . . a lot and it shouldn't because it's dead.

I had a root canal on my #18 tooth (tooth before wisdom tooth on the bottom left) about 3 years ago. About six months ago my tooth started hurting - aching a little here and there, especially when I'd eat something warm or hot. I visited my dentist who noticed that the crown on that tooth wasn't fitting correctly so he made me a new one. That seemed to take care of the problem until . . . . a month or so later when it started hurting again.

I went to the dentist again but for a filling on a different tooth (two away from the aching tooth). My toothache then went away! But sadly, it's come back with a vengence. I am sensitive to hot, cold and pressure now. And it throbs. ALL THE TIME.

How can this be? Doesn't having a root canal mean that my tooth can't feel anything now? I'm visiting the endodontist on Friday but would like to be armed with as much information as possible about my supposedly dead roots.

posted by Sassyfras to health & fitness (12 answers total)

A few things can happen to a root canal.

1. Teeth have multiple roots and sometimes they can have multiple roots that dentists miss. This can mean you have another root that needs to be cleaned out and filled.

2. Also, root canals can "fail" I don't know what this means, maybe they left some sort of tissue or organic matter in there, and this means another root canal.

3. It may be that you have pain in a nearby tooth that you are confusing with that tooth. Dentists will do tests to see if this is the case, but you can do the same tests and have them be more under your control. Put a metal fork in the freezer (or even a glass of ice water), then take it out and touch the end to your teeth one at a time. If it's only painful when you've hit that one tooth then you're probbaly accurately reporting, but dentists often assume that you're not, so you can test it.

4. It's possible also that if you have a high crown and/or a problem with tooth grinding, that you are having a stress related problem. I was convinced that I had a failed root canal last year, but I was just going through a rocky point in my life and I had to get all the way to the endodontist before he said "you are not having an endodontic problem"

So, there are a few options, most of which the endo can clarify In the meantime, hit the ibuprofen hard so that you can sleep at night and not obsess over it.
posted by jessamyn at 3:31 PM on March 21, 2007

It could be referred pain. A tooth nearby could be having problems.
posted by 6:1 at 4:24 PM on March 21, 2007

It is most definately the #18 tooth. I have had numerous x-rays on surrounding teeth and have had the tooth tested to be sure it was this particular tooth (and it is). I guess I'll have to wait and see.

I never knew root canals could "fail" or that the dentist could miss a root.

Thanks!!
posted by Sassyfras at 4:30 PM on March 21, 2007

Jessamyn is right on, and 6:1 might be too - just because you're "sure" the 18th tooth is the one hurting doesn't mean it's not referred pain.

Beyond what Jessamyn said, one word: apicoectomy. Yes, sometimes root canals do fail to take care of the whole problem; sometimes there is a small abscess at the edge of the rooted portion that is not removed and goes on to cause infection problems in surrounding tissue. Definitely consult your dentist yet again, and possibly ask for a referral to an endodontist if your normal doc doesn't find anything. Something's definitely up and it could require some (minor, in-and-out-in-a-day) surgery.
posted by rkent at 4:51 PM on March 21, 2007

IANAD, but jessamyn nails all of the main points.

On certain molars there can be a fourth root. It's not particularly common, but incidence is high enough for it for dentists to usually look for it. It's often hard to find though, and if they miss it.. you can be in trouble. That's one way a root canal can 'fail'.

I believe this page could reassure you and educate you a lot. I always love reading that site and you end up learning a whole ton of fun stuff. There's a massive list of all the ways things can 'fail' on there. Once you've read that page, you'll likely have a good idea as to what your problem is.. or at least provide better explanations to your dentist so he can try a few different approaches.

One question though.. do you have any swelling of the gum or pain on the outside of the tooth? If so, I might have further advice.
posted by wackybrit at 4:53 PM on March 21, 2007

wacky - I do not have any swelling of the gum or pain outside the tooth, although my crown feels like it's loose or something. It's not loose, however, it's fitting perfectly. I've had 2 x-rays of it to confirm it's not a crown problem. (thanks for the link!)
posted by Sassyfras at 5:00 PM on March 21, 2007

rkent - I do not like that word.
posted by Sassyfras at 5:02 PM on March 21, 2007

Unfortunately from what you're saying it sounds like an infection in a missed root to me, just based on the symptoms. However, an x-ray would validate that, which makes it quite odd since you've had 2 already.

