Hot tooth nightmare, 2nd RCT attempt in 2 days

[hychamuswo]

This is my first post in here Looking forward to hopefully share a success story in the near future!

I'm dealing with a very painful lower molar (#19) that's been a "hot tooth" for weeks, extremely inflamed pulpitis, hurts constantly unless I take meds (500mg acetaminphen or 200mg ibuprofen knocks the pain out for about 6-8 hrs).

First attempt last Monday, failed because I couldn't get numb enough despite blocks/injections; dentist couldn't even open it without me jumping.

Took dexamethasone (dexa) for 4 days and penicillin for 7 days; both courses ran out today (Saturday). RCT #2 scheduled Monday - is it ok to go in without more meds, or should I ask for refill/extension?

If it fails again (hopefully not, but possible given inflammation), my plan is IV sedation extraction next, then single-tooth implant (no bridge, hate grinding healthy adjacent teeth). Crown 1wk after RCT if it works, but prognosis feels iffy.

My concern is this: After finishing dexa/penicillin course, is that ok for RCT on Monday or should I get more anti-inflammatories/antibiotics? My dentist says it will still be in your system so it should be fine, but from what I saw online the half time for penicillin and dexa is hours, not days... So not sure.

I am planning on taking 400mg of ibuprofen + 1000mg acetaminophen about an hour before the appointment, but that's just my own planning and not a dentist recommendation.

I appreciate any input. Thank you!

 

[Gordon]

My concern is this: After finishing dexa/penicillin course, is that ok for RCT on Monday or should I get more anti-inflammatories/antibiotics? My dentist says it will still be in your system so it should be fine, but from what I saw online the half time for penicillin and dexa is hours, not days... So not sure.

I agree with your dentist FWIW. Good luck.

 

[Dr. Daniel]

Hi. Numbing a lower back molar for a root canal treatment is a known challenge in dentistry, and there are good solutions for that. I made a video exactly about that, hope it helps:
How to prevent painful drilling

 

[hychamuswo]

@Dr. Daniel @Gordon

Thank you very much for your input!

Unfortunately, things didn't go well today. I took 400mg ibuprofen + 1000mg acetaminophen before the appointment, and the dentist still couldn't get me numb.

X-tip, IAB, intraosseous, among others were administered but still the tooth was very (very!) sensitive to any heat (drilling) or cold (the Q-Tip cold test).

The weird thing is that the tooth wasn't painful when tapping or pullingremoving the temp crown, only when heat/cold is involved.

Right now, I am looking at IV sedation and extraction unfortunately. Hopefully since there is no need to get into the inside of the tooth for that it is not as painful. Hoping its just yanked out and that's it!

If IV sedation is still not adequate I guess general anesthesia is the next step. I hope it doesn't come to that.

 

[Dragobfly1975]

Hi! I’m in a similar situation and terrified. They tried yesterday and the day before and the pain was too much. I’m on clindamycin for 7 days and go back for a third try. What ended up happening with yours?

 

[hychamuswo]

Hi! I’m in a similar situation and terrified. They tried yesterday and the day before and the pain was too much. I’m on clindamycin for 7 days and go back for a third try. What ended up happening with yours?

Actually, great news!

My endodontist recommended waiting about two more weeks and kept me on antibiotics. My understanding (and I could be slightly off on the exact mechanism) was that as the inflammation settled and the pulp tissue became less vital (pulp died a little?), it would be less reactive/sensitive and easier to work on. The antibiotics will "contain" the infection inside the tooth.

About two days before the final root canal appointment, my constant pain had completely stopped. I only had some mild cold sensitivity at that point. It seemed like the pulp had quieted down significantly (or "died" enough to not be as sensitive).

At the third attempt, everything went smoothly. I was fully numb, felt no pain during the procedure, and the root canal was completed without issues. I had a crown placed a few days later, and I’ve had no problems since.

I know it’s definitely miserable while you’re in it, but it does get resolved

Good luck! Let me know how things go