When Root Canals Fail...
November 12, 2009 1:39 PM   Subscribe

I had a root canal two months ago and now have pain in that tooth. I am supposed to have the crown put on tomorrow. Should I wait to have the crown procedure started?

I am supposed to have the first part of my crown procedure done tomorrow (they will file the tooth and put on a temporary crown). I went to the dentist - a different dentist than the one I had that ordered the root canal; I had a root canal and then moved to a new city - two days ago with tooth pain and she didn't seem to think that the pain was coming from the tooth that I had the root canal on but from a different tooth entirely. She did something to my teeth that involved grinding them down (the teeth on my lower jaw, the root canal was on an upper tooth) to correct my bite and that seemed to relieve the pain temporarily but now it's back. It is a dull ache, not a throbbing, searing, or sharp pain. It's just kind of annoying at this point. Sometimes it tastes a bit weird and maybe metallic, but I do not have any metallic fillings, so I'm not sure if that is psychosomatic or what.

After waiting a few days, I am now certain that it is the tooth that I had the root canal procedure done on that hurts. I am worried that the root canal is failing and that putting a crown on is a bad idea. I currently have a temporary filling. I will discuss this with my dentist tomorrow when I go in for the crown, but I wanted an opinion from someone who was not my dentist as well. I also wanted to have some information before I go in because it's a high-pressure situation with money involved and I am worried about making a choice under stress in the heat of the moment, so to speak.

I do not currently have dental insurance. It cost over $100 to see this dentist in the first place for the pain, and I don't think I can afford to go to another dentist for a second opinion and pay for the crown (over $1000), especially if I also end up needing a second root canal on this tooth. I found this dentist through several recommendations from friends and I don't know how I would even go about finding another one for a second opinion. If people agree that a second opinion is what I need, I will do my best to get one.

Also, if the root canal fails, what do they do? Do they just pull the tooth, or try to perform another root canal on it?
posted by k8lin to Health & Fitness (17 answers total) 2 users marked this as a favorite
Funny, I just had a temporary crown put on top of a root canal not an hour ago. I would give a call to your dentist and let them know what's going on, to start with. That aside, I would be cautious of telling them to put the crown on right now, since it's possible the root canal didn't clear out all of the dead/decaying tissue. However, two months strikes me as a VERY long time to go in between root canal and crown. My endodontist said 2-3 weeks was ideal; longer than that and you're putting a lot of stress on that temporary filling, and leaving yourself open to decay/chipping/etc.

If the first root canal didn't clear out all of the bad tissue, IIRC both extraction and another root canal are options.
posted by craven_morhead at 1:46 PM on November 12, 2009

Best answer: When I went back to my dentist with pain from a recent root canal they x-rayed the tooth and did tests for sensitivity and stuff (putting cold on teeth to see what I could feel, things like that to isolate which one was hurting). Remember that even though you feel the pain in the tooth it actually has no nerve, so it has to be coming from somewhere else. Most likely somewhere in the jaw above or beside the tooth which is why the x-ray is necessary, and it's apparently the best way to see what's going on in there. This will tell you if the root canal failed.

So it sounds like going back to your dentist is the best option anyway. Just make sure you're really clear that there's a problem and that you definitely think it's with that tooth and want it checked out. They should take your concerns seriously and talk with you about the best options (and I'd be surprised if they don't x-ray it). You shouldn't have to be the one deciding about the crown, that's what the dentist is for, but do make sure that you're happy with their reasoning for what they're planning to do. You're not in second opinion territory yet, see how they handle it this time and go from there.

