Archives for January 2021

Pain after root canal treatment got better then worse

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After getting a second root canal on my tooth, the pain came back a few days later. I called my dentist, and she said my tooth should be fine. I read online that after root canal treatment, peak inflammation and pain can occur for 48 to 72 hours but should improve. The hygienist at my dentist’s office is a good friend of mine, so I called her yesterday, and she said that the pain returning can mean that the second root canal failed. I hate to take a hygienist’s word over my dentists, so I decided to write for a tiebreaker. I know that I will need to see my dentist again, but which prognosis seems correct? I am concerned about losing the tooth and needing a dental implant – Sareda from Knoxville, TN

Sareda,

Peak inflammation after root canal treatment occurs in the following 48-72 hours if a dentist does not treat the pain by reducing the occlusion (the way your upper and lower teeth fit together). Inflammation can cause post-operative pain that hurts right away, peaks, then improves. When the local anesthetic wears off, an untreated tooth feels worse the second and perhaps third day before improving.

When root canal post-operative pain improves, then returns

If you experience peak pain on day two or three, but it improves and begins to hurt again, it can be a sign of post-operative infection. But not every case of post-operative pain is a sign of root canal failure.

  • The risk of root canal failure increases in a tooth with two or more root canal treatments.
  • If a tooth had a repeat root canal treatment and you have passed the peak pain period (48-72 hours), but the pain returns, it is often a sign of root canal failure.
  • The American Association of Endodontics advises that if severe pain or pressure lasts for more than a few days, you should contact your endodontist.
Diagram of the phases of a dental implant for a comparison to a partial denture.

A dental implant can replace a tooth after root canal failure and extraction

Please schedule a follow-up appointment with your dentist. If your dentist’s response is unsatisfactory, we recommend that you get an exam from an endodontist (root canal specialist). When root canal treatment fails, an endodontist might recommend root canal surgery by making an incision in the root tip to treat the tooth. If you want to avoid tooth extraction and a dental implant and your dentist cannot resolve the issue, an endodontist or a dentist with advanced implantology training will give you the best chance at saving a problem tooth.

For information about how to avoid implant failure, read our post: My painful dental implant and bone graft failed

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.

When will jaw numbness after wisdom tooth extraction go away?

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A week after getting all my wisdom teeth extracted, the lower left side of my jaw still felt numb. Three days ago, the oral surgeon did sensation tests. I will return in two weeks for a follow-up appointment.

The numbness is causing problems when I eat and brush my teeth. Did the IV sedation affect my jaw nerve? Is there anything else I can do to improve the situation? Is this common, or should I be more concerned than the oral surgeon seems to be? – Thank you. Tiffany P. from Athens, GA

Tiffany,

Thank you for your inquiry. Your description sounds like your lower-left jaw nerve is damaged. The extent of the damage determines how much the nerve will recover.

Nerve Damage with Wisdom Tooth Removal

Nerve damage can occur with wisdom teeth removal because the nerve for your lower teeth and lip is close to your wisdom tooth roots. During wisdom tooth removal, the nerve can be damaged. But the damage is not related to receiving sedation to help you relax before the procedure. Before surgery, an oral surgeon should do the following:

  • X-ray your teeth and jawbone to see the location of the nerve
  • Notify you of the risk of damaging the nerve during wisdom teeth removal

Many surgeons overestimate the risk of nerve damage to protect themselves from possible lawsuits.

Categories of Nerve Injury During Wisdom Tooth Removal

The three categories of nerve injury during wisdom tooth removal have different results:

Photo of woman sitting back in a dental chair with her eyes closed; for information on Baton Rouge sedation dentistry during tooth extraction.

Sedation relaxes you during tooth extraction but does not cause lingering jaw numbness

  • Bruised – You will feel numbness for about a month, after which the feeling will return.
  • Crushed – Symptoms last about a year as new nerve fibers grow.
  • Severed – Permanent injury prevents nerve fibers from regrowing, and you will continue to experience symptoms.

What to Expect

  • Depending on the extent of damage to the nerve in your jaw, you may not see improvement when you return to your oral surgeon for a checkup.
  • It may take a month or up to a year for improvement. If the nerve can recover, you will begin to feel tingling in your lip as it heals.
  • Some patients say that their body adjusts to the numbness and symptoms become less intense even with a severed nerve.

Although there isn’t anything you can do to repair the nerve, try to be patient as you wait for signs of improvement. Your oral surgeon can advise you on how much progress you might expect to feel over the next few months.

 

 

Steven Brooksher, DDS, of Baton Rouge, sponsors this post.

Can I Get Only One Porcelain Veneer Replaced?

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I received six porcelain veneers in May 2019. My dentist didn’t get the bonding quite right on one veneer, and I had a lot of sensitivity in the tooth. At first, he suggested that I use Sensodyne toothpaste, but it didn’t help much. I mentioned the sensitivity at my next dental cleaning appointment, so my dentist looked at the tooth and said that the veneer is not in its original position and the dentin is exposed. He suggested replacing the veneer (upper left center) and the right-center veneer next to it to ensure the veneers match. I’m disappointed because this dentin exposure business was my dentist’s fault. Why did the porcelain veneer move out of place? He offered to reduce the cost of replacing the two veneers, but I don’t think I should have a fee at all. And why can’t he just replace the one veneer anyway? I’m afraid that if he must remove the veneer on my right front tooth that it might become sensitive, too. Should I insist that he only replace one veneer? Thank you – Zachary from GA

 

Zachary,

You didn’t mention if your general or family dentist provided the veneers. But it seems that you saw a dentist with limited training in cosmetic dentistry who aggressively prepared your teeth.

Is It Possible to Replace One Porcelain Veneer?

Photo of the tip of dental forceps holding a single porcelain veneer; from the Baton Rouge office of accredited cosmetic dentist Dr. Steven Brooksher.

A skilled cosmetic dentist can replace a single porcelain veneer

Yes, it is possible to replace a single porcelain veneer. Any dentist with advanced cosmetic dentistry training can replace one veneer and perfectly match the color with your existing veneers. Dentists who are skilled in aesthetics use dental laboratories that keep color formulas for each patient’s case so they can perfectly match it in the future.

Dentin Exposed with Porcelain Veneers

When a dentist prepares your teeth for porcelain veneers, and the dentin is exposed, they over-prepared your teeth. When tooth preparation is necessary, skilled cosmetic dentists only remove a fraction of a millimeter of tooth enamel for several reasons:

  • Preserve as much tooth structure as possible
  • Provide better bonding—veneers adhere better to tooth enamel than dentin, which is softer.
  • Avoid exposing dentin because dentin tubules lead to the pulp and risk irritation and infection.

Insist on Replacing One Veneer?

If your dentist says he must replace veneers on both central incisors (center front teeth) to achieve a color match, he probably doesn’t know how to do otherwise. You can decide if you trust your dentist to do the work or want a second opinion. If you choose to get a second opinion on your porcelain veneers, look for a dentist with post-graduate training and experience in dental aesthetics.

You probably want to get the issue resolved quickly, so don’t delay—especially because dentin exposure is unhealthy for your teeth.

Steven Brooksher, DDS, an accredited cosmetic dentist in Baton Rouge, LA, sponsors this post.

Get details from a previous post on reasons that porcelain veneers might fall off.