Is Treatment for a Gum Cyst Necessary?

Posted on April 22, 2025 by AllSmiles.

My dentist said the tender bump on my gum above my first molar is a chronic, benign abscess. I’m concerned the lump doesn’t hurt, so my dentist referred me to an endodontist. The endodontist wants to perform a root canal for a cyst or abscess. Is that necessary, or is this exploratory surgery? Am I increasing the risk of damaging my tooth and needing it whittled down for a crown? Thanks, Layla from Seattle

Layla,

It’s understandable to feel concerned about the lump in your gums, particularly when receiving unclear information from your dental providers. We want to acknowledge your concerns and provide clear information to help you navigate this situation.

Clarifying the Likely Issue and Treatment Path

Root canal emergency diagram of five procedure steps — Root canal therapy

Finding a lump on your gums causes worry. While a cyst is possible, it’s statistically less common in the gums than an infection stemming from a tooth’s nerve. An endodontist specializes in treating these issues, and the standard, highly effective approach is root canal therapy. This treatment focuses on cleaning the infection from within the tooth to save it. An apicoectomy (root canal treatment from the root tip) is generally considered a secondary measure, used primarily if unique circumstances prevent a successful outcome with standard root canal treatment alone.

Why Timely Treatment Matters for Your Well-Being

Addressing a dental infection, especially one that has been present for two years, is crucial for oral and overall health. Your body actively fights infection, which can be draining over time. Taking steps to resolve the infection is essential for several reasons:

Your body will no longer need to constantly fight the infection, which may increase your energy levels.
Removing the infection protects your jawbone and surrounding teeth from potential damage or spread.
Treating the source eliminates the risk of bacteria entering your bloodstream.

Root canal treatments performed by specialists boast a success rate of 85% or higher, often enhanced by modern technology. If, in a rare case, the root canal doesn’t fully resolve the problem, an apicoectomy could be considered down the line. Feeling unsure is perfectly normal, and you can seek a third opinion from another endodontist’s office for reassurance and clarity. By planning your care proactively, you can manage the situation effectively and avoid the need for urgent dental treatment.

Baton Rouge family dentist Dr. Ryan Perry sponsors this post. Please read about how he strives to provide his patients with the best care possible.

Why Is My Tooth Still Infected After an Apicoectomy?

Posted on November 28, 2023 by AllSmiles.

My tooth is still infected after an apicoectomy. I had a raging toothache and infection that required a same-day visit in early October. The dentist did an apicoectomy on a tooth that had a root canal 2 years ago. I had a checkup and x-ray two days ago. The bone is rebuilding, but a small pus sac on my gums shows an infection is lingering. My dentist gave me antibiotics to take for ten days. Is there anything else I can do to get rid of this infection? I

t’s going to be three months and counting with this. I’m waiting for it to clear before I get a new crown. I opted for a one-visit crown because I want to wrap this up and move on. Since I’ve had problems with this tooth, my dentist wants to wait before making the crown. I feel like making an emergency appointment with another dentist before I return to mine – if I return. I don’t know what to do. Thanks. Marianna from TN

Marianna

After your struggle with a tooth infection for almost two months, your concerns are understandable. We will share some information that may help you decide whether to wait for your dentist or to get a second opinion.

What Is an Apicoectomy?

Unlike root canal treatment that approaches the pulp chamber by drilling a small hole in the tooth, with an apicoectomy, a dentist or endodontist surgically accesses the tooth through the gums.
The surgery allows the dentist to access the root tip and remove infection or inflammation.
The dentist places a small filling to seal the root tip.
Stitches close the small incision.

How Will Antibiotics Help?

Root canal treatment, apicoectomy, and any other apical surgery will help the tooth heal, and the infection will eventually disappear. The dentist or endodontist needs to remove all the dead tissue inside the tooth and seal the end of the root well.

Antibiotics

Although antibiotics can speed up the healing process, removing the source of the infection determines if the treatment will succeed.

If the bone around your tooth is healing, your dentist likely removed the infection. Any residual infection will eventually disappear, and the antibiotics will speed up the healing process. It takes patience, but your tooth will heal, and you can get a dental crown.

