Why Am I Having a Tooth Flare-Up Five Years After a Root Canal?

Posted on November 15, 2024 by AllSmiles.

Six years ago, my dentist performed a root canal procedure on my upper left first molar. The procedure went fine, and the tooth felt comfortable until late September. I hadn’t eaten anything unusual but noticed a dull toothache. Now, the tooth hurts daily, and the pain is getting worse. My dental appointment isn’t until two weeks after the Thanksgiving holiday when I return from vacation. Is a tooth savable if I’ve already had a root canal? – Thanks. Kaitlynn from IN

Kaitlynn,

Root canal failure occurs in 10% of teeth treated. Failure occurs when the tooth doesn’t fully heal and eventually flares up, as is the case for your situation.

Why Might a Tooth Flare Up Years After a Root Canal?

Root canal emergency diagram of five procedure steps — Lingering infected tissue can cause irritation months or years after a root canal

A tooth might become irritated years later if some infected tissue lingers after a root canal. Due to the intricate anatomy of teeth, particularly those with curved or branching roots, removing all infected tissue during a root canal procedure can be challenging. Any residual infection can lead to future complications.

Either root canal retreatment or surgery may be necessary to address root canal failure. A dentist may refer you to an endodontist (specialist in root canal therapy) for retreatment. The goal is to identify and eliminate the source of the persistent infection. While the success rate of retreatment or surgery is often estimated at 50%, the outcomes are usually more favorable.

It’s also possible that the tooth has developed a crack, which could contribute to the ongoing issues. Unfortunately, the prognosis for saving a tooth with a crack is generally poor. If the tooth is unsavable, your dentist will explain tooth replacement options.

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.

Tooth still hurts after a second root canal

Posted on January 29, 2021 by AllSmiles.

In 2007, I had a root canal on my upper right first molar (tooth #3). Last October, I began to feel pain in the second molar (tooth #2) behind it, which had a large filling in it. My dentist took x-rays and said that I needed a root canal for the second molar. Although I didn’t have pain in the first molar, my dentist saw a black area in the bone above that tooth.

An endodontist completed the root canal on the second molar, and then the first molar began to hurt. Although I had a root canal in 2007 for the first molar, the endodontist said I needed repeat treatment. The second molar improved, but I continued to feel pain in the first molar.

Over the next two months, the endodontist re-medicated both teeth four times. But the first molar still hurts even if I rub my tongue on it. The endodontist is cooperative and says that the tooth has no visible internal or external fractures on the x-ray. He said that the holes at the tooth root are a little large from the 2007 root canal. He pushed filler material through the holes. The dark area above the tooth is not around the roots. It is a pocket in the jaw.

The endodontist thinks that the pain might be from bone loss over the years and a slow-growing infection. Should I ask for an antibiotic to see if the tooth is infected? If the black area is bone loss, will the bone grow back? If it is an infection, will it reinfect my other teeth? I’m concerned about a third root canal on this tooth failing and requiring extraction and an implant. I am still wearing temporary crowns because the endodontist does not want my dentist to restore the teeth with permanent crowns until the pain goes away. I am not confident that this will be resolved. Thank you. Benji from MO

Benji,

Dr. Perry would need to examine your tooth and see your x-rays to give you an accurate diagnosis. But your description sounds like your endodontist is careful and wants to save your tooth. A second or third root canal treatment is more conservative than tooth extraction. And the endodontist’s explanations sound reasonable.

As your tooth heals, the black area on the x-ray will fill in with bone over the next few months. It doesn’t seem that an infection is spreading.

Pain after root canal treatment

If you have pain in a tooth after root canal treatment, your dentist can determine if the pain is from infection or if your bite (the way your upper and lower teeth come in contact) is the problem.

Antibiotics decrease pain – If you take an antibiotic and the pain resolves, it usually means that the pain is from an infection rather than a tooth nerve, stress on the tooth, or another factor. Your endodontist might be willing to use antibiotics to determine if an infection is causing the pain.
Painful chewing – If you feel pain when you chew, the tooth is too high, and your dentist can reduce it. If your bite is too high, when you chew, that tooth takes more impact than the others and becomes sensitive.

Give your endodontist more time to try to identify the source of the pain. An extraction and a dental implant may not be necessary. Sometimes tooth pain is referred from somewhere else—even an opposing (or lower) tooth.

After your dentist and endodontist are satisfied that they have resolved the issue, you can receive your permanent crowns. If you get the crowns prematurely and the pain persists, your dentist would need to remove the crowns for further treatment.

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

Read our post, Root Canal Tooth Hurting Again?, for information about causes of root canal failure.