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.