Ongoing issues after root canal

[AJK64]

A long post but want to try and explain as best as possible.

Starting at the beginning of October 2017 I developed a constant pain in the left temple area of my head. The pain varied on the pain scale day by day between a 5/10 up to about an 8/10. It was ruining my life and was stopping me from sleeping a lot of the time. I saw a neuroogy consultant and had 2 MRI scans and was tested for Temporal Arteritis (even though I was out of the risk group). The MRI's didn't show anything and the TA tests were negative. My neurologist was at a complete loss as to what was causing my pain. I was near suicidal at one point the pain was so intense and constant.

Fast forward to February. Still having the same issues, still no answers. I register with a new dentist (hadn't seen a dentist in about 8 years and my old practice had closed down). The dentist took xrays and said that there appeared to be a bit of decay under my already filled upper left 1st molar. So he took the old filling out and was shocked to find extensive decay underneath. He removed the decay but it went very deep and he was worried the filling would aggravate my nerves, but tried anyway. Well the filling did aggravate the nerve. The head pain was now joined by extreme tooth pain. So he decided it needed a root canal.

So he did the treatment. He did the whole thing in one session (which I now understand is not usual) and fitted a permanent amalgam filling. After he finished he looked annoyed. He told me that he had never actually done an unsupervised molar root canal before. He told me that he could only find 2 root canals. He was clearly angry at something, and told me that he couldn't do anything more to help me.

Well the root canal was now 9 weeks ago. The tooth still hurts if I touch it (it is no longer sensitive to heat or cold at all, but if I try to chew on my left side and when I brush it aches like a bruise or something).

I was now pretty scared of that dentist. It took me ages to find a new one but 2 weeks ago I went to a new surgery. The new dentist took an xray and said that the other dentist had seemingly left infection at the root tip of the tooth, and he gave me 10 days of Amoxicillin (500mg). He also said that it looks like there is a calcified 3rd root canal in the tooth. I took these and within a few days the head pain that I had had for over 8 months completely vanished! To say this was a relief is an understatement. I finished the coarse of antibiotics and for about 4 days the pain was still gone. However it is now back and slowly increasing again.

I feel completely lost. I don't know what I can do. I feel at the end of my ability to cope with this pain. The new dentist said that it appears that my upper molar roots are very close to my sinus, so extraction could be difficult. He offered to refer me to a private endodontist (I am an NHS patient). I have very little money and I am now wondering, would it be even likely that this tooth could be saved now by a specialist endodontist? Would filling the calcified canal solve this? What on earth happens if I have the tooth removed and end up damaging the sinus?

Then to add further stress, I have been having to chew exclusively on my right side. Now my lower right molar, which is also filled is hurting every now and then when I bite on it. I am so frightened after what has happened with the left upper molar that I don't know whether to get this tooth treated or just ignore the occassional pain.

 

[Raj Kumar Bhushan]

A long post but want to try and explain as best as possible.

Starting at the beginning of October 2017 I developed a constant pain in the left temple area of my head. The pain varied on the pain scale day by day between a 5/10 up to about an 8/10. It was ruining my life and was stopping me from sleeping a lot of the time. I saw a neuroogy consultant and had 2 MRI scans and was tested for Temporal Arteritis (even though I was out of the risk group). The MRI's didn't show anything and the TA tests were negative. My neurologist was at a complete loss as to what was causing my pain. I was near suicidal at one point the pain was so intense and constant.

Fast forward to February. Still having the same issues, still no answers. I register with a new dentist (hadn't seen a dentist in about 8 years and my old practice had closed down). The dentist took xrays and said that there appeared to be a bit of decay under my already filled upper left 1st molar. So he took the old filling out and was shocked to find extensive decay underneath. He removed the decay but it went very deep and he was worried the filling would aggravate my nerves, but tried anyway. Well the filling did aggravate the nerve. The head pain was now joined by extreme tooth pain. So he decided it needed a root canal.

So he did the treatment. He did the whole thing in one session (which I now understand is not usual) and fitted a permanent amalgam filling. After he finished he looked annoyed. He told me that he had never actually done an unsupervised molar root canal before. He told me that he could only find 2 root canals. He was clearly angry at something, and told me that he couldn't do anything more to help me.

