Question on x-ray radiolucency?

[michisafraid]

Hi there,

I have a question on a 10 year old root canaled tooth. My last set of x-rays from 2009 showed a little radiolucency on my root canal tooth (#14). I just had x-rays last week and it was the same - no better, no worse. I grind my teeth and get pain all over, everyday I have pain in one or more areas...sometimes the jaw, sometimes a tooth or teeth. Well I had mentioned to my dentist I was having pain around that tooth so because of the radiolucency he said it might not be a bad idea to see an endodontist. I saw her today. She said she could retreat the tooth. I opted for an extraction. She told me not to rush into anything for fear of abscess. I do not want to abscess so I already scheduled my extraction. I am thinking about getting another opinion from another endodontist before I have this pulled. In 10 years it only hurt a few times and that was recently during a bad head cold and after I have been grinding my teeth more due to a death in the family. Could this tooth be ok despite the radiolucency on x-ray that has been present for years with no symptoms?

Thank you.
Mich

 

[carole]

Yes maybe. I am not a dentist but I am having a rct'd tooth re treated, I personally would go with the re treatment your endodontist seems to be confident in thinking it would be fine.

Once you have the tooth extracted it is gone, but a re treatment is worth a try I think. It is of course your choice and you know how you feel and if you think you could cope with a re treatment. I am really nervous and went to my dentist shaking and not knowing how the heck I was going to get it done, but my dentist is really good and I am still having the treatment which takes a few appointments and even if it isn't a success it is worth trying. They are confident it will be fine but cannot say 100% but I can live with a confident, should be fine prognosis.

Good luck with whatever you decide to do

Your choice in this is the right choice, and it has to be your choice.

 

[Dr. Daniel]

Could this tooth be ok despite the radiolucency on x-ray that has been present for years with no symptoms?

Definitely yes.

If there is some kind of active inflammation, the tooth should be sensitive when the dentist taps on it. However, the tooth might be sensitive due to the grinding and not because that it needs a new root canal.

After reading your thread, my instinct says you should wait a bit. If you want to be sure about it, first eliminate the forces applied on the tooth due to the grinding. You can do it by treating the grinding directly (for example by a night guard, but there are many other effective methods), or you can ask the dentist to lower the tooth one less than millimeter so that while grinding the tooth does not touch any opposite tooth (dentists name it bringing the tooth out of occlusion) and than check whether the tooth is sensitive or not to tapping.

 

[michisafraid]

Yes maybe. I am not a dentist but I am having a rct'd tooth re treated, I personally would go with the re treatment your endodontist seems to be confident in thinking it would be fine.

Once you have the tooth extracted it is gone, but a re treatment is worth a try I think. It is of course your choice and you know how you feel and if you think you could cope with a re treatment. I am really nervous and went to my dentist shaking and not knowing how the heck I was going to get it done, but my dentist is really good and I am still having the treatment which takes a few appointments and even if it isn't a success it is worth trying. They are confident it will be fine but cannot say 100% but I can live with a confident, should be fine prognosis.

Good luck with whatever you decide to do

Your choice in this is the right choice, and it has to be your choice.

Thank you so much carole! That is so true...once it is gone it is gone - no going back. I am truly weighing the pros and cons here before deciding on what to do. I just hope I don't chicken out from whatever I decide to do, lol Uggg this fear is crippling and I wish it would go away! I barely slept last night from worry about all of this. I wonder if I will make it there, if I will be able to sit still, if I will jump out of the chair and leave (I have done this...years ago but I actually did and I am embarrassed!).

 

[michisafraid]

Definitely yes.

If there is some kind of active inflammation, the tooth should be sensitive when the dentist taps on it. However, the tooth might be sensitive due to the grinding and not because that it needs a new root canal.

After reading your thread, my instinct says you should wait a bit. If you want to be sure about it, first eliminate the forces applied on the tooth due to the grinding. You can do it by treating the grinding directly (for example by a night guard, but there are many other effective methods), or you can ask the dentist to lower the tooth one less than millimeter so that while grinding the tooth does not touch any opposite tooth (dentists name it bringing the tooth out of occlusion) and than check whether the tooth is sensitive or not to tapping.

Thank you so very much for your reply Dr. Daniel - you have given me hope! I do wear a night guard that I had made at my dentist. It is actually my second one as I chewed through the first one in 3 years. My mouth guard takes a beating, that is for sure. I do however still get pain despite religiously wearing it each night and even for naps. I had a lanap done on my lower left quadrant a few months ago and my bite HAS been off from that. I have had a few adjustments and my root canaled tooth was smacking a bottom molar and that has been fixed...I think. Due to the lanap everything is moving around so I have to keep going back for adjustments. I am hopeful this is perhaps what could be going on and maybe I won't need to re-root canal or extract after all. Thank you for the hope.

 

[rob wain]

I don't want to complicate this ....but.
I agree that the symptoms are more likely related to the grinding and a niteguard is one of the possible solutions for that. However, if the endodontist is advising a retreat then you should give this serious consideration. The radiolucency could give rise to problems in the future so my advise would be firstly treat the grinding then do the retreat. Don't go for the extraction.

 

[michisafraid]

I don't want to complicate this ....but.
I agree that the symptoms are more likely related to the grinding and a niteguard is one of the possible solutions for that. However, if the endodontist is advising a retreat then you should give this serious consideration. The radiolucency could give rise to problems in the future so my advise would be firstly treat the grinding then do the retreat. Don't go for the extraction.

