Is a Recent Toothache a Reason for an Extraction?

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Is a recent toothache a reason for an extraction? I moved here from Connecticut in July, so I haven’t had time to search out a dentist like I want thoroughly. I’ve had a lower jaw and toothache on the back left side of my mouth for two weeks. The pain comes and goes. I went to a nearby dentist who took an x-ray. She said that a molar that already has a filling in it has a large cavity. She recommends pulling the tooth and replacing it with a dental implant.

Does this sound right? I had no idea this was happening with the tooth because the pain started only two weeks ago, and it comes and goes. I haven’t had a throbbing toothache or significant discomfort in other ways. Thanks. – Victoria

Victoria – If the pain in your tooth just started, the tooth has only recently become infected. If a dentist cannot save the tooth, it would be more likely that you would have felt pain months ago. The tooth may be badly broken or decayed, and a dentist may think it is unsavable. Or, the dentist may want to remove the tooth rather than try to save it because of its condition and the time it would take to restore it.

Model of a dental implant with the crown, abutment, and root form labeled

A savable tooth may need root canal treatment,  not extraction and a dental implant

It is best to seek a second opinion without telling the second dentist about the diagnosis from the first dentist. Your independent second opinion should include an X-ray to determine the tooth’s condition. A dentist or endodontist may be able to save the tooth with root canal treatment. Otherwise, you may get a recommendation for an extraction and dental implant.

We advise patients to get second opinions before agreeing to significant treatment that is costly or will impact their oral health. For example, a missing tooth can lead to other concerns, including teeth drifting out of place and creating a need for braces to realign them.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Read about his education and training, and learn what he does to provide some of the best dental care in Baton Rouge.

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.

Unsure If You Need Root Canal Treatment? – 4 Clues from the X-ray

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In April 2019, I received a filling in a tooth, and now my new dentist is recommending root canal treatment. I relocated, and in January of this year, I went to a new dentist for my yearly cleaning and exam. I also received x-rays, and the dentist said that the x-ray seems to show some decay beneath the April 2019 filling. She recommended root canal treatment, which I declined at the time. Now that I have time to think about the tooth, which isn’t bothering me, I want to get an online second opinion. If there is decay, I don’t want it to get worse and end up needing an extraction and dental implant. – Thanks, Segura from San Antonio

Segura,

X-ray of an invisor tooth with a filling and a dark spot beneath it

Although there is a dark area near the fillng, the tooth doesn’t need root canal treatment, an extraction, or a dental implant

Thanks for sending us a copy of your x-ray. Maybe dental schools need to give more training in x-ray diagnostics. Although Dr. Brooksher would need to examine your tooth, your x-ray doesn’t show inflammation or any reason that a dentist would disturb it with root canal treatment. But what about the dark area beneath the filling?

Facts About a Dark Area Beneath a Filling

  1. Dark areas – Not all dark areas on a tooth x-ray are a result of tooth decay. Decay, a gap in the filling, or a radiolucent material beneath the filling will appear dark on the x-ray.
  2. Location of darkness – The dark area on your x-ray is on the surface of your tooth. In this case, your dentist can use an explorer and poke the area. If it’s soft, there is decay.
  3. Effect on tooth pulp – Tooth pulp includes the living tissue and nerves inside the tooth. Root canal treatment removes infected pulp. When the dark area on your x-ray isn’t near the pulp, you don’t need root canal treatment. On an x-ray, it might seem that the dark area is between the filling and tooth pulp. You can resolve the illusion while looking at the x-ray: Cover the white filling with your finger and look at the remaining tooth structure. You can see the dark area and the distance from the pulp.
  4. Comparison with adjacent tooth – The lamina dura is a thin white line around the tooth root. An infection will break the line around the root tip or pull it away from the tooth. Look at the x-ray on this page. The tooth with the filling, and the canine tooth next to it, has a lamina dura that intact. Both teeth are healthy. You won’t need root canal treatment. And you surely don’t need an extraction and dental implant.

If you still have reservations about the health of your tooth, consider scheduling an appointment for a second opinion. You can take your x-ray with you for a dentist to examine it in person.

 

Steven Brooksher, DDS practices in Baton Rouge, LA. Dr. Brooksher is one of ten dentists in Louisiana accredited by the American Academy of Cosmetic Dentistry.