Root Canal FAQs

[CuriousPoster]

Is my tooth ready for a crown?

Hello all,

First time poster here and seeking some advice. (Professional, if possible!)

I had root canal treatment (RCT) on my lefthand side, bottom first molar in September 2020. Prior to this, the tooth had a very significant filling and had always caused me problems. In the end, it was incredibly sensitive to anything that wasn't the usual temperature of my mouth, therefore I consulted with my dentist and a root canal was recommended.

The treatment was carried out over a couple of appointments. I got the impression throughout things hadn't gone too smoothly and the tooth was 'difficult' to work on, just from the vibes I was getting throughout the appointments. (Appointments overrunning, dentist looking flustered at times, sealing a bleed in the tooth shut with a heated up drillbit (????), me experiencing some pain from what I believe was the dentist's accidental lack of concentration during one moment and drilling too deeply etc.) Nevertheless, when all was said and done, x rays were done and I was told the treatment was a success and I was sent on my way.

I can confirm that, broadly speaking, the tooth has been considerably better to live with since. The original pain that I had has completely gone. I can chew on the tooth with no real problems. However, ever since the treatment was completed (as in, ever since day one), I've always still had some sensation in the tooth if I push against the inside wall of the tooth with my tongue or tap the tooth. This surprised me, since I understood following RCT, you should never feel anything whatsoever and anything otherwise suggests there is a problem.

Anyway, my dentist had said to me back in September 2020, to call up in the new year when they would be resuming routine appointments and I could have a crown fitted. So, I attended a check up appointment last week, the dentist acknowledged that I still had some discomfort in the tooth when it's prodded, but says that this can be normal in some instances, and that it was okay to go ahead with the process of getting a crown sorted if x rays came back okay - which they did.

I'm now booked in for my first appointment this coming Friday and I've foolishly started searching online around the process of having a crown fitted, and what constitutes a failed RCT. I've now worried myself sick that the RCT wasn't a success and the crown is going to be a bad idea.

So, I guess why I'm posting, is to ask if some sensation in a treated tooth can still be possible but not necessarily indicative of there being a problem, as my dentist has suggested? My friend also works as a dental assistant and has said to me that this isn't uncommon, and to to ahead with the crown.

As I've said, it's not what I'd describe as painful, but more a sensation and some slight sensitivity when prodded, almost like that the inner wall of the tooth is weakened or damaged perhaps.

Anyway, I throw it out to you, the dental gods, and will see what you say!

Thanks in advance.

Regards,

Daniel

 

[Niall Neeson]

Hi CuriousPoster,

To explain about the feeling you get, basically the tooth has 2 nerves. The ‘hot or cold’ nerve is inside the tooth called the pulp. This is the nerve that was inflamed with the original toothache that led to the root canal initially. This area has been cleaned, disinfected and sealed in with the root canal treatment.

The second nerve surrounds the tooth and is in what’s called the periodontal ligament. This is the nerve that allows us to pick out a fishbone or a hair in our food. It picks up on pressure. This ligament is still alive and will function.

So your root treated tooth will not (or certainly should not!) feel hot or cold, but it can still feel pressure.

Admittedly, we prefer when things settle down 100% and there are no symptoms whatsoever before proceeding with someone investing in a crown but it sounds like there’s still a good argument to proceed.

At the end of the day, when working with teeth and the human body, nothing is guaranteed. We are essentially working on probability and weighing up the risks and benefits.

To me, it sounds like the benefit of protecting a weakened root treated tooth with crown, probably outweighs the risk (over time, root treated molars that are not crowned are much more likely to break and require removal than crowned root-treated teeth). But, ultimately that is a decision that only you can make as it’s your money.

One final thing, I find that lingering issues like this can sometimes relate to clenching or grinding the teeth, or unhelpful forces being applied to certain areas when the bite is functioning. If you think any of this could be relents to you maybe just mention it to your dentist as they might be able to protect it with a splint for example.

I should clarify that obviously I have not assessed the condition of your tooth so cannot give an authoritative professional opinion on your case specifically and the suitability for a crown. I hope that this information is helpful nonetheless.

