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.

I’m Holding My Split Tooth Together with Floss

Posted on April 4, 2023 by AllSmiles.

My tooth split in half below the gumline, and I am holding it together with floss. It split last night, and I am calling offices for a same-day crown. I’ve been asking dentists how soon I can get a crown, but the first available appointment is at the end of next week. How long will the tooth hold? It’s beginning to feel loose. – Thank you. Andrej

Andrej –

Thank you for contacting Dr. Perry’s office. We recommend getting an emergency appointment with a dentist. Your request for a same-day crown was insufficient for a dental office appointment scheduler to understand that you need urgent care. Instead of asking for a same-day crown, please explain that your tooth split, and a dentist will see you immediately if the office is open. Otherwise, the dentist will return your call with advice on handling the situation.

What Is the Treatment for a Split Tooth?

The treatment for a split tooth depends on its condition. According to the American Association of Endodontics, these factors affect your treatment options:

The extent of the crack
Crack location
Whether a dentist or endodontist can save a portion of the tooth

You should not tie the floss around your tooth. The floss can add more tension to the tooth and cause more damage. You should see a dentist right away.

Please remember that a dental crown is insufficient for saving your tooth. Sometimes, an endodontist (root canal specialist) will recommend root canal treatment to remove damaged, inflamed, or infected tooth pulp.

The longer you delay treatment, the more challenging it will be for a dentist to save your tooth. Call a dentist or endodontist’s office to get care right away.

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.

How Long Does a Sinus Perforation Infection Last?

Posted on October 14, 2022 by AllSmiles.

My cheek swelling increased after wisdom teeth extraction from a sinus perforation. I called the oral surgeon when a yellow discharge started coming from my nose and sockets. The surgeon prescribed Augmentin, which decreased the welling. After two weeks, one sinus was still infected. The surgeon took a CT scan and said my sinus was clear of any fragments that could cause infection. He prescribed Azithromycin, and I have a few pills left. The sinus hole is still draining, and I feel some pressure in it. I use a prescription rinse and Flonase. Are my symptoms typical, or do I need to see a sinus specialist or make an emergency appointment with my dentist? Thank you. Naaman from Brooklyn

Naaman,

Thank you for your questions.

Dr. Perry would need to examine your tooth or refer you to a specialist for an accurate diagnosis. Still, we will use your description of your symptoms to explain what may be happening.

Does a Sinus Perforation Cause an Infection?

Although a sinus perforation does not usually cause an infection, bacteria from the tooth can push into the sinus as a doctor removes the tooth. Augmentin and Azithromycin are appropriate medications for swelling and infection. If a CT scan does not show any tooth fragments in the sinus that can interfere with healing, your oral surgeon is managing your symptoms well.

Lingering Sinus Infection After Finishing Antibiotics

After finishing the antibiotics, you may need an Azithromycin refill if you have a lingering sinus infection. Continue taking the medication until the infection clears to avoid antibiotic resistance.

Flonase reduces inflammation and sinus pressure over time. Although we do not have all the details about your case or dental records, you should not need to see an ear, nose, and throat specialist or schedule an emergency appointment with your dentist. Call your oral surgeon if the infection lingers because you may need another prescription to continue taking Azithromycin.

We wish you a steady recovery.

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

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 emergency diagram of five procedure steps — Root canal therapy access a tooth from the crown, but an apicoectomy is performed at the root tip

Should I Get My Molar Tooth Extracted?

Posted on November 22, 2021 by AllSmiles.

I had a toothache in my bottom right first molar several weeks that escalated so bad I made an appointment with a nearby dentist even though I was not her patient. The dentist took an x-ray and said that the tooth is infected, so I need a root canal to save the tooth. I already lost my second molar. The dentist also recommends a dental implant for the missing tooth. I was hoping for a cheaper resolution. Can I just have the tooth extracted and use a removable appliance like a snap-on smile when I am in public. I work from home, so I think I can manage social with something cheaper than an implant. Thank you. Brandon from WV

Brandon,

Thank you for your question.

It is good that you saw a dentist right away. Without treatment, a tooth infection will spread and become more costly to treat.

Should You Get Your Molar Tooth Extracted?

You should not get your tooth extracted unless it is so damaged or infected that it cannot be saved and is affecting your health. If you have already lost your second molar, removing the infected first molar would leave you without any lower right teeth for chewing. It would affect your diet and your oral health—not just how your smile looks in public. Also, without molar teeth, the neighboring teeth will begin to drift into the space.

Any appliance that snaps onto front teeth with no support in the back will be unstable. The instability is like a long table with legs in the middle and only one end. Any pressure on the table will cause it to tip or fall. Your oral appliance will lift or fall out without back teeth supporting it.

