A Metal File Tip Broke in My Tooth During a Root Canal

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My dentist told me that a metal tip from his instrument broke off in my tooth during root canal treatment. I heard it break. However, my dentist said the instrument was sterile, so he didn’t want to probe my tooth for the metal tip and potentially irritate it. I asked for a temporary cap only until I decided what to do. Should he have left the metal tooth? Could I develop an infection later? I don’t want to pay for a final crown and then need it removed to get the metal tip out. I’m unsure that my dentist knows how to remove it anyway. Thanks. Quinn from TN

Quinn,

It’s not uncommon for dentists to encounter situations where a metal file breaks during a procedure. These files are delicate and can break easily.  If the tip of a file breaks, a dentist would need to navigate around it to seal the tip of the tooth root. However, if the metal tip obstructs the root tip, it increases the risk of root canal failure. Depending on the location of the root tip in your tooth’s canal, you may need to repeat root canal treatment, underscoring the importance of getting the tooth evaluated.

Asking your dentist to refer you to an endodontist (root canal specialist) will increase the chance of a better outcome. A file tip can be challenging to remove for many dentists. However, an endodontist’s specialized tools can reach deep into a tooth’s canal to extract the tip of a metal file.

If your dentist hesitates to refer you to an endodontist, insist on it or find one yourself. You were wise to explain to your dentist that you want to keep the temporary crown until you decide how to treat the tooth. Ensure you see an endodontist to resolve the issue rather than relying on a general dentist. It can help you avoid another infection and root canal failure, which can lead to replacing the tooth with a dental implant.

Dr. Steven Brooksher, a Baton Rouge cosmetic dentist and a Fellow of implant dentistry, sponsors this post.

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.

Should I Skip a Root Canal If I Take ELIQUIS®?

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I saw a dentist last week for a toothache, and she suspects that I need root canal treatment for a tooth with an old filling that is loose. I completed the new patient paperwork and gave my prescription information. The dentist referred me to an endodontist and told me she would transfer my records to remind the dentist that I take Eliquis. She said the procedure should go smoothly, but I shouldn’t take any chances. Now, I am more nervous than usual. I always need sedation before a procedure. Is there any way we can replace the filling and skip the root canal? – Thanks. Kandace from Lansing, MI

Kandace,

We understand your concerns. Dentists and other healthcare professionals ask for your medical and prescription history to provide safe, efficient care.

Should You Skip a Root Canal If You Take ELIQUIS®?

You should not skip a root canal if you take ELIQUIS® or other anticoagulant medication. Without root canal treatment, the tooth infection will thrive, potentially affecting your gums, jawbone, other teeth, and overall health. The American Dental Association confirms that, in most cases, patients do not need to discontinue anticoagulant or antiplatelet medication. However, patients with high bleeding risk should consult their medical doctor for advice.

How Can Eliquis® and Other Blood Thinners Affect Dental Procedures?

Eliquis® and other blood thinners can affect the blood clotting process. Consider how:

The blood clotting process has two phases

  • Platelet bonding – These small red blood cells stick together and adhere to blood vessels to slow blood flow.
  • Coagulation – Protein chemicals in the blood interact, fill in the gaps between the clumps of platelets, and form a solid clot to help the bleeding process stop.

The purpose of antiplatelet and anticoagulant medication

  • Antiplatelet agents – These agents prevent the first phase—platelet bonding.
  • Anticoagulant agents – These agents prevent the second phase—the formation of protein chemicals that give the clumps of platelets a stronger bond.

How Can Antiplatelets or Anticoagulants Affect Dental Procedures?

Many dental procedures can produce bleeding. However, bleeding is usually minimal, even when patients take antiplatelet or anticoagulant medication. Your dentist or oral surgeon will consider the risks of performing a particular procedure while the medicine is in your bloodstream versus when you have not taken the medication.