Niall

 

[Annie364]

Long-term effects of abscesses that take a long time to go down after root canal treatment

I have a large silent abscess on each side, very high up, hidden away pushing into my sinuses. They were only found recently on a CBCT scan and had been there for years without me knowing. The pulp had died a long time ago.

My teeth and gums look OK in my mouth, with no swelling or inflammation, and no swelling visible on my face either. The abscesses are completely hidden away and inaccessible, up above the roots on each upper arch.

I am undergoing a root canal on the tooth on each side causing the problem. The 1st half is done where the pulp was removed and temporary dressing put in. I will be going for the 2nd and final half soon.

I was told the abscesses will take up to one year to go down. Because of their location they can't be drained.

The bacteria are affecting me systemically and have done for a long time. My endodontist did not think antibiotics are needed. I can see that a course of 5 days of antibiotics is not going to do anything, as the abscesses would still be there after the course ended.

I am concerned about the long term effects of having this infection around the new root canals, for up to a year. The two slowly healing abscesses will surely be leaking infection into the area around the newly done root canals. Won't this infection for up to a year affect my newly done root canals and infect them, causing long term problems with low level infection in the root canals?

I have spoken about this to my dentist and he said the abscesses would just heal on their own, but I would really appreciate some more opinions on this as it's been bothering me. Please be kind, as I'm having a pretty bad time at the moment.

 

[Gordon]

Your immune system is obviously holding its own fine against the bacteria present at the moment, hence lack of symptoms. It can't completely eradicate the issue because your white cells etc. can't get to the source of the problem, the dead nerve space inside the tooth.

So if your dentist removes the dead nerve and associated gubbins from inside the tooth then your immune system can be left to get on with the job. So the abscesses will heal on their own. Antibiotics are not necessary at all.

 

[Annie364]

Thank you very much I do appreciate it a lot. The only thing I don't understand, is won't there be a route from these abscesses to the gums around the root canalled teeth, and wouldn't the infection travel from the abscesses to the new root canals and cause them to get infections around the root?

I totally see that antbiotics are not going to help. But why finish the root canal with active abscesses still going on? Wouldn't it be better to do a few more temporary clean/fills, while waiting for the abscesses to go down, then only do the final stage once the abscesses are clear on a new CBCT scan?
Thanks again for your help.

 

[Gordon]

Nope. There is little to no active infection in the abscessed areas, they are being kept going by the bacteria exiting from where they are feasting on the decaying remnants of the pulp tissue in your root canal spaces. Remove them, sterilise the canals and fill them up to prevent any more bacteria getting in and the abscesses will clear up quite nicely.

You can't "clear" the abscesses while they're still being replenished from the canals, so your approach will never work.

 

[Annie364]

Thank you so much for replying, I really appreciate it so much!

I'm fine about the abscesses going down on their own, but I was more concerned about the other way around going wrong ! ... That once my root canals are finished and filled with gutta percha, then the bacteria in the still-present abscesses could come down to my nice freshly cleaned-out root canalled teeth, and infect the gum around them or even get inside. This is why I was wondering about the idea of delaying the final clean-out and gutta percha fill, until the abscesses have resolved. I was just thinking about the long term health of the root canalled teeth themselves, wanting to avoid a root canal failure in the future.

Especially as I was told the abscesses can take a whole year to go down (as they are not being touched as they are inaccessible). So I'd have up to a year of the abscesses of bactera being present next to the freshly root canalled teeth.

But this scenario of re-infection would not happen?

(I'm assuming that because I've had Stage 1 of the root canals done (all the diseased pulp removed, the teeth thoroughly cleaned out with sodium hypochlorite etc, and the canals filled with temporary calcium hydroxide), that the source of infection is completely gone and the abscesses are not being replenished with infection from the canals any more. And I see that the abscesses are just repositories of bacteria and not a source of infection.)

Thank you again for your help.

 

[Gordon]

Basically the abscesses will be full of dead/inactive bacteria. The root fillings seal the root canals up and will prevent any bacteria from re-entering the canal spaces.

 

[Annie364]

OK that makes sense thanks ever so much