Root Canal Treatment or a Dental Implant?

Root can treatment is better than removing your tooth and replacing it with a dental implant. Although dental implants are highly effective, they are not better than preserving natural teeth.

Root canal

The root canal procedure removes the infection. After getting a root canal on a molar tooth, you will need a crown to protect it and help the tooth withstand the forces of grinding and chewing on back teeth. Also, a root canal is less expensive than a dental implant.

Dental implant

When a dentist must remove your tooth before placing an implant, it requires oral surgery. And after your dentist places the implant, you will need three to four months of healing time before receiving your final dental crown.

We hope you will decide to keep your natural tooth and protect your oral health for the long term.

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

Is it too late to save my broken tooth?

Posted on July 14, 2021 by AllSmiles.

Three days ago, my tooth broke off at the gumline. I didn’t go to a dentist right away for reasons that I don’t want to talk about online. Will you please tell me if it is too late to fix the tooth? Also, what is the least expensive and easiest fix? Thanks for your help. Tim C. from GA

Tim – Thank you for your question. Unfortunately, a cheap, easy fix for a tooth broken at the gumline will not last. The priority is a lasting solution. And you may want it to look natural; neither is cheap or easy.

When Your Tooth Breaks at the Gumline

When your tooth breaks at the gumline, possible solutions include root canal treatment and a crown or a dental implant.

Root Canal and Crown for a Tooth Broken at the Gumline

Sometimes root canal treatment and a crown can restore a tooth broken at the gumline. But the treatment works if the tooth is not subject to a lot of stress. For example, if you have a strong bite (the force of biting or chewing) or deep overbite, it would be challenging for the crown to stay on.

Root canal treatment – A dentist must complete the root canal on what remains of your tooth. A flexible fiberglass post in the tooth root can help stabilize the tooth. In some cases, a dentist will place two side-by-side fiberglass posts to withstand stress on the tooth and keep the tooth intact. The dentist would build up the tooth with composite and bond a dental crown to it.

Dental Implant for a Tooth Broken at the Gumline

A dental implant is a long-term solution for a tooth subject to a lot of stress from a deep overbite or a strong bite. Although an implant can cost twice as much as root canal treatment, posts, and a crown, it will last. An implant dentist or oral surgeon anchors a dental implant in your jawbone, and it takes three to four months to heal. But when it heals, it is a solid foundation for a natural-looking crown.

Although you might choose a root canal and crown, you will need a dental implant anyway if it doesn’t work.

It helps to see a dentist right away after tooth trauma, but it is still possible to save your tooth. We suggest that you schedule an appointment with a skilled dentist to examine your tooth. The dentist will explain your treatment options and what you can expect from them.

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

My dentist doesn’t know what to do for my cracked tooth

Posted on April 30, 2021 by AllSmiles.

One of my right lower molars has a filling in it. The tooth cracked last Friday, but my dentist’s office is closed on Friday. I found an appointment with another dentist to look at it and see if anything needed to be done to save it. The dentist said it didn’t look like I would lose it, so I followed up with my dentist on Monday. My dentist then referred me to an endodontist who suggested that I get the filling replaced with a crown. My dentist wanted the endodontist to remove the filling to see the depth of the crack. When I returned to my dentist, he tried to mend the crack. Now the tooth is very sensitive. My dentist does not want to put a crown over the tooth. I suggested that he refer me to another endodontist. My dentist seems a little clueless, but maybe because he is young and in a big practice. Anyway, should I go with a crown or see another specialist? – Thank you. Clay from MS

Clay,

Dr. Perry would need to examine and x-ray your tooth for an accurate diagnosis. Cracks in teeth can be tricky, but we will provide some insight. You were wise to see a dentist right away to ensure your tooth was stable enough to see your regular dentist.

Types of Cracks in Teeth

Cracks in teeth have varying degrees of severity. But cracks differ from fractures. When tooth pieces move independently, the tooth is fractured.

Types of tooth cracks

Superficial crack in the enamel
Deep crack beneath the enamel
Crack into the tooth pulp
And tooth cracks can vary in location and can be vertical or horizontal.

Restoring a Cracked Tooth

There are different ways to protect your tooth depending on the extent of the crack. But if your tooth is sensitive, it may be infected. Your dentist or an endodontist will need to determine if root canal treatment is required.

Porcelain onlay – An onlay is a custom-made restoration that covers a portion of a tooth. If you have a horizontal crack on just one cusp, or peak, of your tooth, an onlay can cover it. But an onlay is not strong enough to stabilize a vertical crack.
Gold onlay – Gold is durable, and a gold onlay can cover the entire chewing surface of a tooth to protect it.
Dental crown – It will cover and protect the entire tooth.

