Dr. Brad Hylan’s Dentistry Blog

I am 31, male and have had a root canal procedure in the past. Due to a cavity, one of my wisdom teeth has been damaged badly enough that the root had died, the cavity was filled and appeared fine for 6-8 months. Unfortunately it appears an infection of some sort has presented itself and removal has been recommended. Essentially I do not want to loose this tooth, or would want it replaced, but my dentist does not agree with my motivation and it is possible I do not understand the risks.

Thank you.
Orbatos from Japan

Orbatos,
There are two reasons that dentists don’t generally do root canal treatments on wisdom teeth. The first is that these teeth aren’t really very useful.

The second is that the roots are generally very difficult to treat with root canal treatments. They tend to be very curved, and access is very difficult.

With any root canal treatment, there is a chance of root canal failure. On a wisdom tooth, those chances for failure will be the highest of any tooth, and the cost of the treatment will be the highest of any tooth.

Generally, most dentists wouldn’t recommend going though any extraordinary means to save a wisdom tooth unless you are missing the adjacent tooth and this tooth is needed as an anchor for a replacement tooth.

I actually have two questions. The first is concerning a root canal I recently had on tooth #7. It has been five days since the procedure and I am still in immense pain. I went back to my dentist yesterday, she did a visual check of the tooth, shaved down the back of the tooth some, gave me pain killers, and said it could take up to a week to feel better. Is this normal? I’ve had another root canal before (years earlier by a different Dr.) and had no pain. Plus before this treatment my tooth had no pain (the dentist saw something on an x-ray that indicated a need for the root canal). I have never had such intense and CONSTANT tooth pain before and was looking for a second opinion as to if this sounds normal. My second question is in regards to having crowns put on the teeth that had root canal treatments. My dentist said I would need a crown put on tooth 7 and tooth 11, but I am weary of having crowns if I don’t need them. I had a root canal on tooth 11 15 years ago and it has not bother me at all. Are crowns on front teeth safe? Will it change the appearance of my smile? Are there other options? Thank you in advance for you help and advice.
Sincerely, Carrie

Carrie,
You can have an infected tooth and it doesn’t hurt. If the pulp of the tooth is dead, it can be infected, but since the nerve is dead, you won’t feel it. And you will have infection spilling out into the bone (which is probably what your dentist saw on the x-ray), but your body walls it off, and it really doesn’t hurt. But then when the dentist goes in to clean that out and seal the tooth, that can upset the equilibrium and cause a temporary flare-up like you are experiencing. Usually the flare-up heals within a few days. Reducing the occlusion so you don’t hit the tooth when you bite together is a helpful move. So the fact that this tooth hurt so badly after your root canal treatment doesn’t mean the dentist did something wrong. I’m guessing it will probably settle down in a few days. Then, when you go back in 6 months for a regular checkup, you should have this tooth x-rayed. If the bone has healed in that time, that indicates that the root canal treatment was a success.

As far as whether or not it needs a crown afterwards, your tooth #7 is your upper right lateral incisor, which is one of your four front teeth. For a front tooth it isn’t always that necessary to get a crown, unless there was a large cavity in the tooth. There is an interesting blog post about front teeth, root canals, and crowns. On that post, it says that if you don’t get a crown, you want to be sure that the dentist cleans out all the root canal filling materials from the crown of the tooth, which is the part that shows that isn’t the root. Old gutta percha and sealer cement will cause the tooth to quickly darken and be ugly, so that needs to be cleaned out. A lot of dentists don’t realize that. And then a flexible fiber post placed inside the tooth could be helpful to strengthen the tooth against breaking off.

Dr. Hall

I had a serious problem with two teeth. I had root canal treatments done in Russia maybe 15 years ago. I had no idea that the roots on these teeth were not finished. This year when I went to a dentist and he told me that I had an infection.

4 days ago I had root canal treatments for the second time in these teeth performed very well, by an endodontist. When I left his office I suddenly realized that my pressure headache went away so is my chest pain, and on the next day my gums looked better than ever. But today the headacke and the chest pain is back again. Do you think I should go on antiboatics? Because endodontist told me that infection started destroying my bone already, but he told me that it will be healed.
Please help. Natasha from Minnesota

Natasha,
We find that in many foreign countries their treatment standards are way below ours in the United States. And incompletely done root canal treatments are very common abroad. Fortunately, it looks like you finally have this long-standing problem taken care of.

Usually antibiotics are not needed after a root canal treatment. Once the source of the infection (the tooth) is treated, your body can easily take care of the bacteria that may have entered the bone. There may be some slight pain and sensitivity afterward, but that should go away over a few days.

There is always a possibility that a root canal treatment won’t work, and every dentist who does root canals should explain that to the patient. There is no guarantee. So there is that possibility that your treatments may fail. But it doesn’t sound to me like you need antibiotics. I would wait out this pain you’re having, as long as it’s not too bad. If it persists more than 2 or 3 days, or if it gets very bothersome, I’d go back to the endodontist and ask him to check the teeth.

Other information:
Read about dental implants.

I’m very frustrated with my recent root canal! I’m still having some pain when my teeth touch.

Here’s the history: I had crowns put on both #7 and #10 (lateral incisors) with no pain. I wore the temporary crowns for 2 wks with no pain or discomfort, but after the crowns were place, #10 began to hurt. I went 1 month with the pain and had several adjustments on my own bottom teeth and the new crowns. Finally the doctor did a root canal on # 10. This solved the cold sensitivity, but there is still pain. I’m not sure what to do. I’ve lost my trust in my dentist over all this. I don’t know if its an infection or something. I still have cold sensativity in #7 also but was told to wait another month after yet another adjustment. Help!
- Ann from California

Dear Ann,
These lateral incisors are thin teeth, and it’s very easy for them to get over sensitive with a new crown, and sometimes they end up needing root canal treatments.

There are several possible explanations for your pain. It could be that there is still infection present even after the root canal treatment. Sometimes biting sensitivity can also be caused by gum irritation, provoked either by a poorly fitting dental crown or sensitivity to the metal in the crown. It could be a bite problem.

If you’ve lost confidence in your dentist, I would suggest getting a second opinion. But I would encourage asking for a “blind” second opinion. You don’t need to tell the second dentist about your frustrations or too much of your history because that invites a diagnosis that tells you what you want to hear. Just tell them about your symptoms, how long you’ve had the crown and the root canal, and see what they find.

I had root canal treatment on a front tooth 3 weeks ago, and am getting a crown. However, it is sometimes still a little sensitive above the tooth along the gums, not super-sensitive, just a little bit, and sometimes the temporary feels a bit sensitive. Is this normal or do I have a root canal that didn’t work, or some other issue?

Thanks for your help.
- Mike from Florida

Mike,
It isn’t unusual at all for a tooth that has had a root canal treatment to be a little tender for a while afterward. The reason for doing a root canal is that the tissue inside the tooth is infected, and removing this infected tissue causes some irritation around the end of the tooth. It takes the body a while to resolve this.

Related links:
Cleveland emergency dentist – Hylan Dental Care tries to see dental emergencies right away.
He also offers oral sedation for Cleveland dental chickens. Our office motto is “we cater to cowards.”