Baton Rouge Dentist

Dentist Said I Need an Apico Instead of Root Canal

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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

Will I Need a Veneer After a Front-Tooth Root Canal?

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I have a front tooth that is turning dark and requires a root canal. Will the tooth be just as dark after the root canal? Will teeth bleaching before and after help? Or will I need a veneer? I’m sure my dental insurance will not cover all of this, but I am concerned about my smile. Thank you. Nicholas from Springfield, MO

Nicholas,

Thank you for your question.

Generally, root canal treatment darkens a tooth.

Why Does Root Canal Treatment Darken a Tooth?

Root canal treatment darkens a tooth if a dentist leaves root canal filling material in the pulp chamber, which is visible above the gumline.

How to Prevent Tooth Darkening After Root Canal Treatment

After treating the tooth, a dentist can prevent discoloration with these steps:

  • Remove root canal filler material from the pulp chamber
  • Bleach the tooth internally by sealing bleaching solution inside
  • Insert a fiberglass post into the root
  • Fill the tooth with composite

Your dentist should complete internal bleaching as soon as possible after the endodontist completes the root canal. Also, they should wait to place the post until the endodontist is confident that the root canal is successful. After removing the filler material, your dentist will wait a few weeks to check your tooth color. If it is stable, the results can last for several years.

What If Your Dentist Cannot Correct Your Tooth Color?

Root canal emergency diagram of five procedure steps
A cosmetic dentist can lighten a tooth after root canal treatment

If your dentist is not familiar with the techniques required to lighten your tooth color after root canal treatment, we recommend scheduling a consultation with an advanced cosmetic dentist. It may be helpful to consult with two cosmetic dentists before root canal treatment to ensure you have found a dentist to treat the tooth as soon as possible after the endodontist confirms that your root canal was successful.

Otherwise, a skilled cosmetic dentist can correct your tooth color with a porcelain veneer. A dental crown is an aggressive treatment that can weaken your tooth and increase the risk of breaking. And unless the tooth is dead, you will not need to replace it with a dental implant. Talk with the dentist about making treatment affordable with payment plans or financing.

 

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

My new crown is now sensitive to heat and cold

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Man holding face in pain and needng an affordable dentist for root canal treatmentAlthough I had not seen a dentist in more than five years, I knew I needed help when my bottom left second molar cracked. I asked co-workers about a dentist they like because none of us have dental insurance from the job. And we all need affordable care, so I looked at Google reviews for recommendations and chose a dentist. I probably should have asked my co-worker if he ever had major work done with this dentist and not just a dental cleaning. Anyway, the dentist prepared my tooth for a crown. While I wore the temporary crown, it hurt when I chewed, and it was sensitive to cold. Maybe it was too tight or something because it made my gums sore. I got the permanent crown in earlier this month, and the symptoms got worse. The dentist took another x-ray and did a cold and pressure test, and tapped on my tooth. The cold sensitivity went away quickly, but I felt no pain with the pressure test. And he tested my bite, which of course hurt because it hurts when chew. The dentist said the pressure sensitivity is expected for up to three months. So he wants me to wait. Now my tooth is sensitive to hot food. Is my tooth nerve dying.? I hate to see another dentist, but I am not a fan of pain either. What is going wrong? Thank you. Myles from GA

 

Myles,

Thank you for contacting our office and clearly describing your symptoms. We recommend that you call and endodontist today.

Issues that Can Result from a Cracked Tooth

When a tooth cracks, the tooth pulp (living tissue and nerves) can be damaged. And if the pulp is irritated and infected, it will die.

When a New Crown is Sensitive to Cold and Painful

When a new crown is sensitive to cold and pain, and the symptoms linger, it is usually a sign of an infection. Although it is common to feel some sensitivity for a few days, it should not last if the dentist adjusted your bite correctly. As the crown gets sensitive to heat, you might have irreversible pulpitis, and an endodontist will look for damage to your tooth ligaments.

