Should I Switch to an Endodontist If I Need a Repeat Root Canal?

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Hello,

Should I switch to an endodontist if I need a repeat root canal? I had a root canal on my upper right canine, which is a porcelain veneer tooth. I have six veneers on my upper front teeth from canine to canine. My dentist did a root canal on the tooth a year ago, but the filling fell out. This was not a temporary filling. Anyway, the tooth has an abscess, so I saw my dentist last week, and she says I need another root canal. I am concerned about this tooth because of the porcelain veneer on it. I don’t want to risk losing the veneer or the tooth. I wish my dentist had noticed the filling was loose before it fell out. Should I switch to an endodontist? Thank you. Mikayla

 

Hi Mikayla,

Your tooth is infected and needs treatment. An infection may have remained in your tooth after the root canal last year. Losing the filling may have let saliva and bacteria leak into the tooth. Over time, saliva will weaken the seal in your tooth, infecting it or causing a new infection to flare up.

Should You Switch to an Endodontist for a Repeat Root Canal?

Tips of dental forceps holding a porcelain veneer next to a woman's teeth

Get a second opinion from an endodontist if you have concerns about root canal treatment on a porcelain veneer tooth

If you are uncomfortable with your dentist’s ability to resolve your tooth abscess, ask for a referral to an endodontist. Root canal treatment weakens a tooth, so you increase the chance of success with an endodontist since they specialize in root canal treatment.

The treatment should not harm your porcelain veneer. However, you can consult the endodontist before your treatment and express your concerns about keeping the porcelain veneer and tooth intact.

Schedule an appointment with the endodontist as quickly as possible to prevent the infection from spreading into your jawbone and affecting other teeth. An untreated infection will erode the tooth, making it unrestorable. That scenario would cause porcelain veneer and tooth loss, creating a need for tooth replacement, such as a dental implant.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post. Learn more about the porcelain veneers process.

When steroids after root canal treatment don’t work

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In April, my dentist did a root canal on a molar tooth and put a crown on it. About two weeks after the procedure, the tooth started to hurt. My dentist did x-rays and said there are no cracks in the tooth, and it appears to be stable. My dentist referred me to an endodontist two months letter because the pain persisted. The endodontist prescribed antibiotics for two weeks. When I returned to the office, the endodontist examined my tooth and said it would continue to improve. I traveled to late July for an extended stay with my elderly parents, who needed my help with a personal issue, and my tooth was fine. After returning home last Tuesday, a severe toothache woke me up from sleep. The endodontist prescribed more steroids, but my tooth is still throbbing. Help! What is wrong with my tooth? Am I going to need an extraction? Jennifer from Laurel, MS

Jennifer,

Although steroids are a popular treatment for root canal pain, sometimes they don’t work. And in your case, it’s clear that your endodontist’s treatment isn’t working. A combination of poor diagnostic skills and a lack of understanding of pharmacology for your case—is prolonging your recovery.

Root Canal Treatment Pain and Steroids

We disagree prescribing steroids for your root canal treatment pain several reasons:

A steroid is an effective anti-inflammatory drug that calms the body’s response to inflammation. But inflammation has a purpose. The body’s response is to send white blood cells to fight infection. So steroids not only block inflammation, they block the body’s response to infection. A dentist must understand what’s happening inside a tooth—irritation vs. infection—before prescribing medication.

After root canal treatment – Immediately after treatment, tissue around the root end gets irritated for a variety of reasons:

  • Pushing infected pulp through the end of the tooth
  • Pushing disinfectant and filling materials through the tooth
  • Root canal files poking the end of the tooth

Irritation and inflammation – The irritation causes the tissues to swell, push the tooth up, create traumatic occlusion, and results in a cycle of post-operative inflammation and pain. Although steroids can treat the inflammation, some of the infected material was pushed through the tooth’s end. Both antibiotics and steroids may be required.

Ongoing inflammation – When a tooth is inflamed for weeks, as in your case, infection is usually the sole cause. That’s why the antibiotics that your endodontist prescribed in April/May worked.

But at this point, we disagree with your dentist. Weeks after the root canal treatment was completed, your tooth became infected. That means there was a problem with the root canal treatment. Sometimes root canal systems in teeth are complex. It can be easy for a dentist to miss some of the canals and thoroughly clean and seal them. We’re unsure of why your endodontist, a specialist, would tell you that it will take time, but your pain will improve. In most cases, as you experienced, another infection occurs.

And unfortunately, the endodontist placed a crown on the tooth before knowing if the root canal treatment was successful. Now root canal treatment is more complicated because an endodontist will drill a hole in the crown to access roots. And visibility is impaired.

What’s the Solution?

How can your endodontist not understand that your tooth is infected, not just inflamed? In your case, steroids are not the answer. You need antibiotics, and an endodontist needs to repeat the failed root canal treatment.

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

And unfortunately, the endodontist placed a crown on the tooth before knowing if the root canal treatment was successful. Now root canal treatment is more complicated because an endodontist will drill a hole in the crown to access roots. And visibility is impaired.

We recommend that you find another endodontist who is willing to tell you why you’re in so much pain and how to treat your tooth. Your options will include:

  1. Root canal re-treatment,
  2. Root canal surgery, or
  3. Extraction of the tooth and tooth replacement with a dental implant

Steven Brooksher, DDS, a Baton Rouge dentist and founding member, L.D. Pankey Alumni Dental Study Club, sponsors this post.

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.