You are so right...and she did recommend retreating or extraction based on the x-ray she saw. So...I don't know what I will do. I will probably end up going for the extraction. I want a guarantee I will never have trouble with this tooth again and the extraction would be the only way to get that. I don't want to let it go for fear of future problems...what if we are on vacation or something and it decides to abscess. I want to avoid that. It abscessed 10 years ago and I had a root canal to fix it. I don't ever want to go through an abscess again if I can help it. Thank you for your reply.

 

[Dr. Daniel]

I don't want to complicate this ....but.
I agree that the symptoms are more likely related to the grinding and a niteguard is one of the possible solutions for that. However, if the endodontist is advising a retreat then you should give this serious consideration. The radiolucency could give rise to problems in the future so my advise would be firstly treat the grinding then do the retreat. Don't go for the extraction.

That's also a good point and I feel the urge to open it for a discussion. However, this kind of discussion would not be fair for michisafraid because it would be a theoretical discussion which might have nothing to do with this specific case.
michisafraid, I suggest you post the X-ray of the tooth and let the dentists of this forum to say their opinion. That would be the best way in order for us to advise you.

 

[michisafraid]

That's also a good point and I feel the urge to open it for a discussion. However, this kind of discussion would not be fair for michisafraid because it would be a theoretical discussion which might have nothing to do with this specific case.
michisafraid, I suggest you post the X-ray of the tooth and let the dentists of this forum to say their opinion. That would be the best way in order for us to advise you.

Thank you Dr. Daniel. I would love to hear what you all think. Here is my x-ray:



Thank you so much.

 

[Dr. Daniel]

The fact that the X-ray from a few years ago does not look different from the recent one indicates that most likely the tooth is stable. The RCT on the X-ray seems not ideal, and it seems as if there is indeed a low grade inflammation, but my instinct says it is not the source of your complain. I would first attend the grinding. By the way, there is a deep pocket on the distal side of the tooth, that could also be a source of discomfort. In any case, extracting the tooth would be unreasonable.

 

[michisafraid]

The fact that the X-ray from a few years ago does not look different from the recent one indicates that most likely the tooth is stable. The RCT on the X-ray seems not ideal, and it seems as if there is indeed a low grade inflammation, but my instinct says it is not the source of your complain. I would first attend the grinding. By the way, there is a deep pocket on the distal side of the tooth, that could also be a source of discomfort. In any case, extracting the tooth would be unreasonable.

Thank you Dr. Daniel! I really appreciate you looking at my x-ray and letting me know what you think. I had a lanap 18 months ago and my gums are doing very well on that quadrant so the deep pocket - is that from my gum disease? I do wear a night guard but I still grind away. I am hoping it will protect my teeth. I have worn one for many years. Could the low grade inflammation be an abscess starting to form? If I choose to just do nothing with this tooth that would be okay as far as you could tell, am I correct? Thank you so much again.

 

[Dr. Daniel]

I had a lanap 18 months ago and my gums are doing very well on that quadrant so the deep pocket - is that from my gum disease?

Difficult to answer, because it is difficult to really diagnose deep pockets just with a panoramic X-ray. If your gums are being cared of, than probably the reason from the pain can not be a periodontal one.

Could the low grade inflammation be an abscess starting to form?

No.
Or should I say: theoretically speaking there is a grain of truth but in real life not.

If I choose to just do nothing with this tooth that would be okay as far as you could tell, am I correct?

Since hearing more details about your dental situation, it makes it more reasonable that the source of the pain is from that tooth. Having said that, it is OK to wait a bit longer with the treatment. Low grade inflammation is a chronic situation so there would not be much difference after a few weeks. During that time you can follow up your tooth/mouth. If it becomes too much for you, maybe it is better to let the endodontist to redo the tooth.

 

[SirST]

The fact that the X-ray from a few years ago does not look different from the recent one indicates that most likely the tooth is stable. The RCT on the X-ray seems not ideal, and it seems as if there is indeed a low grade inflammation, but my instinct says it is not the source of your complain. I would first attend the grinding. By the way, there is a deep pocket on the distal side of the tooth, that could also be a source of discomfort. In any case, extracting the tooth would be unreasonable.

Hi Dr. Daniel,

I'm having the same issue Michisafraid mentioned above. I was hoping for some input. Radiolucency over a RCT tooth. I, too, clench/grind my teeth a lot and have a mouthguard. I had additional attributes I wanted to share. I went in for an xray due to pain yesterday (the 2nd of 2 x-rays) because I worried I'd done something to the root canal and the dentist said he saw no difference between this and the last x-ray. We had discussed the potential of an implant earlier this year. I believe he said, eventually, this will probably need to come out. I'm wondering if you share that assessment. Could this potentially not need an implant? He said retreating a root canal isn't possible. Or maybe specifically my root canal.

I'm afraid I don't have the x-ray to share at this time. The pain i've experienced I'm thinking is from teeth clenching. About a month ago, I had woken up with tightness in the area after a night's sleep, as if something was compressed and then eventually it relaxed but after it did, I felt almost a burning for awhile. Is that a more severe symptom of the teeth grinding or should I be concerned it may be infected from a shift in the RCT tooth? Structurally in the x-ray, my dentist feels it looks fine. I've scheduled an extraction for the path to an implant, he left it to my choice, but i'm wondering if I'm being impulsive or if it may be good to do it now and save the headache later, assuming I have no fear or infection here. The gums are all normal, no abscess visible on the gum, none in the x-ray.

I had an implant done on same tooth on the right side (this situation is on the left) because an abscess had developed on that tooth. so i understand the cost and time it will take to complete this. And admittedly, beyond cost and time, I would rather not be missing a tooth for an extended period of time due to vanity but I will have to get over that.

Any input is appreciated.
Thanks