Your tooth sensitivity began after crown preparation. Possible causes include:

  • Incompletely sealing the temporary crown
  • Tooth irritation during preparation
  • A combination of the above

A dentist can minimize sensitivity by:

  • Coating the tooth with a desensitizing product, but may your dentist did that
  • Cementing the temporary crown with strong material to help the tooth settle down
  • Remove the crown for root canal treatment if symptoms do not improve
  • Not cementing the final crown on an already irritated tooth

Finding a New Dentist

After root canal treatment, you will need a quality dental crown. Look for a dentist with advanced cosmetic dentistry training who offers financing or payment plans—ways to make your care affordable. Most dentists have payment options for patients who do not have dental insurance.

Do not delay getting treatment because an endodontist may be able to save your tooth.

 

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

How long can I wait to get a root canal if I don’t feel pain?

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I’m trying to figure out when I need a root canal if I don’t feel any pain. I am job searching, and if the tooth can wait, I would prefer to postpone it. My left first molar tooth is discolored, and my dentist says that the tooth is infected. She wants to complete a root canal and cover the tooth with a crown. If the tooth does not hurt, is this really urgent? – Thank you. Marcus from OK

 

Marcus,

Thank you for your inquiry. Your dentist is right; a dark infected tooth requires treatment.

Why Is Your Tooth Turning Dark?

Diagram of abscessed tooth in need of emergency dental care and root canal treatment
A dead tooth need urgent dental care to stop the infection

Your tooth can turn dark from infection. When the tooth pulp (the living tissue inside) dies, it turns dark, and the discoloration shows through your tooth. Tooth pulp contains tissue and nerves, so you will not feel pain if the tooth is dead.

Can You Delay Root Canal Treatment?

Although you do not feel pain, your tooth infection is lingering. A dark tooth means that you have probably had the infection for some time. It can spread into your bone or your bloodstream. Although you may not feel pain, other symptoms of a long-term tooth infection include:

  • A foul taste or smell in your mouth
  • Difficulty breathing or swallowing
  • Swelling in your face or cheek
  • Tenderness or swelling under your jaw or in your neck (lymph nodes)
  • Fever
  • Gum disease
  • Dehydration
  • Stomach pain
  • Fatigue

A dead tooth is an urgent matter because the infection can poison other parts of your body.

What Can You Expect with Root Canal Treatment?

Root canal treatment is painless, but your tooth will be weak. And your dentist must protect it.

  • Painless – A skilled dentist uses a local anesthetic for painless root canal treatment. But if your tooth is dead, you will not feel any nerve pain.
  • Foul smell – A tooth that has been dead for years has a bad smell. You will probably notice it and be happy that your dentist removed the infection.
  • Protecting the tooth afterward – If you have a strict budget, you do not have to get a dental crown right away. Instead, ask your dentist to complete the root canal and protect your tooth until you can afford a crown.

After the dentist completes the treatment, you will probably feel better. You might have mild symptoms that you ignored or did not associate with your tooth.

Best wishes.

Ryan Perry, DDS of Baton Rouge, sponsors this post. For more information read our post, Does a Root Canal Tooth Always Need a Crown?

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

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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,

Man frowning and holding the side of his face; for Baton Rouge emergency dentistry from Dr. Ryan Perry.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.

Horrible toothache and headache, but my dentist sees no problem

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In January, my dentist did a root canal on an upper right molar tooth. The tooth felt better afterward but has not been symptom free. Two weeks ago, I felt a flare-up of pain that felt like it affected the tooth next to the root canal tooth, and I have a headache, too. I returned to my dentist on Monday, and she took x-rays. She says that both teeth look fine. She suggested that I see a neurologist. I do not think my dentist is investigating enough. Why a neurologist?  Thank you. Bryson from Arkansas

Bryson,

Although Dr. Perry would need to examine your tooth and x-ray to give you an accurate diagnosis, we can offer insight that might help you decide what to do next.

