Have bacteria got inside my root canal - piece of tooth and filling crumbled off the side

[Annie364]

I have a upper 2nd molar that is root canalled, and there is a little piece of tooth (maybe 1-2mm) that has come off the side where it meets the filling with a bit of filling crumbled off the side as well. The tooth is half-height as the endodontist took the cusps off as it was a very large filling with thin tooth walls. I can’t see it in the mirror so I’m feeling with my finger/nail and trying to estimate how much has come off.

I'm worried that the seal on the root canal is now broken and it's letting in bacteria. And that once even the tiniest amount of bacteria has got in, they will slowly multiply and then cause an infection in the root canal at some point.

I think it happened maybe 2 months ago when I was eating too crunchy food, but I only properly realised and felt it with my finger very recently. So unfortunately there's been some time for bacteria to get in. The root canal is 3 years old and I will be getting an onlay on it, I waited at first for the large abscess to go down, but then carried on waiting too long. The onlay will take a while due to waiting for appointments, getting hygienist cleanings etc.

Is the root canal ruined now, and are there bacteria inside it? Is there any way they can clean it for me and patch it up? Should I try and get seen as an emergency (when I make a normal appointment the wait is usually 5+ weeks) for a patch up?

I’m worried that I’ll be told it’s fine, and patch-up or not, bacteria are in there now, and the onlay will seal them in, then the bacteria will multiply and cause failure of the root canal in the future at some point.

I’d be happy to get the whole root canal re-done if that would lessen the chances of it failing.

This is a picture from my old CBCT scans – before the root canal (3 years ago), then one year later (2 years ago).




Thanks!

 

[Gordon]

Two part answer.
1) Yes, possibly, but I can't say for sure without looking
2) Even so, it's very likely to not be a problem if you get it sorted fairly soon.

A quick look by your dentist and a bit of temp filling if required in the short term, should sort it out.

 

[Annie364]

Thanks very much Gordon!
Should I try and get in with the dentist for an emergency appointment to repair it, or would it be OK to wait for about 5 weeks from now, so total 3-4 months since it happened?
Will he be able to tell me if bacteria have likely got in?
I'm so worried that he'll repair the filling but the bacteria are inside now, and it will be a case of wait until the root canal fails as a result of this.

 

[Gordon]

Sooner the better really, but given that it's already been months then it won't make a huge difference.

He'll hopefully be able to see if the break has exposed the root canal filling, if it hasn't then no bacteria have got in. If it has, then maybe.

Unfortunately wait and see is the only sensible thing to do tbh. The only other option is redoing the RCT which would have its own risks and IMO would not be justified.

 

[Annie364]

OK, thanks so much Gordon, I really appreciate your help. I'll see him as soon as he can fit me in.

When you say 'exposed the root filling', I think that means the part where there is the gutta percha and sealant. In that case, maybe I have some hope, and although some of the filling has come off along with the little bit of tooth, it's up at the top of a quite deep composite filling I think. And there would be a good amount of composite below the break that is hopefully still sealing off the part with the gutta percha and sealant where we do not want any bacteria.

I suppose I was imagining that once the side of the tooth is broken and composite crumbed, the bacteria would travel down between the inside of the tooth and the composite filling - but maybe I can hope that the composite filling is securely stuck to the side of the tooth and bacteria will not get past it.

Have I got that right, in terms of the anatomy of the root canalled tooth?

 

[Gordon]

Yes, that's right. Bacteria can't easily get through the composite, it'll be bonded into the remaining tooth structure. So if no root filling is visible, you should be fine.

 

[Annie364]

Thank you Gordon, that's really helpful!