Some dental procedures that can cause bleeding are:

  • Biopsies
  • Dental implant placement
  • Periodontal (gum surgery)
  • Regular and deep dental cleaning
  • Tooth extraction

Each patient’s case is unique. In some cases, discontinuing the medication is very dangerous. You should not automatically stop taking ELOQUIS® or other anticoagulants before a dental procedure without your doctor’s approval. Continually update your dentist and medical doctor with any medication changes.

Medication Precautions Before a Dental Procedure

Diagram of root canal treatment instead of a dental implant - from Baton Rouge denitst Steven Brooksher, DDS

Inform your root canal specialist or dentist about medications or supplements you take

Your dentist or endodontist will take precautions to minimize bleeding and give you aftercare instructions to help prevent excessive bleeding. Follow the instructions closely. For example, after surgical treatment, you will be advised to avoid smoking, drinking from a straw, spitting, and rinsing your mouth for at least the first 24 hours. Sharp, sticky, and hard foods should be avoided because they can aggravate an oral surgical site and dislodge blood clots.

Some herbal-based products can interfere with—or enhance—the effects of antiplatelet or anticoagulant medication. So, include them all in your list of medications and supplements.

During your consultation with the endodontist about a root canal, explain your anxiety and sedation needs. Also, ensure the specialist has a list of medications and supplements you take.

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.

Can I Have a Cavity In a Porcelain Veneer Tooth?

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Could I have a cavity on a porcelain veneer tooth and not know it? I relocated in February of this year, and my dentist says my left incisor has a cavity, and the tooth needs a root canal. I have no symptoms in the tooth. Could I need a root canal, and can I keep the porcelain veneer on the tooth? Thank you. Jerome

Jerome,

Thank you for contacting Dentistry by Brooksher in Baton Rouge regarding the cavity in your porcelain veneer tooth.

Can You Have a Cavity in a Porcelain Veneer Tooth?

A porcelain veneer only covers the front of a tooth, so it is possible to develop a cavity in a tooth. If you have no history of tooth decay, trauma can cause a cavity inside the tooth.

Can You Have Tooth Decay Without Any Symptoms?

You can experience tooth decay without any symptoms. According to the National Institute of Dental and Craniofacial Research, early tooth decay may not display any symptoms.

Advanced tooth decay can cause the following symptoms:

  • Toothache
  • Sensitivity to sweets
  • Sensitivity to cold

You may experience the following symptoms with An infected or abscessed tooth:

  • An abscess
  • Pus pocket
  • Pain
  • Facial swelling 
  • Fever

Do You Need a Root Canal for a Cavity?

Whether you need a root canal depends on the condition of the tooth and its pulp (living tissue inside). We recommend getting a second opinion from another dentist or a root canal specialist (endodontist).

  • Ask for a copy of the x-ray to take to your second opinion dentist.
  • Avoid mentioning the diagnosis during the second opinion.

Will You Lose Your Porcelain Veneer If You Have a Cavity?

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

Porcelain veneer

You will not lose your porcelain veneer if you have enough healthy tooth structure left after getting a filling or root canal treatment. Speak with a cosmetic dentist about the tooth to help you anticipate what you can expect with the veneer tooth.

Baton Rouge dentist Dr. Steven Brooksher sponsors this post.

I Have a Hole in My Tooth and It Smells

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I have a hole up an upper molar tooth. I looked at a tooth chart online, and it is tooth #13, a second premolar. The tooth smells worse than it hurts, but I wonder if I can fill it or pull it. I have a lot of anxiety about medical and dental appointments. Even though I can expect some pain, it’s easier for me to do it myself than have someone else invading my mouth. Is the hole a cavity I can fill with something from the drugstore, or will I need to pull it? Thank you. Marv

Marv,

Thank you for contacting Dr. Brooksher’s office. He would need to examine and x-ray your tooth to determine the cause of the hole and recommend treatment.

Can You Fill a Hole in Your Tooth?

You should not attempt to fill a hole in your tooth. Your efforts will be temporary and may make the tooth worse. Also, if the tooth has a foul odor, it may be infected even if you do not feel pain.

Drugstore-bought fillings are temporary. Even if you try to fill your tooth with filling material sold in drugstores, it will temporarily fix your tooth.

