Is a Root Canal Enough, or Do I have a Cyst?

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For the past two years, I’ve had swelling above my top left premolar. It’s tender but not painful. My dentist has labeled it a chronic abscess, suggesting we could either leave it or consider removal. Recently, a specialist evaluated it for a potential root canal, estimating a 70% chance of success. He mentioned the risk of an underlying cyst, which an X-ray’s dark area might indicate.

How do I choose between a root canal or extraction? I’m concerned about the possibility of a cyst affecting my health. Both professionals have mentioned a more invasive gum procedure (apicoectomy) as an option if other treatments fail, involving cutting and peeling back the gum to address the issue directly. I am anxious and already have dental anxiety, so this doesn’t help. Whose diagnosis can I trust? Thanks. Juan Carlos from El Paso

 

Juan Carlos,

Most dentists encounter various oral health issues, but cysts are rare.

The Rarity of Cysts in Dental Practice

In my years of service, cysts were notably absent, suggesting that, while possible, the likelihood of such complications is minimal. Some dental professionals may overstate potential risks as a precautionary measure. While there’s a slight chance of developing a cyst, addressing the infection with a root canal often resolves the issue without more invasive treatment.

An Apicoectomy or a Root Canal?

The suggestion of an apicoectomy, a significant gum surgery, seems excessive for many cases. Aggressive interventions are not always necessary. Generally, root canals have a high success rate, mainly when performed by specialists (endodontists) equipped with advanced technology. However, if root canal treatment doesn’t work, you still have the option of an apicoectomy.

Observations on Your Dentist’s Care

Palm tree on the beach, representing relaxation with sedation dentistry for routine care or a root canal

Sedation can help you relax during root canal treatment, an apicoectomy, or any dental procedure

Monitoring swelling without immediate intervention, especially for an extended period, raises concerns about your dentist’s managing the infection. Continuous exposure to bacteria from an untreated abscess can have systemic health implications.

We recommend getting a third opinion from another specialist. If you need treatment, talk to your dentist or specialist about your anxiety and whether you can benefit from dental sedation.

 

Baton Rouge accredited cosmetic dentist Dr. Steven Brooksher sponsors this post.

Is a Tooth Infection Causing My Fever?

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I’ve had a low fever for two weeks, and I think a tooth infection may be causing it. At first, I thought it was the flu or some virus because I have been running a temperature and am achy. Last night, my temperature was 102.6. I know I have a few decayed teeth that I think might need fillings or root canals, but I have put off going to the dentist. Could the tooth infection be giving me a fever and making me sick? Marcus from New Haven, CT

Marcus,

You may have a tooth infection. Fever alone is not a sign of a tooth infection, but you may be right if you have decayed teeth that need root canal treatment. But please do not guess what is causing your symptoms. It is best to see a dentist promptly because you may have a tooth abscess.

What Are the Symptoms of a Tooth Abscess?

Some of the symptoms of a tooth abscess include:

  • A persistent toothache with pain in your jaw, ear, or neck
  • Sensitivity in the tooth to heat and cold
  • Pain or sensitivity when you chew or bite
  • Fever
  • Swollen face or cheek
  • Swollen or tender lymph nodes in your neck or under your jaw
  • A sudden rush of foul-smelling and foul-tasting fluid in your mouth and toothache relief if the abscess ruptures

What Is the Treatment for a Tooth Abscess?

A dentist can save an abscessed tooth with root canal treatment or surgery (apicoectomy). A tooth infection can poison your system and cause the symptoms you describe. See a dentist immediately to determine if you need a root canal treatment or a different treatment.

Dental implant components, including root form, abutment, and crown

Dental implants imitate natural teeth

Most likely, a dentist can save teeth in bad condition with root canal treatment. In rare cases, a dentist must remove and replace the tooth. Replacing missing teeth protects you from further oral health problems. When several teeth are missing, your body resorbs the jawbone and uses minerals from it elsewhere. Dental implants are the most effective treatment because they fuse with your jawbone and prevent jawbone resorption and facial sagging.

The sooner you seek treatment, the easier it will be to resolve the issue. Contact a dentist right away.

Dr. Steven Brooksher, a Baton Rouge dentist, sponsors this post.

How many times can I get a root canal on the same tooth?

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Six years ago, my dentist did a root canal on a top right molar. The tooth is hurting again, and I am worried that I will need a dental implant. Is it possible to save a tooth that already had a root canal? Can a tooth remain stable after a second root canal? Thanks. Rachel

Rachel,

A dentist can repeat root canal treatment on a tooth two or more times. But successive root canal treatments don’t always make sense.

