Advice about root canal complications

[Moomintina]

Hello,

I am 31M, based in the UK, and currently undergoing private care. I had a root canal completed on my LR6 tooth on 19 July, just over two months ago. The reason for the root canal was a deep filling that got close to the pulp. I was in mild, intermittent pain before the root canal, and a specialist endodontist did it.

Before the root canal, I was told that I had a very good prognosis (92%+) for the tooth, as I had caught everything relatively early and there was no infection.

The procedure went well, much better than I had built up in my head. At the end of the procedure, the endodontist said that she was very happy with how it went – that all the canals were found and that the roots were filled to the tips.

I have been on a soft food/liquid diet since the root canal, and I haven't chewed on that side of my mouth at all.

Originally, I booked to have my crown process started on the tooth 3 weeks after the procedure, as per the guidance I was given.

Unfortunately, ever since I got the root canal, I have been in some pain. This includes tenderness on biting and applying pressure to the tooth and a constant dull ache that only seems to get better when I'm relaxed or when I go to sleep.

I had a check-up with the endodontist a week after the root canal, and was told that I likely had inflammation that would clear up after a while.

I then went for my crown appointment 3 weeks after the root canal (with a specialist prosthodontist), and explained that I was still experiencing the same symptoms, and was told to continue waiting until the symptoms cleared up before placing a crown. I was also told that it could take up to 6 months for the root canal to heal.

A month after the root canal, I was getting nervous about the continued symptoms, and the fact that I hadn't had a crown placed yet. I had a phone call with the endodontist and was again told to continue waiting.

Last Friday, 2 months after the root canal, I went for another check-up with the endodontist. This time, she probed the gums around the tooth and found signs that I had developed a crack since the root canal. At this stage, we don't know for sure how deep the crack might be.

The endodontist suspects this may have occurred due to nighttime grinding or clenching – I'm due to have a nightguard made.

I have now been told to place a crown on the tooth as soon as possible and to see if this will resolve my symptoms.

My question is:

What do dentists on this forum think about this course of action? I was given the impression that a crown shouldn't be placed until the tooth is asymptomatic, so I'm concerned this will only prolong my symptoms. I'm obviously concerned this is actually a VRF.

I have an appointment with the prosthodontist later today, and I'm hoping to understand a) if there's any way to further confirm the crack, b) to see how deep it might be, and c) how likely it is for a crown to resolve my problems.

I am having to think about two things: my finances and my mental well-being.

I can't afford to keep throwing money at this tooth. It's very unfortunate that I'm in this situation as I have already paid a lot of money for specialist care. The crown is very expensive, and if things don't work out, that's money I could have put towards an implant.

And then there is my mental well-being. Two months of continued pain has had a huge impact on my mental health and general well-being. As much as I really don't want to lose a tooth, especially at my age, I don't see how I can continue like this.

I don't currently have access to my X-Rays but once I do, I will attach them here.

 

[Gordon]

You're caught between the metaphorical rock and hard place. A crown might fix the tooth, by reinforcing the margins and basically holding it all together. Or it might not. There are absolutely zero guarantees possible when it comes to cracked teeth.
It'll be worth having a frank discussion with the prosthodontist, I'd be leaning towards extraction followed by implant as carrying a higher chance of success and not much higher cost.

 

[Moomintina]

@Gordon, many thanks for taking the time to reply; I really appreciate it.

I saw the prosthodontist yesterday, and he said that we could try placing a temporary crown on it and then wait a few weeks to see how the tooth responds before deciding whether to go ahead with a permanent one. If my symptoms don't improve, then we know that there is something deeper going on, which may mean I'll have the tooth removed. He did say after doing some tests that he'd be surprised if there were a crack. You're very right about being stuck between a rock and a hard place – I really don't want to make the wrong decision. Especially if it ends up being something that could heal or be treated.

The only thing that does stump me a little is the dull ache I've experienced pretty constantly over the last few months. It's very hard to describe, but it can sometimes feel like a burning sensation in the gums on the mesial side of the tooth. It seems to flare up when I talk excessively or get stressed, and it is always better when I'm relaxed or go to sleep. I've also noticed tissue sloughing. I have had quite a bit of work in this general area since June, including removing my impacted LR8 tooth and a small filling on the LR7...all in quick succession...is it possible for nerves to become irritated from lots of work?