One thing that can also happen is that the tooth can split into two, but this is more common without a crown. One way to test for this is to see if pressure to different parts of the tooth cause rather different sensations. If you have a cracked tooth, usually at least one area will be painless when pressure is applied. You will usually also lack the symptoms of infection (red hotness, bad taste, etc).

Unfortunately I have found dentistry an inaccurate science at best, and dentists often need more detailed guidance than the average patient can provide (which is why it's great to read online and 'work out' some ideas for yourself). It's really hard for them to give great diagnoses in such tight conditions unless you can give very detailed explanations.. so asking here is a great start!

I wish you the best of luck as I've just come out of a whole pile of dental work. It's all worth it in the end, luckily.
posted by wackybrit at 5:37 PM on March 21, 2007

the tooth can split into two - correction.. two or more parts..

And apicoectomy is a relatively rare procedure. Depending on your situation, your dentist may (or can, at your request) perform a second root canal instead. You will usually get a referral for that as it's a more difficult procedure (although it seems you already have that if you're visiting a specialist endodontist). Of course, there are pros and cons of both techniques that only he/she will be able to relay!
posted by wackybrit at 5:39 PM on March 21, 2007

Nthing possible root canal failure. If your general dentist has ruled that out, if he has checked your occlusion(high fillings or crowns can cause sensitivity on teeth even if they have had root canals.) If everything points to it being that tooth without a determined cause, I'd go to an endodontist. Most general dentists do not have the diagnostic equipment that an endodontist has. There are pulp vitality tests they can administer.

The endodontist in the suite next to ours has the ability to take an xray and view it under a microscope (or take his own digital and blow them up) and can detect artifacts not readily visible under normal means. It is possible you have a fractured root or an extra accessory canal that got missed in the original procedure.
posted by Jazz Hands at 5:33 PM on March 22, 2007

Is it an upper tooth? It can be all the things mentioned, and yeah root canals only have a 70 to 90% sucess rate (depending on the dentist and the difficulty of the procedure, this is according to my dentist last week). But I can tell you from direct, current experience that it can also hurt when you have a simple sinus infection.

My tooth was root canaled last December and the procedure is perfect, the xrays are lovely apparently. But it's an upper tooth near the sinuses and I have a nasty sinus infection right now. The only symptomn I had was a very specific pain in that one tooth, similar to how it felt before the procedure and to how you're describing, and it was diagnosesd by clouding on my sinuses in the xray (and confirmed by the headaches and faceaches that hit the next day). The tooth next to it actually looks closer to the sinus on the xray (apparently they can actually protrude right in there, which I didn't know and kind of grosses me out) but something about how the nerves are located and the 3D structure up there means it's that one tooth that is getting the transferred sinus pain. I wouldn't be surprised if the root canal itself somehow changed things so the sinus pressure is transferred to the tooth in a way it wasn't before. It's a quick fix, I'm on antibiotics and it's nearly gone now.

Going to an endontist is the right move. There are lots of things it could be, ranging from needing dental surgery to a quick antibiotic prescription, and they'll help you figure it out. Good luck, I know how much that throbbing drives you crazy.
posted by shelleycat at 11:29 PM on March 22, 2007

I admit to having a rather troubled dental history: I can't even remember the time I had a #18 tooth (unless the system is different in Australia than where you're from) so caveat emptor.

I've had a full-blown infection in a root-canal treated tooth that had me awake and wailing for four days straight disappear into thin air. The pain was not touched at all by the very serious cocktail of painkillers and sedatives I was given. After the dust had settled my dentist wanted to remove the tooth but because in my exerience dentists tend to be rather keen to remove troublesome teeth (and as a result I don't have that many left) I refused. I wanted to wait and see.

It's been more than three years now and not a peep; nothing showing up on x-rays, it's as if it never happened (other than the mental scars left by that endodontic torture).

Not so long ago I've had a tooth crowned on which I had a root canal two years ago. Because of my problematic teeth, we decided to wait and see before going through the expense of having it crowned. Everything was fine for 24 months, but of course just a month after the crown was placed that bloody tooth started hurting and feeling like something was seriously wrong. However, that only lasted three or four days and everything is fine now (FWIW both are lower teeth).
posted by ponystyle at 4:15 AM on March 30, 2007