Well the root canal was now 9 weeks ago. The tooth still hurts if I touch it (it is no longer sensitive to heat or cold at all, but if I try to chew on my left side and when I brush it aches like a bruise or something).

I was now pretty scared of that dentist. It took me ages to find a new one but 2 weeks ago I went to a new surgery. The new dentist took an xray and said that the other dentist had seemingly left infection at the root tip of the tooth, and he gave me 10 days of Amoxicillin (500mg). He also said that it looks like there is a calcified 3rd root canal in the tooth. I took these and within a few days the head pain that I had had for over 8 months completely vanished! To say this was a relief is an understatement. I finished the coarse of antibiotics and for about 4 days the pain was still gone. However it is now back and slowly increasing again.

I feel completely lost. I don't know what I can do. I feel at the end of my ability to cope with this pain. The new dentist said that it appears that my upper molar roots are very close to my sinus, so extraction could be difficult. He offered to refer me to a private endodontist (I am an NHS patient). I have very little money and I am now wondering, would it be even likely that this tooth could be saved now by a specialist endodontist? Would filling the calcified canal solve this? What on earth happens if I have the tooth removed and end up damaging the sinus?

Then to add further stress, I have been having to chew exclusively on my right side. Now my lower right molar, which is also filled is hurting every now and then when I bite on it. I am so frightened after what has happened with the left upper molar that I don't know whether to get this tooth treated or just ignore the occassional pain.

Nothing to worry about. Yes nerves are attached with the root of tooth. Get x-rays properly both frontal & lateral. Then individual x-rays of teeth/tooth area. RCT need to be done under 'dental loupe/binoculars' for good magnification. 1st maxillary molar has 3 roots (palatal, mesio buccal, distobuccal) with 4 canals. Gates Glidden drill with aerotor will be used to make canal shape. It is not difficult to locate canals under good magnification. If any complicated case or RCT failure due to accessory canal imperfection, any lesion, nerve involvement, anatomical defects etc. can be resolved. In your case teeth is decayed and infection is going deep to bone. Proper cutettage will be done after extraction. Any underlying granuloma tissue will be removed. I suggest to do extraction of this decayed tooth. Either simple or may be open flap surgery while cutting window (bone) can be done. Why not you later on go for bone grafting and 'dental implant' ? RPD is not fit here. Meet a well equipped dentist at your place.

 

[AJK64]

Nothing to worry about. Yes nerves are attached with the root of tooth. Get x-rays properly both frontal & lateral. Then individual x-rays of teeth/tooth area. RCT need to be done under 'dental loupe/binoculars' for good magnification. 1st maxillary molar has 3 roots (palatal, mesio buccal, distobuccal) with 4 canals. Gates Glidden drill with aerotor will be used to make canal shape. It is not difficult to locate canals under good magnification. If any complicated case or RCT failure due to accessory canal imperfection, any lesion, nerve involvement, anatomical defects etc. can be resolved. In your case teeth is decayed and infection is going deep to bone. Proper cutettage will be done after extraction. Any underlying granuloma tissue will be removed. I suggest to do extraction of this decayed tooth. Either simple or may be open flap surgery while cutting window (bone) can be done. Why not you later on go for bone grafting and 'dental implant' ? RPD is not fit here. Meet a well equipped dentist at your place.

Thank you for your reply. I am still trying to decide between extraction or root canal retreatment. I will see what the endodontist suggests on Wednesday. Ideally I would like to save the tooth (even though it's caused me so much pain). I definitely cannot afford an implant. If I do get the tooth removed I will ask about either a single tooth denture or a Maryland bridge I think.

 

[AJK64]

Saw the private endodontist. He was very thorough (which he should be given how much he's charging me). He took several xrays and his conclusion...the dentist who conducted the root canal had apparently completely ignored 2 of the actual roots of the tooth. Both of the canals he filled were in the same root and from the xrays alone the specialist said he could see at least 3 unfilled canals in the tooth. He was also uncertain if there was still a dying nerve remaining in the tooth!

He said he believed he has around an 80% chance of saving the tooth. I think those are fairly good odds so I am going to go through with the treatment. He will do it in 2 parts. First part this Saturday (2nd June). It' very expensive, (£1000) but if it saves my tooth and gets rid of the pain in my temple it is a worthwhile investment I think (goodbye savings).