Can Root Canal Treatment Be Repeated?

Although a dentist can do a second or third root canal treatment—or more—on a tooth, the results are unpredictable. Even the most skilled dentists can perform root canal treatment that fails.

Studies show that root canal treatment has an 86 – 98% success rate. But cleaning out the canals of a tooth can be tricky. If a dentist doesn’t thoroughly remove infected tooth pulp, the infection will be sealed in the tooth only to flare up later.

A molar tooth has three canals, but sometimes a tooth has a “hidden” fourth canal. Sometimes a canal will branch out at a right angle. And although a dentist uses tiny, flexible instruments, it can be difficult—if not impossible—to get the device into angled canals to remove the infection.

Although highly angled canals are rare, when they exist, the probability of needing a repeat root canal increases. Retreatment has a 50 – 75% success rate. And if a highly skilled dentist performed the first root canal treatment, a second one might not work.

What About Root Canal Surgery?

Diagram of the phases of a dental implant for a comparison to a partial denture.

Get a root canal second opinion before agreeing to an extraction and dental implant

Root canal surgery is also known as an apicoectomy. During the procedure, a dentist makes an opening in the bone, cuts off the infected root tip, and fills the end of the tooth. But if tooth roots are not readily accessible, the surgery is risky and can damage the lower jaw and lip nerve.

An extraction and dental implant are the last options. If you’re uncomfortable with your dentist’s skill level, you can seek a second opinion with a dentist who is skilled in root canal treatment. Or you can ask your dentist to refer you to an endodontist, a root canal specialist. If you’re anxious about future procedures, ask your dentist or endodontist about sedation options.

 

Dr. Steven Brooksher of Baton Rouge sponsors this post. Dr. Brooksher has advanced training in restorative dentistry.

Pregnant and Need a Repeat Root Canal? 3 Facts to Consider

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I’m in my second trimester of pregnancy at 22 weeks. I experienced sensitivity in an upper left molar tooth that my dentist did a root canal on about six years ago. The sensitivity got worse and became painful, so I went to the dentists. My dentist did an x-ray and found an infection. My options are to do another root canal, try an apicoectomy, or get the tooth extracted and replace it with a dental implant. My dentist said that there is more than a 50% -60% chance that my root canal treatment will be successful.

Since I’m pregnant, I have several concerns: the anesthetic and how it might affect my baby, a second root canal failure, and needing an apicoectomy or extraction anyway, discomfort, and a long process with a dental implant. And if something goes wrong with the treatment, I might need a pain killer or antibiotics, so I’m concerned about how that will affect the baby, too. Will you please tell me whether a root canal or an apicoectomy requires more anesthetic? How long does it take to determine if a root canal is successful? I’ve been with this dentist for about three years, so another opinion will increase my comfort and help me decide on a treatment option. – Thanks. Miriam from Tulsa, OK

Miriam,

We recommend that you repeat the root canal treatment because it’s the least invasive treatment. If you can avoid an apicoectomy or dental implants while you’re pregnant, try to do so. But only have the treatment completed by a root canal specialist (endodontist). Endodontists have advanced training and specialized tools that will produce predictable results. An endodontist will reduce the risk of root canal failure.

1. Reasons to Get Root Canal Treatment During Pregnancy

  • The tooth is infected, and removing the infection protects you and your unborn child.
  • An untreated infection will spread.
  • Allowing the infection to linger might create a dental emergency at the most inconvenient time.

2. Local Dental Anesthetic During Pregnancy

Diagram of the phases of a dental implant for a comparison to a partial denture.

If you can get root canal treatment instead of a dental implant during pregnancy, choose a root canal

Repeating root canal treatment requires a minimal amount of anesthetic because the tissue and nerves inside your tooth are dead. Root canal surgery, or apicoectomy, requires ore anesthetic because the tooth is accessed through your gums. Although dental anesthetic is generally safe during pregnancy, it’s best to limit it with a procedure that requires less of it.

3. Evaluating the Success of Treatment

An endodontist can quickly tell if treatment is successful. A canal often leads to unsuccessful therapy if ledges, curves, or blockages are challenging to navigate. Your endodontist will know if there were difficulties or not. If the endodontist’s instruments can get to the root tips and successfully seal them, the treatment will likely heal well. Otherwise, the endodontist will recommend root canal surgery.

We hope you have a smooth root canal treatment, recovery, and delivery of your new baby. Congratulations!

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