In my case (also an upper tooth) the ache turned out to be due to a low level sinus infection. This was picked up on the x-ray and was treated with antibiotics. The root canal had pushed into the jaw just a little further than the original nerve (which makes sense) and now presses on my sinus cavity, so now I get that ache everytime I have allergies. Bleh. Hopefully yours is something as innocuous, but preferably less annoying.
posted by shelleycat at 2:15 PM on November 12, 2009

I've had a bunch of root canals done over the years. One particular one that had a crown decided to act up and get infected somehow. So I had to get dental surgery $$$$, where attach the root canal through your jaw bone. They cut your gum, get access to the bone and drill under that tooth that way and fix it up. Surgery was about an hour or so, made much better afterward with Tylenol 3's, took about 2-3 weeks to recover but couldn't get punched in that side of the face or risk messing my jaw up. Its was pricey to fix but more of a permanent solution.
posted by boomcha76 at 2:28 PM on November 12, 2009

two months strikes me as a VERY long time to go in between root canal and crown
I might depend on the technology used in the filling. My dentist said I should get it done within 6 months optimally, but could really go up to a year.
My dentist also told me you should not be feeling anything in the tooth itself once the soreness from the needle sticks/tissue jostling goes away. Definitely tell your dentist ASAP so they can do x-rays to make sure they don't need to re-do anything. Much better to check this out before the crown goes on.
posted by ishotjr at 2:32 PM on November 12, 2009

*it might depend, not I might depend. :-)
posted by ishotjr at 2:32 PM on November 12, 2009

Best answer: By all means discuss this with your present dentist and be clear that you are having symptoms in the tooth itself. Be open to the idea of seeing an endodontist for a second opinion.
It is possible that a) you have a recurrent infection in some portion of the root canal tooth; b) a fracture of said tooth; c) referred symptoms from another area; d) symptoms from your gums around the unrestored tooth that feel like they are coming from within your tooth e) something else.
Your options should include, but not be limited to a) a second opinion; b) temporary crown on said tooth and re-evaluation of your symptoms after a short but reasonable time c) re-treatment of the root canal and go from there ; d) extraction/implant/crown on implant d) something else.
IANYD, but I always hesitate to go to the final crown if there are symptoms in a tooth.
posted by OHenryPacey at 2:40 PM on November 12, 2009

Best answer: I had a root canal earlier this year, and the temporary filling post-prep was breached-- I'm a hell of a back-molar grinder-- allowing decay and food to get in there and upset what was left. They performed X-rays, went back in with the little flexible files and cleaned it all out again, postponed the crown by a visit or two, and didn't charge me.
posted by fairytale of los angeles at 2:41 PM on November 12, 2009

Response by poster: fairytale of los angeles, were they able to see the breach on an x-ray or with their eyes? My dentist said that the filling looked fine, but a breach is what I am most concerned about, especially since I also grind my teeth like crazy.

I had x-rays when I went in the other day and the dentist said that the tooth looked fine; however, the technician could not get the entire root of the tooth in the picture. My dentist also did the cold test that shelleycat talks about, as well as a tapping test with the end of her mirror instrument, and said that my teeth behaved normally.
posted by k8lin at 2:54 PM on November 12, 2009

Response by poster: I also wanted to say that my original dentist put on a filling that he said would last 6 months to a year like ishotjr mentions. Due to a series of unfortunate events I had to cancel my last two dental appointments for the crown; otherwise, I would have gotten this done sooner.

Thanks for the answers so far. This has been very helpful. I would already be anxious if I wasn't having pain, but the pain is taking my anxiety to another level entirely.
posted by k8lin at 2:59 PM on November 12, 2009

Best answer: however, the technician could not get the entire root of the tooth in the picture.

This is the bit I'd be most concerned about or at least most wanting to fix. If there's an infection or a tiny bit of nerve root remaining this is possibly where it would be, and in my case they had to rephotograph to get the top to see the sinus problem. My tooth only just pressed on the sinus cavity right at the very top of the root canal filling and it didn't show when they x-rayed just the main part of the tooth (they didn't charge me for the extra x-ray FWIW since it was their error). The rest of their treatment sounds reasonable from your description, that bit just jumped out at me.

(I don't know about the breach part sorry, but the dentist should be aware of this possibility so ask them to explain what they've looked for and how they know if there is or isn't a crack or whatever present)

Not having the crown on yet at least gives you some flexibility. If you have to get things redone they're only drilling out the temp filling rather than the expensive reconstruction. I know that doesn't help much on the money front, but it's something!
posted by shelleycat at 5:01 PM on November 12, 2009

Even if they can't isolate the source of the current problem and you go ahead and get the crown, it doesn't mean that it is wasted. If they have to redo the root canal at some later date, they can often just drill a hole in the top of the crown, do the root clean up and then fill the hole back up just like a regular filling. It doesn't necessarily mean you have to get a new crown. You might ask your dentist if your crown allows that option.
posted by JackFlash at 6:11 PM on November 12, 2009

were they able to see the breach on an x-ray or with their eyes?

