Gordon - Root canal problem

[mala64]

Hi Gordon, I remember you a few years ago, from newsgroup which I can't find any more. I found this forum on a search.I think you're the same Scots Gordon.

I have a root canal worry. On March 1, I had an abscessed tooth (not much pain) with some swelling inside my one cheek -not visible outside, but a softish lump if I put my finger on that cheek.My dentist did root canal 5 days later. He does root canals sometimes and been in business a long time.Tooth could not be frozen enough (due to infection I guess). So he gave me an injection into tooth nerve which was excruciating pain. Temp. filling was put in the tooth. Swelling in cheek was worse for a few days, then went back to size it was before RC and has stayed that way. The gum where the root of the tooth would be, is tender if I press on it to test it.

Dentist said swelling inside my cheek would go down in a few days or maybe a few weeks. But 4 weeks after RC, swelling was not down any, so I asked dentist for referral to endodontist.I went few days later. Endodontist did RC on me once a few years ago. He examined tooth and took Xrays and said he thought swelling inside cheek was inflammation, and said could take a few weeks or maybe longer for inflammation to go down. Now its 6 weeks since I saw endodontist and nearly 3 months since RC but swelling is not down any and I am wondering why its taking so long to go down. Was the root canal procedure more difficult than the dentist thought it would be? Is the swelling an infection even if its not painful?

I am going to dentist this Thursday and get temp filling out and permanent filling in. Since the bad experience, I am now phobic about going this Thursday in case its painful if all the nerve is not all out or if there is a crack in the root or bone and my gum is a bit tender still.The tooth is pretty fragile. I don't think I will ever get root canal done again.Its been an ordeal.

Unfortunately, I've lost confidence in my dentist and this experience has put me off him. I suppose it could happen with any dentist, but it happened with him. Any ideas why I would still have this swelling inside my cheek almost 3 months after root canal? I am worried the swelling will never go down. I realize you don't have my Xrays or can examine this tooth, but I would appreciate any help. Sorry this is long. I wanted to explain clearly.

 

[Gordon]

Probably not the answer you're looking for, but without seeing some x-rays I can't even begin to guess what's going on. If the endodontist is convinced that the root canal is OK, then I think you need to ask your general dentist for a further referral to have the swelling investigated.

 

[mala64]

Hi Gordon, thanks for your reply. I have 4 Xrays at home of the tooth. Dentist gave them to me to take to Endodontist. These 4 Xrays were taken before root canal. I don't think any were taken after. My tooth and gum were too sore by then anyway.

I have a computer scanner, and know how to scan things, but have never scanned tooth Xrays and don't know if it can even be done or should be.
I also have a digital camera which makes jpgs. Can tooth Xrays be safely photographed with a digital camera and uploaded to you by jpgs?

The Endodontist I saw knows my dentist for quite a while, at least as far as my dentist refers patients to him sometimes. Endodontist took his Xrays almost a month after root canal and as I said, he seemed to think the root canal work was done OK, and said it could take several weeks or even a few months after root canal for swelling to go down in gum or inside the cheek (or any swelling I guess). He didn't seem to think it was alarming, But I am a bit alarmed as its now almost 3 months since root canal (in about 10 days) and swelling not down. If it has gone down any, must just be slightly down. As I said, no pain in my cheek.

I will be seeing dentist tomorrow. He may think I don't need to see anybody and repeat it will eventually go down. I don't think he's a bad dentist, but he's not a good listener, as I've found out. Maybe I should be seeing a physician about the swelling and not a dentist?. Wouldn't a panaromic Xray show details of the swelling inside of my cheek and find out what caused it?
Thats what I want to know. The Dentist does panaromic Xrays every few years during yearly exam. Have you ever run into my situation before?

 

[Gordon]

You can either scan the x-rays or re-photograph them, there's nothing special about them, they're just film. I'm somewhat surprised that the endodontist didn't take any post-root filling x-rays, that's not common. Did they use a microscope? Did they mention finding any more canals that the general dentist might have not found?

 

[mala64]

You can either scan the x-rays or re-photograph them, there's nothing special about them, they're just film. I'm somewhat surprised that the endodontist didn't take any post-root filling x-rays, that's not common. Did they use a microscope? Did they mention finding any more canals that the general dentist might have not found?

Hi Gordon, maybe I can try scanning the x-rays.You mention above you were "surprised that the endodontist didn't take any post-root filling xrays", but I said in my last message " Endodontist took his Xrays almost a month after root canal" -so YES, endodontist took xrays 3 weeks after root canal had been done by the general dentist. I don't think the endodontist used a microscope in my mouth if thats what you mean. I don't think I've ever had that. He took Xrays and tapped teeth next to the root canal tooth to make sure they were not adding to the problem.He did not mention anything about finding more canals that the dentist might have missed.(I've read this can happen). He was good at explaining things.