I am starting to have nagging worries now though. What if the temple pain is unrelated and remains? What if the retreatment fails and I've wasted all of my savings? Should I have just had the damned thing extracted months ago? Eek

 

[Busybee]

Try not to worry. It sounds like you are in good hands. It will take a while for aches and pains to subside so you need to give it a couple of months at least. It's not a lot of money vs losing a tooth.

 

[AJK64]

Just had the first part done. It was long but painless. All together it took about an hour and a quarter from numbing to temp filling placement. The endodontist used a lot of equipment that my dentist didn't have, like a rubber dam, microscope and electronic root length detector. He found another 2 canals, and said he believes there is yet another one that he will get at the follow up appointment. He said that there was indeed still the remains of a nerve in there and a pretty nasty infection which he drained and scraped out. He said there is no evidence of a crack or perforated canals, but the previous dentist had obviously been pretty rough in his handling of the canals.

I am now on yet another course of Amoxicillin for 7 days. I told him that it hadn't worked the last time, but he said it should do now as there wont be fresh infection leaking into bone at the apex of the route so the antibiotic can better do it's thing.

I am now waiting for the numbness to wear off. I have taken some Ibuprofen as a prophylactic in case there any soreness or swelling afterwards. I am deperately hoping that this retreatment fixes the pain!

 

[Busybee]

This sounds like a good guy AJK. I'm sorry you had such poor treatment on the NHS. You really should complain. The reason patients should go to a specialist for root treatment is precisely because they will have all the equipment needed to carry out root treatment. They do this every day and most private dentists in the UK will automatically refer for root canal therapy for these reasons, particularly when it's a complex root.

I really hope the medication works and that you start to feel better. How is the pain in your temple? I hope it's subsiding. Be gentle eating on that side as he probably put a temporary dressing on it. When is your next appointment?

 

[AJK64]

This sounds like a good guy AJK. I'm sorry you had such poor treatment on the NHS. You really should complain. The reason patients should go to a specialist for root treatment is precisely because they will have all the equipment needed to carry out root treatment. They do this every day and most private dentists in the UK will automatically refer for root canal therapy for these reasons, particularly when it's a complex root.

I really hope the medication works and that you start to feel better. How is the pain in your temple? I hope it's subsiding. Be gentle eating on that side as he probably put a temporary dressing on it. When is your next appointment?

Thanks so much. You have all been great support on here. I wish I had found this forum sooner.

My temple is still a bit sore (about a 4/10...it was around a 7/10 a few days ago for context) but so far the tooth itself doesn't hurt at all, just feels a bit strange (like it is alien or something...hard to describe). I am hoping that the temple will slowly clear up as the infection in the bone settles and is taken care of by the antibiotic and my immune system.

I am going to avoid eating on that side altogether until the permanent filling is placed. My next appointment is on the 13th June. I will update over the next week or so as to how it is settling.

 

[AJK64]

Quick update.
My pain level is on average around a 4/10 following the first stage of retreatment. The pain seems to vary throughout the day, with it being at its lowest when I wake up (as low as 2/10 this morning), and as high as a 8, or 9/10 after brushing my teeth at night (I am not brushing in the morning at the minute, instead I have just used salt water rinse). I am unable to eat on the left side of my mouth or experience excruciating pain and as said, brushing my teeth is torture on that side.

The pain in my temple seems to fluctuate too, and seems tied to the relative pain in the tooth . I am hoping that this means that the temple pain really is connected to the tooth and not a seperate issue all its own.

 

[Busybee]

Are you sure the pain isn't coming from a neighbouring tooth?

 

[AJK64]

Are you sure the pain isn't coming from a neighbouring tooth?

I have had a small pain to percussion in the neighbouring premolar but the endodontist examined it thoroughly with temperature and tap tests as well as on the xrays and he said it's a perfectly healthy tooth and the slight discomfort is just referred pain.

If I push on the root canaled tooth itself with my finger I instantly get excruciating pain but none from the surrounding teeth. I can only assume it's from some infection still in the bone around the roots there or from the tendons? I will be sure to talk this all through with the endodontist next Wednesday when he does the second part.

The pain is definitely lower (generally) than it was before the retreatment started. It would regularly reach a 7 or 8/10 back then with no stimulus...whereas now it only hurts a lot if I touch it.