In my case, it was the Worst Interpersonal Moment Ever, with the assistant and my student dentist peering into my head, wielding the hooky pick, and suddenly going "...does THAT look like FOOD?!"

I suspect an X-ray would work fine in your case, although I'm no dentist.
posted by fairytale of los angeles at 8:35 PM on November 12, 2009

Best answer: Listen to OHenryPacey. He's a dentist.

She did something to my teeth that involved grinding them down[...]to correct my bite

That sounds like occlusal adjustment. I had it too. I have straight teeth but a crooked jaw and my teeth were hitting each other in a bad way, causing tiny cracks that eventually led to cavities. I don't think it's related to your pain, though.

If you have lingering pain after a root canal the big worry is that there could be a bit of tissue down in there that did not get cleaned out. This happens sometimes no matter how good the dentist or endodontist is, especially if it's a molar with four or five canals and/or they are really crooked and twisty. But the pain could be something else.

I think you need a satisfactory explanation of what could be causing your pain before you proceed. A "satisfactory explanation," could mean getting a better answer from your current dentist or getting another opinion. If it were me, I wouldn't want to do crown prep (and I definitely wouldn't get a final crown!) until I had some idea what was up with the pain. If there's any way you can swing it, I would advise seeing an endodontist rather than a general dentist, just for a consultation. This isn't cheap--when I did it it was just over $100, I think--but it's much cheaper than another root canal or paying for a crown you later have to drill through. Also, I really think you need an x-ray that shows the root tips, since that's where you see infection. I know when I was going through this they had a hard time getting the root tips (they kept telling me my mouth was small) and ended up doing four or five xrays until they got them.

Also, if the root canal fails, what do they do? Do they just pull the tooth, or try to perform another root canal on it?

Your options are a second root canal (to try to clean out what the first one missed, if that's what happened), extraction, or apicoectomy.

I don't know if you've seen them before, but some really good resources for understanding dentistry are Mynewsmile and animated teeth.
posted by Violet Hour at 10:09 PM on November 12, 2009

Go back to your endodontist. I once had pain after a root canal. They did more x-rays and thought they found a third root that previously was hidden in the initial x-rays they did. As it turned out that wasn't the source of my problem but the doctor that did the root canal is schooled in this sort of thing.
posted by Taken Outtacontext at 6:47 AM on November 13, 2009

Response by poster: Thanks for all of these really helpful and supportive answers. My dentist was really awesome about it and set me up with an endodontist for early next week. They took a few more x-rays and still couldn't see the entire root, but she went through the pictures with me in great detail and explained that she couldn't see anything wrong, but that an endodontist has different tools and may be able to tell if I have a crack in the root (which I really hope is not the case) or something else going on. She said that it is possible but unlikely that the tooth next to this tooth has something wrong with it but the x-ray didn't indicate that was the case. I find myself almost hoping that this is the problem because I don't want to mess with this particular tooth any more, as it has been both a literal and figurative pain for the past few months.

For some reason I was afraid that the dentist would just want to forge ahead so I felt like I needed information before I went in, but that wasn't the case. She was very concerned about the pain and really listened to me and didn't even charge me for the visit. I've had dentists who weren't like this in the past, so I guess that's where my fear stemmed from. Thanks again for everyone's responses.
posted by k8lin at 1:33 PM on November 13, 2009

Glad your dentist took good care of you. Quality definitely varies from one dentist to another. Good luck with the tooth.
posted by craven_morhead at 1:40 PM on November 13, 2009

Response by poster: Just as a follow-up, I needed a second root canal. The first one did not get at all the roots; there was a secret one hiding in there that was missed. I think everything is better now; I'm no longer in pain, at least.

Thanks again for all of the comments and concern.
posted by k8lin at 3:11 PM on December 13, 2009

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