Although you can get a second opinion from a dentist with root canal treatment experience, an emergency dental visit won’t give you the necessary information.

Baton Rouge family dentist Dr. Ryan Perry sponsors this post. Please read about how he strives to provide his patients with the best care possible.

What’s Next If I Had a Root Canal Fail?

Posted on July 21, 2023 by AllSmiles.

What’s next if I had a root canal fail? A toothache that has been bothering me for the past two months got so bad last weekend that I saw a nearby dentist for a same-day appointment. I did not want to return to my previous dentist because I didn’t like the customer service at the practice, and the hygienist is quirky. The toothache was in an upper left first molar tooth that my dentist did a root canal on two years ago. The dentist I saw most recently said she would need to refer me to an endodontist for a procedure called an apico? I have been a little slack about going to the dentist, and I haven’t seen one since I quit my last dentist, so maybe I could have avoided this. What is this apico procedure, and do I really need it? Thanks. Malachi

Malachi,

It’s good that you made a same-day appointment with a dentist. If you have a lingering toothache, you need treatment. Whether you need an apicoectomy depends on the X-ray results. You can get a second opinion from another dentist or an endodontist (root canal specialist). If you have problems with a root canal tooth, you will probably still need to see an endodontist.

What Is an Apicoectomy?

An apicoectomy is a minor surgical procedure that accesses the tooth root through an opening in the gum tissue and bone. An endodontist will remove the inflamed or infected tissue and remove the root tip. The endodontist will fit the root with a special material and seal it. Stitches will close the area and help it heal. According to the American Association of Endodontics, your jawbone will heal around the tooth root in a few months.

Why Do You Need an Apicoectomy?

If a dentist or endodontist cannot access a tooth infection near the root tip by opening the crown, they will recommend an apicoectomy. Sometimes after root canal treatment, infection in the tooth’s canals in the tooth can remain, particularly in areas that are difficult to reach. Then, you may need a second root canal or an apicoectomy.

You can get a second opinion from another dentist or an endodontist, a specialist who can provide the most accurate diagnosis and precise treatment.

Baton Rouge family dentist Dr. Ryan Perry sponsors this post. Please read about how he strives to provide his patients with the best care possible.

Dentist Said I Need an Apico Instead of Root Canal

Posted on August 31, 2022 by AllSmiles.

Our family was out of the country for three weeks. A toothache that has been bothering me for the past months got really bad, so I had to go to an emergency dentist. It’s a tooth that had a root canal 2 years ago. The emergency dentist said I need probably need to see an endodontist for a procedure called an Apico??? I have been a little slack about going to the dentist, and I haven’t seen one since I moved last year. What is this procedure, and do I really need it? – Greg from Armon, NY

Greg –

The procedure that the emergency dentist is referring to is an apicoectomy. When you receive a root canal treatment, a dentist cleans out the canals of a tooth root the very tip to remove the infection. A filler material is used in the empty space. An apicoectomy uses a different approach.

What Is an Apicoectomy?

An apicoectomy is a procedure that accesses the tooth root through an opening in the gum tissue instead of the crown of a tooth. A trained dentist or endodontist (root canal specialist) will take these steps:

Remove the inflamed or infected tissue and the root tip
Fill the root with a special material and seal the tooth
Use stitches to close the area and help it heal

In a few months, the jawbone will heal around the tooth root.

At times, infection in the canals in the tooth can remain, particularly in areas that are difficult to reach. Sometimes, a dentist or endodontist (root canal specialist) performs a second root canal. If a second root canal treatment fails or if it is impossible to complete it, an apicoectomy may be the preferred method.

You can receive a second opinion from another dentist who will examine your tooth and recommend treatment.

Dr. Ryan Perry, a Baton Rouge family dentist, sponsors this post.

Root Canal or Extraction – How to Decide Which Is Best

Posted on April 17, 2020 by AllSmiles.

In January, my dentist put a crown on an upper right molar with a cracked silver filling. He said the filling had expanded and was putting pressure on my tooth. The tooth was too weak to do another filling. I agreed to the crown, but the entire procedure was uncomfortable, my dentist couldn’t numb my gums enough, and I could feel the drilling. My dentist didn’t mention that the tooth might need a root canal later.