 

[Busybee]

I hope I am wrong but I have a feeling that you will end up with an extraction. Perhaps it will settle in the next few days. Fingers crossed that you feel better soon.

 

[MattKW]

I have had a small pain to percussion in the neighbouring premolar but the endodontist examined it thoroughly with temperature and tap tests as well as on the xrays and he said it's a perfectly healthy tooth and the slight discomfort is just referred pain...

Sounds like going OK considering how you were previously. Hang in there - he sounds like he's doing all the right things but it will take a bit of time to settle.

 

[AJK64]

I have been in an awful lot of pain today since waking up...around a 9/10. I have taken as much pain relief as I am allowed (Combining Ibuprofen with prescription Cocodamol from my Dr), but it only takes the edge off slightly. Even just my tongue brushing against the tooth causes excruciating pain. I phoned the Endodontists and was told to wait it out if possible until stage 2 of the retreatment, but I am really starting to feel defeated, like there will be no end to this 9 month hell. I haven't even been bothered getting out of bed today, and just keep crying, both from the pain and also the feeling of defeat from all of this. I am tempted to just rip the damned tooth out myself with a pair of pliers!

 

[MattKW]

Sorry to hear this. Hard to give you detailed advice over internet, but one possibility is that the endodontist dressed your canals with calcium hydroxide (CaOH). A great antibacterial but some people develop serious pain because it can irritate the bone. It might be worth chewcking if this has been used in your case, and maybe changing it to something more calming like Ledermix or Odontopaste (corticosteroids).

 

[Busybee]

I'm so sorry you are suffering so much AJK. You need a stronger painkiller. Insist to the endo that if they expect you to wait it out they must provide adequate pain management. If there is a chance you might be reacting to the antibacterial as Matt has suggested then they must replace it immediately. You should not have to suffer like this. When is the follow up? Please call the endo and insist on an emergency appointment to investigate.

 

[AJK64]

I saw my gp today. She gave me a short (5 day) course of prednisolone 20mg. I took the first one yesterday and one today and the pain has already dropped. My endodontist is not in the surgery again now until Wednesday, which is when my appointment is anyway. I am going to let him know that my confidence in this procedure isn't very high and does he think It might be best to just extract rather than continue with the retreatment. I'm worried about bone damage from the duration of this infection now and...i just want the pain to go away for good.

Thank you all again. Just being able to voice my fears and distress here helps.

 

[MattKW]

I saw my gp today. She gave me a short (5 day) course of prednisolone 20mg. I took the first one yesterday and one today and the pain has already dropped. My endodontist is not in the surgery again now until Wednesday, which is when my appointment is anyway. I am going to let him know that my confidence in this procedure isn't very high and does he think It might be best to just extract rather than continue with the retreatment. I'm worried about bone damage from the duration of this infection now and...i just want the pain to go away for good. Thank you all again. Just being able to voice my fears and distress here helps.

Best of luck. The final choice is yours. There's not always a right or wrong decision.

 

[AJK64]

Just got back from the Endodontist. I explained my concerns over the likelihood of the treatment working. He told me the pain isn't unexpected and it will take time after the final treatment to settle down, so I decided to let him finish it off instead of going the extraction route.

He took another 1 and a half hours, and said there were no other canals visible, so he sealed it with gutta percha and put a permanent filling in. I am a tiny bit concerned that he used a white filling instead of amalgam as I have heard that white fillings are not as reliable, but I am probably going to need a crown anyway in a few months time (if the root canal succeeds).

He didn't give me any more antibiotics as he said I have had so many courses, and he thinks my immune system can now deal with the remaining bone infection.

If they do send me the xrays I will post them here for MattKW to give his impression.

Will keep you all updated with my progress too.

 

[AJK64]

Here are the xrays. It's astonishing how much extra the endodontist managed to find and fill compared to the dentist!

One question. Is that my maxilary sinus that the root is running directly into (clearly visible on the 2nd xray)? Would this mean a difficult extraction if that is needed along the way?

 

[MattKW]

No. It is quite difficult to break into the sinus because it has a thick lining. However, should the molar ever need to be extracted, they are liable to fracture, and may have to sectioned into pieces. A bit fiddly. That's why you should aim to get this tooth crowned ASAP to maintain the strength. Glad to hear it all went well.