Pain from a tooth that looks healthy

Man in his 40s with a headache and toothache holding the side of his face
Headache and toothache pain are not always easy to diagnose

It is not uncommon to feel pain in a tooth that looks healthy in a visual examination and on an x-ray. Some causes of tooth pain include:

  • Referred pain – Infection from a tooth can refer to an opposite upper or lower tooth. Or it can feel like the pain is coming from an adjacent tooth. But pain does not refer from one side of the mouth to the other.
  • Neuralgia – Chronic nerve pain can transfer in your face, jaw, teeth, or gums. Although the condition is usually not the cause of a toothache and headache, a nerve problem can feel like a toothache. That is why your dentist recommended that you see a neurologist.
  • Infection – A sinus infection can cause headaches and pain that feels like a toothache. The maxillary sinus is near the roots of upper teeth and can press on the roots, causing a toothache sensation. Sinus pain can also transfer to a lower tooth.
  • Other health issues – Some conditions that can feel like a toothache and cause headaches include jaw pain, clenching or grinding your teeth, or gum disease. According to the American Migraine Foundation, TMJ (temporomandibular joint) disorders can contribute to chronic headaches.

If you feel that your dentist is not a good listener or rushed for a diagnosis, we suggest getting a second opinion. You can get a second opinion from another dentist or a root canal specialist (endodontist).

Are your tooth pain and headache a dental emergency?

Sudden or lingering toothache – If you have a sudden or lingering toothache and headache but no recent dental work, see a dentist right away. Toothaches are most often a symptom of infection.

Toothache after dental work – If you had root canal treatment or other dental work that seems to be your pain source, contact the dentist who completed the treatment. If the pain persists beyond the healing period or gets worse, consider it an emergency.

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

 

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

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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:

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.

What to do about a repeatedly rude dentist

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After the anesthetic wore off from a root canal, the pain was horrible. Swelling and terrible pain lasted three days. My dentist prescribed Flagyl. I saw my dentist a week later, and he told me to keep staying the medication because the root looks fine.

My pain didn’t stop, so I had an emergency appointment with another dentist. They recommended that I see a neurologist. The neurologist says I have trigeminal neuralgia and should let my dentist know. I called my dental office, and they said that the dentist wanted to talk to me in person. He spoke rudely and told me that he had nothing to do with my nerve pain.

When I scheduled my dental crown appointment, the nurse said I need clearance to see the dentist, and without it, I won’t get a crown from their office. I’m waiting to hear from my dentist, but I wonder why I’m being treated so rudely. I didn’t accuse my dentist of anything. Should I trust him to place the crown? Thank you. Heather

 

Heather,

What you describe is odd and rude behavior from your dentist. We suggest that you switch to another dentist and ask for a refund for incomplete work. Although emergency dental visits are appropriate in many cases, you need a doctor who will take time to identify the source of your pain.

Doctors usually prescribe Flagyl for the lower GI tract and vaginal infections. It is an alternative antibiotic when other types won’t work for oral infection. Flagyl has a limited spectrum and is usually combined with amoxicillin or another.

Man frowning and holding the side of his face; for Baton Rouge emergency dentistry from Dr. Ryan Perry.
Sometimes, an emergency dental appointment isn’t enough

Trigeminal neuralgia causes extreme facial pain when an area of the face is touched or stimulated. Strangely, a neurologist diagnosed your case based on your dental incident alone. But why would your dentist become rude and defensive? We can’t answer that, but your dentist’s office doesn’t seem like a trustworthy place to get a new crown.

You can report the “non-visit” to your dental insurance company. You can ask for a refund. If your dentist doesn’t cooperate, you can report the incident to the state dental board.

 

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

My dental crown keeps falling off

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My dentist did a root canal on an upper right tooth about 12 years ago. Two years ago, the crown fell off, and my dentist replaced it. Since that time, the crown fell off three times, and my dentist cemented it back on. But my crown still feels a little loose. Not much tooth is left beneath the crown. Is this recementing something that I need to accept? The next time it falls off, I’m tempted to find a completely different dentist who takes urgent appointments to see if they can do any better than my dentist.