Tooth decay may be the reason for a hole in your tooth. Without removing the infection, it can spread to other teeth or your bone.

Filling a savable tooth is better than removing it. Although filling your tooth won’t work, pulling creates more concerns. You may damage other teeth while pulling the one with a hole. Removing the tooth will cause nearby teeth to shift. Misalignment issues affect your smile and digestion. In the future, you may need braces to correct the misalignment.

How Can You Save a Tooth with a Hole in It?

A dentist can use root canal treatment to save a tooth with a hole. A gentle dentist can explain sedation options to help you relax during the procedure. You will not feel anything throughout treatment, including the numbing injections.

What happens during root canal treatment?

A hammock on the beach for information on relaxing with dental sedation when you have a hole in your tooth

Sedation relaxes you through dental procedures

A dentist will remove the decay and any infection and sanitize it. Afterward, the dentist will fill the tooth with a dental filler material. You may need a dental crown or a composite filling to protect the tooth.

We recommend looking for a gentle dentist who offers sedation. The dentist will explain what to expect from your treatment options. You can start with an exam, which will be comfortable and painless.

 

Dr. Steven Brooksher, a Baton Rouge accredited cosmetic dentist, sponsors this post. Request a consultation with Dr. Brooksher today.

 

Will My Root Canal Tooth Break?

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My dentist says I need a root canal on my left incisor before beginning Invisalign treatment. I was concerned about needing a crown on a front tooth that would turn yellow or dark around my gums. But my dentist explained that she does not need to place a crown after the root canal; she will fill it instead. I wonder if the tooth will break because it is weak after the root canal treatment. And with Invisalign repositioning my teeth, isn’t it just a matter of time before the tooth breaks? Thanks. Jamison from NY

Thank you for your question, Jamison. Although Dr. Brooksher would need to examine your tooth for an accurate diagnosis, we will offer some basic information about root canals and orthodontic treatment.

Does Root Canal Treatment Weaken Teeth?

Teeth that require root canal treatment are already weak from decay, trauma, or extensive fillings. And root canal treatment can weaken them. But whether a dentist places a crown on the tooth depends on the tooth’s condition and position.

  • Back teeth – Back teeth must withstand the forces of chewing and grinding food. So, dentists protect the teeth with crowns after root canal treatment.
  • Front teeth – Fewer forces affect front teeth. It is unlikely for an incisor to split vertically, but sometimes it can break horizontally. But preparing an incisor for a dental crown can weaken the tooth near the base before its roots. If you have lost most of your tooth structure or the tooth is already cracked. A dentist can reinforce your tooth with a flexible post and fill the tooth with a dental composite. Removing root canal filler material will prevent your tooth from turning dark.

Will Invisalign Break Your Root Canal Tooth?

Invisalign upper and lower aligners

Invisalign

Your dentist will begin Invisalign treatment when your root canal tooth is stable to prevent any trauma during treatment. Healing time can take one to two months, but each patient’s case is different, so your dentist will explain what you can expect. Also, Invisalign and other alternatives for clear braces move teeth with precision and gently apply force on your teeth.

If you are hesitant about your dentist’s treatment recommendation, ask questions to ensure you understand them. And you can consider getting a second opinion.

 

Baton Rouge accredited cosmetic dentist and Fellow of implant dentistry Dr. Steven Brooksher sponsors this post. Read about his efforts to offer some of the best dental care in Baton Rouge.

No pain in my canine root canal tooth, but my dentist recommends a crown

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In 2002, I had a root canal on a canine tooth. My dentist of 3 years suggests putting a crown over the tooth to prevent it from breaking. The tooth does not hurt, so I asked my dentist if something is visibly wrong with the tooth. He said no, but the crown is preventive care. Do I need a crown on the tooth? I do not want to refuse treatment and end up with extraction and dental implant. Thank you. Leland from GA

 

Leland,

Thank you for your question.

Root canal weakens a tooth and increases the risk of breaking. But differences between molar teeth and front teeth causes some cosmetic dentists to avoid placing crowns on front root canal teeth.