 

[Gordon]

The tissue sloughing and burning feelings don't sound like they're hard tissue related. Sometimes low folic acid and Vitamin B12 can manifest as that kind of thing, a quick easy thing to do is to boost the folate in your diet, you can buy supplements but it's easy enough to change your diet up a bit, if you're a cereal eater, switch to Special K, eat more legume vegetables like broccoli or cauliflower, preferably as soups.
Stress can give you burning sensations in your mouth but it's more commonly your tongue or palate areas.

 

[Moomintina]

Thanks so much, @Gordon – I will try that! I may actually have deficiencies, as I have changed my diet quite a bit since having all this work done...

Thank you for your help, and have a lovely day

 

[Gordon]

My pleasure, please let me know how you get on.

 

[JollyPie99]

@Moomintina Hi, I have really similar symptoms and I’m 5 weeks post re-root treatment. I am 28, and like you, trying to hold onto my tooth! How are you getting on? I am keen to know if it was resolved for you. I too am worried I have a crack that hasn’t been detected. Thank you!

 

[Moomintina]

@JollyPie99 – Hello! My tooth is a lot better now, thankfully. We placed a temporary crown on the tooth just to make sure it was protected, and I've started to see a big improvement, in the sense that I can now eat on the tooth fine, and the tenderness has significantly reduced. It's been just over 5 months since I had the root canal done. We're still waiting a little longer before we place the permanent crown, just to make sure everything continues in the right direction. We're still unsure whether it was a crack or just that I'm one of those few cases that takes a lot longer to heal.

I feel for you, it's not easy and a huge part of the challenge is the anxiety that comes with it, which I think can make it hard to accurately judge your symptoms at times.

I've not had re-root treatment before, but I have heard that this type of treatment can take a while to settle. Have you spoken with your dentist/endodontist to see what they think, as they'll have seen inside the tooth?

I really hope things get better for you soon. I totally understand the feeling of being young and not wanting to lose a tooth, but whatever happens, you'll be okay.

 

[JollyPie99]

@Moomintina Thank you so much for replying to me and for writing such a detailed reply!

I am so glad your tooth is feeling better! Yes, I’ve also read that a re-root treatment can take longer to heal. I think my worry is that my initial root canal treatment felt great the same night, and I could eat on it the next day with no pain.

I can even locate a specific point under the tooth where the pain is, and a pain response can be caused by swiping the side of the base of the tooth with my finger, the side closest to the tongue.

I completely relate to this bit of what you said, and getting stressed or lots of movement seems to make it worse: This includes tenderness on biting and applying pressure to the tooth and a constant dull ache that only seems to get better when I'm relaxed or when I go to sleep.

Would you recommend me asking my dentist to place a temporary crown? I do wonder if the tooth just needs more protection whilst it heals. I’ve heard a sprained ligament can be very painful and take months to heal and can be aggravated by speaking or swallowing even.

Yes, I’ve spoken to both the Endo and my dentist and they can’t see any visible cracks, but they have advised it is still possible as these can be hairline cracks. However, the Endo that did the root canal says whilst I’m on the high end of the scale in terms of slow recovery, he isn’t shocked I’m still in pain.

Like you, this is really affecting my mental health at the moment, as I’m in pain everyday and have a job that requires me to be active.

Thank you again for your reply. It is definitely comforting to know you’re not alone in this situation, and you’ve given me some hope that things can get better.

 

[Moomintina]

Hey @JollyPie99 – I'm so sorry you're experiencing this. I completely relate to the emotional burden of dealing with dental pain for a prolonged period of time – it's incredibly hard to deal with that on top of life things like work. My mental health really suffered this year as a result of my symptoms, too.

You're completely right that you are not alone in this situation – I'm sure others have experienced our unique circumstances before.

In terms of the temporary crown, I think it would be totally reasonable for you to ask your endodontist about that. See what they say – they may want to wait until your symptoms settle first. Have they spoken to you about a crown before?

The only advice I can offer, which has helped me, is to always have a check-up booked in so you have some peace of mind that things will be looked at. I also had to switch myself off from looking my symptoms up online (including this forum), as ultimately I think that just exasperated my anxiety.

Take care of yourself and feel free to vent on here if you ever need to. I completely understand what you're going through. You will get through this and you will get better.