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.

 

[AJK64]

I will ask if I can be referred to the NHS oral surgery department at the hospital for the tooth to be extracted and see if that comes through faster than the private maxillo oral surgeon I am due to see on September 7th. I am also going to ask the Endo when he gets back to me about the cbct scan results, whether one of the implant surgeons he works with would be able to safely remove the tooth and if they would be able to fix any resulting sinus perforation that might occur. I am guessing that implant surgeons deal with sinus issues fairly often given that they are screwing bits of metal into the maxillary jaw on a daily basis. At the moment I am just trying to see who can predictably and safely remove this tooth the soonest.

 

[Busybee]

You really should make a formal complaint about the NHS dentist who caused the damage.

 

[AJK64]

I definitely will do yes. I've given him a bad google review and once I'm recovered I will make a formal complaint

 

[AJK64]

Okay. I took the CBCT scan to my Dentists yesterday. He had a quick look at it and said that it looks like the Endo missed a 'MesioBuccal 2' in the retreatment, and it appears that the infection is around that root. I have yet to hear back from the Endo himself (he only works wednesdays and saturdays so I am expecting to hear something tomorrow hopefully). My question now is, would it be possible to re-retreat the tooth and fill the missed canal? Would this even wrok now or should I just progress to having he extraction?

The CBCT scan also shows that the Palatal root tip actually touches the maxilary sinus floor and my dentist believes that it will require a skilled surgeon to avoid puncturing it during extraction. He has submitted an urgent referral to the NHS oral surgeon at our hospital, but he said that even as an emergency it is likely I wont be seen for around a month, so its looking likely that if the tooth is to be extracted then the private Maxillo facial surgeon on the 7th of september is the likely route.

The good news is, since taking the 5 days of amoxicillin last week, my pain level is really low. If I can keep it this low until the 7th I will be very happy.

 

[MattKW]

The endodontist missed the MB2? Very unlikely, but see what he has to say. The palatal root usually lies against the sinus floor, but doesn't point into it. Usually the pal root is straight and conical, and can easily be luxated out with care. I find the mesiobuccal and distobuccal roots to be more fiddly.
I will be interested to hear what the endo says.

 

[AJK64]

Hopefully I will hear back from the endo tomorrow. I'm staying at a friend's flat on the coast for a few days to escape everything so hopefully the endo won't want me to rush in tomorrow to see him...knowing my luck though

 

[Busybee]

If the private Endo has missed something then you should ask for a full refund and threaten to take legal action. It's unacceptable that a specialist makes such a mistake that results in you needing an extraction.

 

[MattKW]

If the private Endo has missed something then you should ask for a full refund and threaten to take legal action. It's unacceptable that a specialist makes such a mistake that results in you needing an extraction.

I wouldn't take a general dentist's word over that of an endodontist. The MB2 is well known to all dentists, and is one of the most common reasons for failure of an RCT in the hands of a GDP. An endodontist would always look for and find an MB2 using microscopes and CBCT. This is the same dentist who also said the palatal root was touching the floor of the sinus - what twaddle. This is just stirring the pot without making any helpful suggestions.

 

[AJK64]

The endodontist is off ill so I have to wait until at least next Wednesday to hear the results of the cbct scan. They cannot access his emails at the practice to see if he has received a reply from the maxillo facial surgeon.

To rub salt into the ever increasing wound, my gp asked if I could get my general dentist to email him with my notes from the treatment so far, as he (as a gp) might be able to fast track me a place at the hospital to see an nhs maxillo facial surgeon to save me more money, but he can't do that unless he knows exactly what to tell the surgeon about my case. So I phoned the dental practice only to be told that they don't email gp's :/

 

[Busybee]

The endodontist is off ill so I have to wait until at least next Wednesday to hear the results of the cbct scan. They cannot access his emails at the practice to see if he has received a reply from the maxillo facial surgeon.

To rub salt into the ever increasing wound, my gp asked if I could get my general dentist to email him with my notes from the treatment so far, as he (as a gp) might be able to fast track me a place at the hospital to see an nhs maxillo facial surgeon to save me more money, but he can't do that unless he knows exactly what to tell the surgeon about my case. So I phoned the dental practice only to be told that they don't email gp's :/

Ask your dentist to email you the notes and then ask the GP whether they will accept an email from you with the notes. You are entitled to your records. There is a formal process via the NHS if they are NHS dentists and being unhelpful.

 

[Busybee]

I wouldn't take a general dentist's word over that of an endodontist. The MB2 is well known to all dentists, and is one of the most common reasons for failure of an RCT in the hands of a GDP. An endodontist would always look for and find an MB2 using microscopes and CBCT. This is the same dentist who also said the palatal root was touching the floor of the sinus - what twaddle. This is just stirring the pot without making any helpful suggestions.