Thanks. Rebeka from Virginia

Rebeka,

When a crown keeps falling off, the problem is usually the design of the crown preparation. If that’s true in your case, you might need a new crown.

When a Root Canal Tooth Is Badly Broken

When a root canal tooth doesn’t have much structure left, a dentist can’t prepare the tooth properly. Some dentists use this method to improve crown retention:

  • Remove some of the root canal filler material
  • Place a flexible fiberglass post about 2/3 the tooth length into the canal and cement it in place
  • Bond core material to the post and tooth
  • Bond the crown to the built-up tooth

A flexible post in a rooth canal tootth to build it up in preparation for a dental crownIt won’t help to see another dentist for an emergency appointment because your situation can’t be corrected that quickly. The resolution takes forethought, time, and skill. The photographs on this page, courtesy of Dentistry Today, are an example of a treatment option that might work for your case.

If a dentist builds up your tooth with a post and composite, the tooth should retain a crown. But you need some remaining tooth structure for this to work. If crown retention only comes from the post, normal function and twisting stress will break the post, and the crown will fall off.

Bonding built up a tooth and postLook for an experienced dentist, schedule a consultation, and ask about treatment options.

 

 

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

Root canal tooth hurting again?

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Almost three years ago, I had a root canal on an upper right molar. In May, the tooth started hurting on and off. I hesitated to do anything about it because I didn’t want to go to the dentist during the pandemic. But now the pain isn’t on and off. It’s just on and getting worse. I don’t want to lose the tooth. I’m not an established patient with any dentist. Part of my hesitancy is that after a dental cleaning and exam last October, I became very ill the next day with what resulted in a month-long respiratory infection. I still have some chest congestion from it. I’m convinced that I got the infection from the dental office. I decided not to return to that office, but now with a throbbing toothache, I’ll have to find a new dentist. In the middle of Covid-19, I don’t want to keep switching dentists. I want an idea of what’s going on. And can you tell me what to expect from a dentist for treatment options? What’s the best treatment is for a root canal tooth that’s aching? Thanks for your input.  Demetrius from Montgomery, AL

Demetrius,

We understand your hesitancy about going to a dentist. Your failed root canal treatment and illness after a dental appointment can create anxiety. But you likely realize that your throbbing tooth won’t improve without help from a dentist. So what’s causing your pain?

What Is Root Canal Failure?

Diagram of tooth with needing a root canal treatment
Although root canal treatment is usually successful, it sometimes fails

Root canal failure is a condition that occurs when a tooth doesn’t heal completely after root canal treatment. Symptoms eventually resurface and get worse. About one in ten teeth experience root canal failure.

Although Dr. Perry has extensive experience in root canal treatment, he would need to examine your tooth for an accurate diagnosis, it seems that root canal failure is causing your pain.

Why Are the Causes of Root Canal Failure?

Root canal treatment can sometimes fail for several reasons:

  • It’s impossible to see deep inside a tooth.
  • Some teeth have curved, branching roots that are difficult to clean.
  • If a dentist misses some of the infection in curved roots, symptoms will resurface.
  • Curvy, challenging roots require specialized rotary instruments to clean them out. Many general dentists don’t have those tools, so they may not completely clear the tooth. You may be referred to a specialist to complete root canal treatment.

What Is the Treatment for Root Canal Failure?

Treatment for root canal failure is either to perform another root canal treatment or root canal surgery. Most general dentists don’t have advanced training in this area, so an endodontist, or root canal specialist, usually completes the work. The specialist will identify the location of the infection that the dentist missed the first time and remove it or seal it off. Many root canal specialists say that retreatment has a 50% success rate, but the results are often better.

A specialist will also examine the condition of your tooth. If it’s cracked, the chances of saving your tooth decrease. Don’t delay treatment. Search online for a dentist with experience in root canal treatment who will see you right away, examine your tooth, and refer you to a specialist if needed.

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