About the swelling, when I pressed the swelling from outside my cheek today, at the area where the root of the tooth probably is or close to it, which is about 1 inch above the tooth(near side of my nose), its still a bit sore, but not much. The tooth is the small upper right molar if I didn't say.

I will be seeing my regular dentist in 2 hours. I am not looking forward to it. The last time I saw him was 2 months ago and I haven't spoken to him since. As far as I know, he is putting in a permanent filling and maybe a post.The whole situation leaves me very anxious about what caused the swelling and why the gum is not completely healed by now. I've never been in a situatiion like this with him before.

 

[Gordon]

Let's try to make it simple for little old me. Did the endodontist redo the root canal? Or did they just x-ray it or look at it?

 

[mala64]

Let's try to make it simple for little old me. Did the endodontist redo the root canal? Or did they just x-ray it or look at it?

Hi Gordon, No, the endodontist did NOT redo the root canal. He only looked at my dentist's Xrays which I had picked up from my dentists office for Endodontist to look at. The Endodontist also took his own Xrays to compare the Xrays he took against Xrays done by the dentist. I saw the endodontist 3 weeks after the root canal was done. The endodontists saw nothing wrong with the root canal work done by the dentist.

I saw my dentist yesterday (Thursday) and things were a little better than before. I told him I need to know more about the swelling inside my cheek as to what caused it and why its lasting so long. He said most of the swelling was caused by the abscess. I asked did the root canal difficulty probably add more swelling to my cheek and he said probably yes. I asked has he had this situation with patients before, and how long has it taken for swelling to go down, and he said its not common to have a swelling last so long after root canal as me, but said he has several patients a year, who have swellings for longer than usual, but said in 95% of his root canal cases, swelling goes down soon after root canal. He also said as people get older (meaning me. I am 64) the body takes longer to heal. He said it can take up to 8 months sometimes, though endo told me "several" months which to me means 5 or 6 months.Its already 3.

He put a permanent filling in yesterday. He decided not to put in a post as the filling is very big (and in case the tooth didn't last I guess). He told me he would not consider a crown for now,for the same reason. He said he wanted the temp. filling out as he doesn't like to leave it in more than 3 months.Also
a permanent filling seals the tooth better and will promote healing of my cheek. I asked about the 4 Xrays he took at the time of the root canal and if he took any after root canal was done, and he showed me on the Xray, one was done before the procedure, 2 during and 1 after root canal was done.

I asked if the root canal I had was difficult and he said yes as the canal was hard to find. I also asked did the tooth not freeze well and he said no and thats why he had to give me that awful needle but he felt the root canal needed to be done fairly quickly.He said the swelling will go down but VERY gradually.Yesterday, I did not need to get a needle as the nerve was not there. It wasn't sore. I am more satisfied that he explained more to me which he should have done all along but didn't. As I said, he is a conscientious person and likes to do good work, but he is usually in a hurry and does not encourage questions.

"Lets connect" sent me a picture of the mircroscope you asked me about (thanks "Lets connect" ). I don't think my dentist has a "surgical microscope". Is it common for dentists in Scotland to have a microscope in their office? I think the Endodontist I went to has one, as I saw a picture of one on his website, but I don't think he used it on me. Are the microscopes used to detect canals before root canal treatment?I asked dentist yesterday if he thinks I have undetected canals in my root canal tooth and he said he didn't think so as Xrays usually show canals, though I read it is possible though not likely that all canals may not show up on Xrays even with the best dentists. I don't think my dentist uses digital Xrays, though maybe the endo does. Do you use digital Xrays? Many dentists in the U.S. do, but not all, same in Canada where I am. Hope this explains things better.

 

[Gordon]

I think the general feeling in dentistry is that you can't do molar endodontics as well without a microscope as with one. The trend is that most specialist endodontists are now using microscopes. This is likely to spread out into general practice in time. Dentists love gadgets

I'm currently lobbying to get one into my clinic, hopefully next year if the money holds out as I expect it to.

Digital x-rays... major can of worms here. We have 2 systems in my clinic, neither of them work well, the one that doesn't work well is better tolerated by patients and easier to use by the dentist, but the quality of the imaging is worse and as of 2 weeks ago, it doesn't work at all.

Our IT department is like a chocolate teapot, only not as useful.