Either way you cannot deny that one professional or another is at fault here. It just proves my view that two dentists = three opinions. How does a patient know who they can trust if there are conflicting diagnoses?

 

[AJK64]

My dentist sent me pics from the cbct. I have attached them here. Can one of the dentists on here take s look and see if they can see what he sees. The first is an axial view with an arrow indicating where he believes the missed mb2 is. The 2nd is a coronal view showing what he believes is the palatal root intersecting with my sinus floor.

 

[AJK64]

Endodontist is still away from the surgery sick so no word from him regarding the cbct.

I have been feeling pretty bad this week with the pain in my head. Worst around the temple/eye area but also painful in the tooth and above the tooth. Been feeling a bit under the weather too but not sure if that's related. I went back again to my gp to see if they could give me something for the pain and she suggested ringing the private maxillofacial surgeon who I have the appointment with on the 7th to see if there's any way I can be seen sooner.

I now have an emergency appointment tomorrow morning. I will go armed with a copy of the cbct scan and hopefully get some finality to all of this mess

 

[Busybee]

You really are being treated shoddily by all concerned. I'm really sorry you're going through this. Maybe the endo wasn't 100 per cent when you were treated? But if that's so then he should not have gone ahead. You should not let any of this go. I can't believe the poor care you've had. Best of luck with the appointment tomorrow. I hope that you have found someone who can help resolve your problem. It's just a shame that you are having the tooth out after all this work.

 

[AJK64]

Thanks again Busybee. I really don't know what to think or feel through all of this. My head is just spinning.

Saw the maxillofacial surgeon. He couldn't access the copy of the cbct scan that I took with me (on usb drive given to me by the endodontist) as the computers at the hospital are a closed system. So he had to do a panoramic x-ray of his own (so much radiation lately).

He said there's a massive infection around the tooth roots. The infection is spreading up around the sinus floor. The tooth needs to be removed and he will do it, but it will have to be under general anaesthesia as he will deal with the surgery assuming there will be a sinus perforation and he will do a 'fat pad' surgery immediately if that occurs to seal the hole.

Bad news is, he is going on holiday for 2 weeks on Sept 14th so the surgery might not be done for another month or so. I told him I'm in a lot of pain, but he said that the clinic doesn't carry any pain killers stronger than cocodamol which I already have. He said if the pain increases again before surgery then I can call in for more antibiotics. Oh, and the surgery is going to cost another £1800!

I really hope the surgery can be done before he goes on holiday as I'm genuinely losing my mind with pain. Some days I can't function, even concentrate on reading a book or watching a film. When the pain gets really bad now I just take a few sleeping tablets and knock myself out for a few hours to escape it.

 

[Busybee]

Remind me again why you are not having this done on the NHS? Go to the A&E at a dental school and get it done for free next week.

 

[AJK64]

I am on an nhs waiting list but wouldn't get it done nhs for another 14 weeks. The most annoying part is that it is the same surgeon who would be doing it if I had it done on the nhs. There used to be 3 maxillo facial surgeons here in Norwich but 2 retired earlier this year.

There isn't a dental school in the area...yet. apparently there is a dental department opening at the university so hopefully in the future that would be an option. But additionally, due to the reconstructive part of the surgery that may be necessary, a dentist can't do the removal. The maxillofacial surgeon told me today that a big part of his surgery is repairing damage done by regular dentists in the area, attempting things outside their abilities (failed root canals by general dentists, botched complex extractions resulting in nerve damage or sinus fistulas etc). So I'm not a unique case :/

 

[Busybee]

you could if you walked in an a&e dept. Tell them you are really sick. Yes of course you'd have to go somewhere like London.

You have to be aware that the private surgeon you are seeing has given you no guarantees along with the other guys you have seen. So what if you end up even worse off with him?

 

[AJK64]

He's the only person here who can offer me the surgery I need now. If I could go back in time and say no to the original dentist when he suggested the root canal I would, and instead would have had an actual endodontist do the treatment in the first place. I don't think the endodontist did anything wrong at all, he told me that there was no guarantee with the retreatment and he did the best with the mess created by the original dentist.

The tooth 100% has to come out one way or another. The maxillofacial surgeon is the best person to do that safely. If I got the tooth removed elsewhere and they cause a sinus communication then this surgeon is the person they would send me to for it to be repaired. Having him be able to fix the damage as it happens is the best solution I believe. I'm very scared. Mostly due to having to have general anaesthesia. And I don't really want to wait up to another month to have the tooth out, but I'm exhausted. I've honestly tried so hard to find solutions to this and I've reached the end of what I can do. The money at this point is something I will figure out once all this is over and I'm well again. Same with whether I persue legal action against the original dentist.

 

[Busybee]

there are maxillofacial specialists at dental hospitals. You have nothing to lose by going to a&e. Has this guy given any guarantees on what he will do if it goes wrong? Will you have to pay more then?