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Issue with Failed Root Canal and Subsequent Retreatment

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michael53288
michael53288

SHORT VERSION: I'm still feeling pressure around tooth after retreatment (following failed original root canal). This is after two antibiotics (Augmentin and clindamycin) and the recent completion of the retreatment. The pain feels like it's in between my teeth, like it's in the gum. The dentist said everything looked good in the tooth and that none of the medicine had been displaced. Could there be some other issue here?

I've been having issues with a tooth for a while now (upper molar). I first had a cavity (which I believe they said was in between the tooth) filled in spring 2014. About a year and a half later (fall 2015), I noticed some sensitivity to hot and cold on the tooth, and I felt some pressure in the gum as well. It felt like I needed to floss in between the teeth, but when I went to floss, it provoked the gum and bled, causing more pain. 

They opened up the tooth about 6 months later (spring 2016), due to an issue they saw with the filling on the x-ray, to find the pulp was inflamed and a root canal was needed. They did a root canal and the sensitivity went away, but afterward, I was still feeling the same pressure/pain in the gum between the teeth. This would sometimes ramp up (feeling like a bad ache), and I used over the counter medicines to tolerate the pain.

About a year and a half later (fall 2017), I was suffered intense pain, and the pressure ramped up significantly. I went to an endodontist, and a cone-beam CT scan revealed a large abscess that had been eating away at the bone. I then started retreatment of the tooth to save it (cleaned out canals, drained abscess, put medicine in), along with two antibiotics: augmentin and clindamycin (after the first one didn't eliminate the feeling of pressure). This significantly reduced the pain, but about a month later, they finished the retreatment and filled the canals, and I'm still occasionally feeling the same sense of pressure and almost a "sting" in the gum around to the tooth. It still hurts and bleeds when I floss in that area, and the pain can increase after significant chewing, just as it did in the years prior.

Any advice on how to proceed next? I know that if this fails, next steps would typically be extraction and implant, but I'm nervous that there is some other issue, since the dentist says everything looks fine and clean within the tooth (medicine was also not displaced). I'd also like to avoid losing the tooth if possible, of course, especially considering that I'm still pretty young at 21 years old. Could there be a separate periodontal issue here?

Thanks for any help and guidance!

0 likes, 3 replies

3 Replies

  • k51551
    k51551 michael53288

    Posted

    Hi Michael -- I'd be very concerned = You've had abscess AFTER you had RCT on that tooth. Prognosis isn't good here. 

    Has your Endodontist said anything about potentially performing an apicoectomy on the tooth? Do the new images show all infection is now gone? Have them explain to you why an apico won't help.  Dental professionals have incredibly advanced equipment and training and they're learning new information about our teeth/gums/oral health everyday. But even with the new knowledge and new equipment they work with, they can't guarantee any procedure will be successful. 

    They've done a lot of work with this tooth. The tooth may or may not settle, even without nerves. Sometimes there are cracks that don't show on imaging (or aren't visible when you're having a RCT).  If it were me, I'd consult with the Endo again and if they don't think Apico will help you, I'd see if the tooth settles on its own. 

    I'm not a Dentist or dental professional so obviously take this with a grain of salt, but If it were me, I'd be very concerned that abscess will return. Abscess can be dangerous. But ask your Dentist and the Endodontist if they think you should extract -- they have treated you and seen your tooth close up, they'd know better than anyone online will. 

    If you have extraction and have the $$$$ for implant, I recommend the sedation. My implants were literally barely sore after the local wore off, don't worry about "pain" because unless you have infection or complications, there is no real pain.  It's a very perfected procedure if you see a reputable oral surgeon. Should note that I've had several extracts, implants but all during sedation so I can't tell you what that procedure is like. I do know people who have extracted wide awake and they've all said it's very quick and they felt nothing but some pressure and never pain.

    Good luck, Michael.

  • Supertractorman
    Supertractorman michael53288

    Posted

    I think I would ask to see a copy of the last xray in case the Dentist has missed the root canal when drilling and gone out through the side of the root. This would give the pain you speak of and alternately go elsewhere for a second opinion which can help with deciding what to do. This happened to me and I have had 3 implants with extractions  recently without sedation just local anaesthetic and never felt anything in fact i had not realised he had even done one of them. Did not even have to cut the gum with a new technique and 3D imaging meant no mouthfulls of gunge for impressions.

     

  • michael53288
    michael53288

    Posted

    Thanks for your replies. My endodontist has never mentioned an apicoectomy, I actually had to look it up to see what it was. She never made mention of the infection still even possibly being there after the retreatment, just that it was good that the medicine wasn't displaced inside the tooth. She seemed to think it sounded more like a gum issue, but I've had this issue on the tooth for years with the same feeling of pressure (regular dentist did not catch it or even suggest it could be infected, even after complaints after the first root canal), and when that feeling really strengthened, I was sent to an endodontist who told me I had a large abscess. So I'm having some trouble believing the infection is completely gone. 

    And thank you both for the advice regarding implants and extractions; I will keep that in mind.

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