The system that does work is not so good for the patient. The sensors are bulky and uncomfortable in your mouth and they are hard to "aim". The quality it produces is good and it appears to be a more robust for the software. Dentists don't like using it because it's hard to get the images you want due to the bulk and difficulty in aiming.

If it was my own money I wouldn't buy a digital x-ray system right now.

Edited to add: the 2 systems cost the best part of 12 thousand pounds!!!

 

[mala64]

I think the general feeling in dentistry is that you can't do molar endodontics as well without a microscope as with one. The trend is that most specialist endodontists are now using microscopes. This is likely to spread out into general practice in time. Dentists love gadgets

They are not the only ones

>Our IT department is like a chocolate teapot, only not as useful.

Chocolate teapot? Haven't heard that one before, but trying to picture it. I guess it means "fragile?"?

Edited to add: the 2 systems cost the best part of 12 thousand pounds!!!

Lotsa money specially when you are not happy with the equipment. I guess its one of these times where it seemed like a good idea, but turned out not to be.

I would like to know (I think I asked before) have you had patients who had swelling inside their cheek caused by an abscessed tooth and you did root canal on the tooth and the swelling still remained after root canal, though the swelling was not painful? My dentist says he has about 10 patients a year who have some swelling for a few weeks or longer after root canal especially if there was swelling before root canal was done and that some had the swelling weeks or even a few months later. Have you had patients like that? How long was the longest time it lasted? My dentist reminded me, when people get older, the body takes longer to heal. I guess when I get to be 65 it will take till I'm 90. He's around 55, so he could be the same

May as well also ask - Have you had to give patients a needle into the root canal when it was not frozen as much as it should be?

My teeth are a bit of a mess which I know. I have lots of fillings, most have been there for a long time. I haven't had any teeth out for 35 years. Now a back molar is loose. Dentist said it should come out. Not a good prospect. I used to have good teeth, but that was quite a while back.

 

[Gordon]

I haven't personally had that happen. I wouldn't finish the root canal if there was still swelling present, I'd expect to have the swelling gone before I finished the canal.

Yes, I've had to do that once or twice. Not pleasant for either the patient nor the dentist.

 

[mala64]

>I haven't personally had that happen. I wouldn't finish the root canal if there was still swelling present, I'd expect to have the swelling gone before I finished the canal.

My dentist initially said he didnt want to do RC when there was some swelling inside my cheek,which he said initially was due to an abscess. He gave me clindamycin for 5 days before RC. I have several antibiotic allergies so I am limited. Maybe he thought the antibiotics were working better than they actually were and that it was better to go ahead with RC as he wanted to quickly treat the tooth.I think RC on the tooth was more difficult than the dentist thought it would be and he pretty well agreed since.

Later on, when I went to an endodontist a month after RC, he said the cheek swelling was caused by inflammation from the result of the original trauma of the abscess, but that it was not infected (at the time I saw him).

If my dentist had waited for swelling to go down, it would have been a long time, because the swelling is stil there. Also, he didn't want to leave the temporary filling in for more than 3 months or says it cann get re-infected. I have no pain.The swelling caused me more anxiety than pain. I not as anxious now, but still have some concern as to when the swelling will go away completely. I have mixed feelings about how the whole thing was such a bad experience.

>Yes, I've had to do that once or twice. Not pleasant for either the patient nor the dentist.

Yes, its terrible.

Mary

 

[Gordon]

I think you've not picked up what I meant. I would start the endo treatment but not finished it until the swelling went down. Antibiotics on their own aren't really very effective in treatment of dental abscesses, the antibiotic can't get to the infected area properly.

 

[mala64]

I think you've not picked up what I meant. I would start the endo treatment but not finished it until the swelling went down. Antibiotics on their own aren't really very effective in treatment of dental abscesses, the antibiotic can't get to the infected area properly.

From my understanding and what the dentist told me, he didn't want to leave the temp filling in any longer as it had been in for 3 months and the tooth is fragile. He wanted to build it up with a permanent filling which he said would seal the tooth better and help promote healing of the inflammation inside my cheek, and also the endodontist's thought the swelling inside my cheek was inflammation from the trauma of the abscess and not infection (this was a month later at endo's office) .The swelling inside my cheek was never big, but its still a swelling.So far the tooth is OK. I didn't need any needles when dentist put permanent filling in.There was no pain which was good. The bad thing is, originally there was going to be a crown, but we don't know yet. The tooth may not last.

I think I've read your above information that antibiotics can't get into the infected area properly. It also occured to me, when I first had the abscess, the inside of my cheek had some swelling, but not very sore, could I also have had inflammation as well as infection at that time and after root canal, could it be just inflammation with no infection? It wasn't sore at all a few days after RC.