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

Posted on by .

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

Posted on by .

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.

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

Posted on by .

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.