Consider Getting a Second Opinion

Your dentist and the endodontist disagree on which treatment is best for your tooth. Consider getting a second opinion from another dentist. You can also ask your dentist for a referral to another endodontist for a second opinion.

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

Does a root canal tooth always need a crown?

Posted on April 14, 2021 by AllSmiles.

I had an emergency dental appointment for a toothache on my top right first molar. The dentist scheduled a root canal for me. But he also looked at my left incisor and noticed that the tooth was a little dark. I told him that I had a root canal on that tooth in 1986. The only reason I remember the year is because it was a month before I got married. The dentist recommended doing a dental crown on that tooth to prevent it from breaking. I do not feel any tooth pain. Is a dental crown necessary? – Karson from GA

Karson,

Thank you for submitting your question to our office.

Whenever you have a lingering toothache, it is wise to see a dentist promptly. But do not agree to let the dentist complete cosmetic work without verifying if he or she has advanced cosmetic dentistry training.

Although root canal treatment can make a tooth weak and at risk for breaking, not every dentist automatically places a crown over the tooth. But the condition and location of a tooth can determine if it is wise to get a crown.

Stress on Molar Teeth

The stress on molar pushes the four cusps—or peaks in the biting surface—apart. Premolars have two cusps. And stress can cause them to split also.

Stress on Front Teeth

Front teeth are subject to horizontal stress. Canine teeth have long roots to absorb some of the lateral pressure on back teeth. When you chew and grind food with your back teeth, the canine tooth forces the back teeth apart to relieve stress.

Protecting a Root Canal Tooth

Back tooth – A dentist can protect a back root canal tooth from fracture by covering it with a dental crown or an onlay. An onlay covers a tooth’s chewing surface and at least one cusp, or tooth point.
Front tooth – Although root canal treatment weakens a front tooth, preparing it for a dental crown will further weaken it. A dentist prepares a tooth for a crown by removing about one millimeter of tooth structure on every side of the crown. A tooth can be left with 50% or less of its initial fracture resistance.

When little healthy tooth structure is left, a dentist may use a crown to protect a front tooth. Otherwise, a crown will only weaken the tooth.

Some advanced cosmetic dentists use this technique:

Clean out the crown of the tooth, removing root canal filler material and cement
Insert a flexible fiberglass post deep into the tooth
Cement the post
Fill the tooth with durable composite
Bond a custom porcelain veneer to the front of the tooth

We recommend scheduling a consultation with a cosmetic dentist to examine your tooth and explain your options.

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

Both my front teeth broke. Can a dentist save them?

Posted on December 25, 2020 by AllSmiles.

I broke both front teeth today. The roots are still intact. I’m checking into an emergency appointment for a dentist to examine them. I know I can get a partial or a bridge, but are root canals and crowns an option, too? Thanks – Kyle

Kyle,

Although Dr. Perry would need to examine and x-ray your teeth for an accurate diagnosis, it may be possible to save broken front teeth with root canals and crowns.

Saving Broken Front Teeth with Root Canal Treatment

Depending on the extent of damage to your broken front teeth, root canal treatment may save them. But not all dentists are willing—or know how—to save teeth with severe breaks. And with the availability of dental implants, most dentists will recommend extractions and implants. A dentist who is interested in preserving your natural teeth might take the following steps if it’s an option:

Complete root canal treatment to remove the tooth pulp and prevent infection
Put two flexible posts in each root canal tooth to add strength and resistance to rotational forces
Attach a crown to the posts

Risks with Posts and Crowns

One risk with post-supported crowns is that rigid metal posts can crack tooth roots. Force on a post can transfer deep into tooth roots and crack them. Many dentists who perform this procedure prefer flexible posts for front teeth, like carbon fiber or fiberglass. Flexible posts are more likely to absorb the stress without breaking your tooth roots.

A flexible post in a rooth canal tootth to build it up in preparation for a dental crown — Sometimes a flexible post can help save a front tooth

We recommend that you look for a dentist with advanced experience and training. Saving your teeth with posts and crowns might not be an option, though. And if a dentist is not experienced with the technique, insisting that they use it anyway can cause more harm than good.

Remember your options:

Root canal and posts
Tooth extractions with a dental bridge, implants, or a partial denture

Please do your research to find two experienced dentists who will see you when their office opens. Get their opinions on treatment options and the results you can expect and schedule treatment promptly. Don’t let the problem linger because it can get worse.

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