When my dentist tested by bite, it was painful and didn’t feel right. He couldn’t get it right to my satisfaction, so he told me to give it a few days. It was painful to chew on the tooth and to brush it and floss around it. I called my dentist’s office and left a message for my dentist. A dental assistant returned my call and said that the dentist thinks the sensitivity is normal and would decrease in a few weeks.

I had an appointment for a second crown in early March, so I thought that would be a good time for my dentist to check the first crown. During the visit, my dentist looked at the crown and put a numbing solution on it. Although he didn’t volunteer to adjust the crown, I asked, and he did, but the crown was still painful. My dentists insisted that my bite needed to be adjusted, and the crown would feel fine. Due to the pandemic, I had to reschedule twice before I could see the dentist. Now that I’ve seen my dentist, he says that the tooth has a periapical abscess. I am sure that my dentist could have done something to prevent this. Now I need an extraction. I feel that I should receive a refund, but my dentist hasn’t offered it. Will you please tell me how to get a refund from my dentist successfully? Thank you. Callie from Pensacola, FL

Callie,

We are sorry to read about your disappointing experience with your dentist. Your concern I understandable. Your dentist should have told you that root canal treatment might be needed.

We’ll share some information with you that might help in the future. Although you’ve already spent time and money on your molar tooth, we recommend getting a second opinion. An advanced cosmetic dentist will explain your options for a crown and how he or she can make treatment affordable—especially since you’ve already incurred expenses with a faulty crown. And you might need to see an endodontist (root canal specialist) to preserve your tooth instead of extracting it.

Cracked Teeth and Root Canal Treatment

A cracked tooth risks needing root canal treatment
After you receive a crown, some sensitivity to temperature changes is normal; prolonged pain is not.
A bite that’s off and pain when you chew are problematic. When a dentist places a crown correctly, it will blend with your bite, and you won’t notice that you have a crown.

It’s alarming that you returned to your dentist, complained about the crown, and didn’t receive prompt attention. Your dentist only wanted to give you a second crown. It seems that your dentist’s priority is collecting fees, not protecting your oral health.

Trying to Get a Refund

Although your dentist might not agree to give you a refund, there are some things you can do that might motivate him. But weigh the pros and cons first, which we describe below.

Online reviews – Check your dentist’s online reviews. If they don’t have many bad reviews, if you threaten to add a negative one, it may get his attention. But if there are already several bad reviews and your dentist hasn’t responded to them online, adding your complaint probably isn’t a motivator for getting a refund.
Complain to the dental board – Although you could complain to the dental board, your dentist’s action isn’t unusual. Your situation could be viewed as a routine dental procedure that wasn’t successful.
File a lawsuit – If a dentist departs from the standard of care, they can be held legally liable. Based on your description, it doesn’t sound like your dentist did that. Although your dentist might have been careless, every dentist has placed crowns and had a tooth react afterward. It seems inappropriate for your dentist to place a crown on a second tooth without resolving the issue on the first one, but if the second tooth was damaged, delaying crown placement can create more problems.

Consider Getting a Root Canal

Diagram of tooth with needing a root canal treatment — A root canal may help save your tooth. Check with a skilled dentist to discuss how treatment can be made affordable for you.

If your tooth now has a periapical abscess, the tissue inside the tooth is dead, so root canal treatment will be painless—even without local anesthetic. We recommend that you see another dentist or an endodontist (root canal specialist). An endodontist has advanced training and technology to increase the chances of successful root canal treatment. If there are any challenges in the canals of your teeth, an endodontist can handle it.

What About Extraction?

Extraction is more invasive and traumatic than a root canal. A missing tooth affects your oral health in several ways:

Teeth keep each other aligned. When a tooth is missing, the surrounding and opposing teeth will drift into the space and create orthodontic issues.
Your bite will be disrupted.
You can eventually experience TMJ disorder.

Ryan Perry, DDS, of Baton Rouge sponsors this post.