Question:
I went in for a check up a few weeks ago on some problems I've been
having with a couple of teeth. One had a crown with a gold band in May
2000 and a subsequent root canal in June 2000 due to the distress of
the tooth. The new endodontist did not want to admit that the doctor
(s) from another state messed up somewhere in my mouth. So, I don't
think I'm getting the whole story of what is going on in my mouth. The
new endodontist also tells me that an adjacent tooth to the one I had
the work on is causing problems as well. And on that point, I do agree
with him.
However, he did find that there is, as he put it, "a possibility that
there is nerve left in the one with the crown and original root
canal." He didn't want to say that anyone had screwed up.
My question, if indeed there is still nerve left in the tooth that had
the root canal, could that be what is causing my pain (it throbs and
has had swollen gum at times)? I go back in this week to possibly have
the root canal redone.
Would this help alleviate the problems in the tooth next to it if I am
careful? I have had a history of sensitive teeth for some time after
getting dental work. Of up to a year or more. Nothing painful though
like this root canal. I can handle bothersome and discomfort, but this
pain business has got to stop. The new endodontist also concerned me
in regards that he said that pulling the tooth may not alleviate the
pain. For that, I am very depressed and distraught as to what to do.
He said I may have "lateral pain" forever with the crowned tooth. The
lateral pain he speaks of is somewhat bothersome and only occurs when I
eat. But this other pain has got to stop, somehow.
Answer:
Please don't fault someone for not making a negative comment of about work
that was not performed in their own presence. (3 negative in one
sentence,,,hmmm let me try again)
It is not fair to make any comments about work one does not personally
witness being performed. It is fair to comment on what the condition of
something is afterwards. Not being present during the execution of the
procedure, one does not know what occurred nor what complications may have
occurred.
Only a foolish doctor would say the previous doctor "screwed up" without
knowing all the circumstances involved.
As far as not treating all the canals in each root,,,, that happens from
time to time. Not every canal can be treated without risking destruction of
the tooth. I would prefer to judge the treatment by the bony healing (or
lack of) on an x-ray image and symptoms. If the adjacent tooth is
questionable, you may never be able to judge until you treat the adjacent
tooth.
All the things your new dentist is telling you are for CYA sake. Part of a
good informed consent includes a warning of all the things that could go
wrong. Sounds like this dentist is sincere and concerned about you.
Regarding your specific diagnosis and treatment recommendations,,,,,,,
CANNOT be done over the internet. Not legal if we could see your tooth and
x-ray images anyway.
In general,,,,,,,, pain such as you describe can come from 1) an inadequate
root canal treatment, 2) cracked tooth, 3) the adjacent tooth, 4) muscle
pain, 5) referred pain from somewhere else, 6) bone disease, 7) and others.
Keep following through on it, and you should be able to resolve your pain.
Ask enough questions so you understand well enough to make a valid decision.
I TOTALLY agree with your point on the new dentist not wanting to admit
someone else screwed up. I didn't expect him to either.
I am curious, what is bony healing? The new endodontist took several
new x-rays. One of which was way way down in the root/jaw area that I
had to hold with my finger.
I do indeed have a cracked tooth. That is what started all the mess of
the crown and all. The side where the gold band is on the inside of my
mouth/tongue area where the outermost severe vertical fracture is.
That side felt "clean" when the new endodontist did the cold test.
However, the other side (cheek side), I could feel nerve on the inner
most part of two of the 4 roots as well as a flat area beneath the
crown.
I have been doing some reading and am concerned as to the extent of
problems I may have if I do not have the "bad" tooth extracted. I may
be one of those people that root canals fail on. Also, my former
general dentist (I've moved and had to change) that did the crown told
me that if indeed I begin to have pain, that I should have it extracted
because bacteria is getting in.
I am on my second shot of antibiotics that is helping to clear up pain
I have in my neck, side of head, earache, down one side of my back and
overall "blah" feeling. But I can't live on antibiotics.
Once an infection extends out the root ends to the surrounding bone, the
infection can cause destruction of the bone. Once the infection resolves,
the bone should heal, but this can take months to become apparent on x-ray.
Also, ideally the area of infection in the bone heals with new bone
formation. Sometimes there may be more or less scar formation. This is
generally not consequential.
This could be a problem. If the fracture extends down the root far
under the gum line, it could be impossible to save the tooth. The
endodontist should be able to determine this, esp. if he/she works with an
operating microscope.
The most important thing now is that he's astute, honest, and a good
operator. Don't be shy if he's hurting you or if you need better pain
control. Hopefully, you won't need his services again.