  • Molar teeth – The stress of biting and chewing pushes the four cusps (the biting points) of molar teeth apart. The teeth are at risk of breaking after root canal treatment.
  • Front teeth – Designed for biting and tearing, front teeth are affected by horizontal shearing stress. Canine teeth absorb horizontal pressure to protect molar teeth. The long roots of canine teeth help them absorb stress.

Does a Canine Root Canal Tooth Need a Crown?

Unless your canine root canal tooth is already missing most of its structure, you do not need a crown. Additionally, a dentist may recommend a crown if the tooth is dark or poorly shaped and detracting from your smile.

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

If your canine root canal tooth is weak, a skilled dentist can reinforce it and hopefully prevent the need for a dental implant

Shaving a canine tooth for a crown requires reducing about one millimeter of tooth structure all around the tooth. The tooth may be left with as little as 50% of its initial fracture resistance.

Many cosmetic dentists strengthen canine teeth by placing a flexible fiberglass post in the tooth and filling in the tooth with composite. This process can protect the tooth from stress and minimize dark discoloration after root canal treatment. The added strength of a fiberglass post helps prevent breakage and the need for tooth replacement options, such as a dental implant.

You can get a second opinion from a cosmetic dentist to see if your tooth is weak and needs a post to support it.

 

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

Can I Get a Root Canal If I Have a Porcelain Veneer?

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Hello there,

My dentist says I have a periapical abscess and I will need a root canal on one of my front teeth. However, my front teeth all have veneers over them. Will this case discoloration? Or will I need my veneers replaced?

Brent, from Alcolu, South Carolina

 

Hi Brent,

Usually, when porcelain veneers are placed, they are done on teeth that have been prepared. Most preparation cuts ridges into the surface of the tooth. However, some dentists go too deeply, or even place crowns under the guise of  veneers. Doing either of these things will cause significant stress on the surrounding teeth. The stress could be the cause behind the root canal.

Getting a root canal on a tooth will cause the tooth to turn dark, and this can lead to discoloration. If the tooth beneath the veneer is discolored, it can show through the veneer. To avoid discoloration, your dentist will need to clean your tooth properly, and may need to replace the post with white fiberglass and use natural-looking composite to fill in any gaps. An expert cosmetic dentist should be able to help you avoid dental discoloration, but if you trust your general dentist, they can help you as well.

This blog post is brought to you by Baton Rouge porcelain veneer provider, Dr. Steven Brooksher, of Dentistry by Brooksher.

 

Novocain Doesn’t Make Me Numb?

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Hello there,

My teeth are in need of a root canal due to nerve damage and nerve damage. My dentist injected me with Novocain, and it did not work. He injected me again and again, and I still could not get numb. Because of that, he sent me home with some painkillers. I cannot get a root canal done unless my teeth can be numbed. Would a numbing paste work? Is there something I can do? Or is there something wrong with me?

Luther, from Huntington, West Virginia

 

Hi Luther,

It is not a problem with you, with some modifications you can get your teeth to get numb. Your problem is likely related to dental anxiety. The higher your anxiety, the less likely you are to get numb, and the more numbing agent that is needed. If you can lower your anxiety, you will be able to get numb with Novocaine or a numbing paste.

One way to help your dental anxiety will be to go to a sedation dentist. A sedation dentist can write you a script for an anti-anxiety medication to take thirty minutes to an hour prior to your appointment. However, you will need a ride to and from the appointment if you take this medication.

If you do not want to take an anti-anxiety pill, you can find a dentist who uses nitrous oxide. Nitrous oxide wears off quickly after the appointment, and has no ill side effects. It also is more effective at numbing and sedation than novocaine, and is a good alternative for those with dental anxiety who cannot be numbed any other way.

If your current dentist does not offer sedation dentistry, you can seek it elsewhere. If you continue to see your dentist, using techniques to control your anxiety will allow you to finally become numb enough to get your root canal.

This blog post is brought to you by Baton Rouge sedation dentist, Dr. Steven Brooksher, of Dentistry by Brooksher.