Continued tooth pain years after root canal and apicoectomy.
October 6, 2020 12:22 PM   Subscribe

I had a root canal on tooth #4 in 2015. It already had a crown on it but was continuing to give me pain. In March 2016 I had an apicoectomy because I still had pain. There was a big pocket of infection. It has continued hurt since then. A dull ache all the time. Generic ora-gel helps a bit and I use it many times a day. I've had my bite adjusted multiple times which has not helped. It is only like a 3/10, but is distracting. What else should I be asking my dentist to look at? I just want the tooth GONE but cant afford an implant.
posted by misanthropicsarah to Health & Fitness (11 answers total) 1 user marked this as a favorite
Is it possible you have a bite issue? Or do you grind your teeth at night/clench your jaw? I have a couple of teeth with crowns after root canals that can flare up because I clench in my sleep and it causes soreness in the tooth itself and the surrounding gums. I didn't believe that could be it at first, but then my dentist had be do a night guard and it made a huge difference. Custom fitted is best but my teeth have shifted and I'm now using a $25 over the counter one, and it's still better than it has been.
posted by amycup at 12:56 PM on October 6, 2020

Did your dentist do the apicoectomy? If you are still having pain have you seen an endodontist yet?

In ~2003 I had a root canal on #2. In 2006 my "temporary" crown finally broke and I had a permanent (gold) one put on. Around June 2015 I had a non-painful abscess form on the gum near the root of #2. I shortly afterward had an apicoectomy on tooth #2 performed by an endodontist Adam I was referred to by my dentist. I didn't have a firm reason for thinking so at the time, but I didn't like the endodontist. The abscess didn't get better.

Adam said that when doing the apicoectomy he only did one of the 4 roots, and said we should do another one. I questioned why not do all 4 tips while my gum was opened up the first time, and he didn't seem to have a great answer other than saying he was trying to be conservative, but it seemed like more work to do one tip at a time. If we did another apicoectomy he wouldn't do all the root tips; only one. No discount would be offered for the work, because he was sure the root he did was fine.

I asked my dentist if they had an alternate referral and they said that Beth was great, but a lot of people had a problem with her accent, and she was a 30 minute drive away instead of 10-15 (but actually only 10 minutes from my employer at the time!). I made an appointment with Beth. She said from the x-rays, the root canal wasn't done well and suggested to redo the root canal as it would be less traumatizing to the gums that had been resectioned once already.

We went forward with that in 2016/May (I did say the abscess didn't hurt, right). Apparently some of the stuff that had been in my root canal wasn't anything she'd seen or heard of before (working in canada 15+ years), and couldn't be confident everything was cleaned up. After the root canal, my abscess went away, but on recheck / x-rays, she apologized for not being able to do better. While my abscess was gone, she didn't have great hopes that I wouldn't have a reoccurence 1-10 years down the road. She offered to do an apicoectomy for a bit under half her standard rate (which was a bit under Adam's rate), and she said she'd clip/reseal my remaining 3 roots and double check the one performed by Adam and fix it if needed. I had that performed in 2016 Aug. Follow ups at a month and a year later and everything looked great. No problems since.

That's a really long way to say 1) second opinions are good 2) if you had a root resectioned and/or pain around a root canal'ed tooth that a dentist can't easily fix a consult with an endodontist would probably be in order.

I'll also throw in a quick mention that while 99.9% of the time my root canal'ed tooth doesn't hurt, if I have some bad sinus congestion I get a dull ache (2-3/10) where #2 is. Before the root canal this never occured. The apicoectomies don't seem to have impacted this. How are your sinuses?
posted by nobeagle at 1:13 PM on October 6, 2020

Response by poster: i did have an apicoectomy with a really great endo who had done a few root canals for me previously.

i do have a bite guard and wear it religiously. have for 20 years. and i've had my bite adjusted (ground down) many times, most recently last month.
posted by misanthropicsarah at 1:34 PM on October 6, 2020

Your endodontist, or even your general dentist, might have a conebeam imager that takes 3-d images of your jaw/sinus/teeth. have a 3-d image taken to see if the the tooth is fractured.

At this point (4 years of pain) I would probably advocate for extraction. There are other ways beside implants to replace missing teeth.
posted by OHenryPacey at 2:12 PM on October 6, 2020 [1 favorite]

I found pain decreased by 50% every 48 hours. you should be on antibiotics as well. Talk to your dentist. don't wait.
posted by evilmonk at 2:34 PM on October 6, 2020

Response by poster: it's been over a decade of pain, and over 4 years since the apico.
posted by misanthropicsarah at 3:23 PM on October 6, 2020 [1 favorite]

I had something similar with tooth 15 and it turned out to be nerve damage. Getting a second opinion was really useful, and then I found a specialist who was able to help me.
posted by k8lin at 4:27 PM on October 6, 2020

Does it go away when you take antibiotics? I had a chronic sinus infection that felt like tooth pain (also post root canal).
posted by soelo at 4:49 PM on October 6, 2020 [1 favorite]

The guy who did my 1st root canal didn't remove everything and gaslit me when I told him I still had pain. What was left festered and I wound up with a fistula. Sheer luck that what was left of the tooth could be preserved.
posted by brujita at 7:57 PM on October 6, 2020 [1 favorite]

I don't know if this will help, but for years I thought I was having tooth problems that sound like this, and it turns out its sinus issues instead. At times it is migraine-inducingly painful, but it comes and goes. Sometimes it hurts for a week or more, then I don't feel anything for ages. For years I was convinced it was coming from my teeth because it felt exactly the same to prior tooth-decay that had led to root canals. But apparently it is not. Once I realized this, I was able to treat it properly with sinus medication. Sinus meds are pretty cheap and easily available, so might be worth a try and at least ruling sinuses out, before you explore more complex issues like nerve damage.
posted by EllaEm at 8:28 PM on October 6, 2020

Seconding investigating if you might have a mild sinus infection. I get occasional pain in molars that had root canals performed on them, and I have found that taking Sudafed (the stuff you may have to show ID for, which has pseudoephedrine in it) helps. At the very least, it may help troubleshoot things.
posted by They sucked his brains out! at 9:24 AM on October 7, 2020

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