Baton Rouge Dentist

Why Is My Tooth Still Infected After an Apicoectomy?

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African American woman wearing glassed and frowningMy 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.

Tooth still hurts after a second root canal

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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.
Dental implant
Although a dental implant mimics natural tooth structure, saving a tooth is often the best option

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.