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Root Canal question

P

patient

Well-known member
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Mar 7, 2014
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I cannot find my last post so I am making a new one. To cut a long story short I had a tooth near the front of the mouth that needed a deep filling. Dentist at the time said I needed root canal. She tried to do it and my nerves could not get numb enough so she did an ordinary filling. Went on holiday and developed an infection in the tooth. Holiday dentist said I need root canal and I developed a pimple on the gum above the tooth which was painful to touch. My dentist said I did not have a tooth infection but a gum infection. She said the tooth still needed root canal but she reminded me that when she tried before my nerve endings could not get numb enough to deal with it but she would see if she could try again. Since she was a private dentist I decided her price was too high and found a new dentist on the NHS. A friend recommended her dentist and I registered. I told the dentist about this issue and he said he would see what he could do.

Today was the appointment and as you can imagine I was a little nervous because of my previous experience. The new dentist did the root canal and it did not hurt at all and at the end of the appointment he said it had been successfully done and I was glad. He said he could see that there was still puss inside the tooth so he put some solution in it and a temporary filling and wanted to complete it all at the next follow up visit. I asked him about the lump on my gum and he said that if root canal is successful then that lump would be got rid of as he cleaned out the tooth.

I have come home and the anesthetic has worn off but I still have the lump on my gum which when I pressed on it was a it tender. I do not know why this is still the case after what he told me today. The root canal went very well (I am quoting his words) so if it went very well why do I still have this tender lump on my gum? I am going to phone the dental practice tomorrow to query this because according to the dentist this lump should not be there if root canal has been successful.

I am very upset about it
 
I am not a dentist, but from reading your post it sounds to me that your treatment is not yet complete and that the dentist has put medicine in the tooth to get rid of any remaining infection (pus). I would hope that once the medicine has done its job, the treatment is finished, and the tooth is clear of all infection, that the lump would then resolve. Do you have another appointment booked to complete the treatment?
 
Yes my next appointment is on 3rd June which is the earliest appointment they could give me. Perhaps I am worrying over nothing but in the past when I have had a tooth infection they drain the tooth. When I had a tooth infection about 10 years ago the dentist drilled the back of the tooth and put some cotton stuff inside the tooth and drained it whist I sat there and it took about 10 minutes and he said to me ok I have drained the tooth and got the infection out but I still need to give you some antibiotics and then he filled the tooth and that was the end of the matter. When I went to the dentist about this tooth I said can you not drain the tooth and he said no. I guess he knows what he is doing but it is frustrating to have it not sorted out yet.

The other thing that I am thinking about is the previous dentist who I thought was good could not do the root canal because she could not get me numb enough and yet this new dentist could. The old dentist wanted to send me to a specialist who specialised in root canals because she said she was incapable of doing it herself. Maybe it was not an issue with my nerves but an issue with her competency.

Doesn't it make you sick when you know people who boast about their teeth? I have a friend who said to me oh I only have four fillings and have never had a tooth extracted or had an infection or a root canal and never needed to wear a brace and my teeth are white. Well bully for you
 
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I had root canal done on Thursday which went very well. I have no idea if the tooth was already dead (it was infected). I went to a previous dentist who tried root canal on that tooth and there were difficulties because the nerves were still alive no matter how much injection I was given so the dentist did not do it. I then decided that I had nerve problems which were a worrying issue for me because that meant that if I needed root canal again it could not be done unless I was put to sleep. Then I developed an infection in that tooth and another dentist who looked at it as an emergency said the tooth was dead. He then said the only way to treat this tooth was root canal and so I pointed out to him that I had been down that road before and explained why it could not be done. He then said to me it would be fine because the tooth is actually dead and so I would not need to have it numbed up.

I go to a new dentist and he also said I need root canal so again, I told him what had happened before and he said that he would try his best and if it was painful he would not continue. He numbed me up. As he numbed me up I was thinking..... I have been told this tooth is dead so why do I need it numbed up? Anyway he numbed it up and it numbed up very well and he got on with the job. As he was doing the work he asked me if there was any discomfort and I said no. Then suddenly he said to me "I am right on the nerve do you feel any discomfort" and again I said no.

At first I thought that whatever injection he had given me was very strong and strong enough to get all the required nerves numb that the other dentist could not. Then after I had come home and the injection had worn off I sat and thought about it more and decided that maybe the tooth was dead and that was why it did not hurt and it had nothing to do with whatever sort of injection he gave me so I then wondered that if the tooth was still alive we would have faced the same issue as the previous dentist who could not do root canal because she could not get the nerves numb.

How do you know if a tooth is dead? It occurred to me that when he looked inside and found puss I said I felt no pain from it which I would have expected to so maybe that is an indication of a dead tooth? I am still a bit nervous about my nerves because another molar could not be numbed up properly for root canal so maybe as I have got older my nerves have become resistant to numbing for the very deep root canal? I hope I NEVER need root canal again
 
Hi,
I’m not sure that I can fully answer your question (not a dentist) but will share my understanding of things. If a tooth is dead it is often discolored (like gray in color) due to lack of blood supply. You may still experience pain and require numbing as the sensitive nerve endings around the outside of the tooth are still alive in the periodontal membrane. Teeth that are root canaled are either dead or in the process of dying. Dentists or Endodontists will test the vitality of the tooth pulp a number of ways but the most common being cold sensitivity. Even if the tooth was not completely dead, you should still be able to be effectively numbed for root canal treatment. Failure to do so may have been inflammation of the nerve (they call this a “hot tooth”) where anesthesia did not work because of the presence of infection (they normally give you antibiotics to take first and try again when the infection is under control). Another reason could be poor technique and maybe the dentist just missed the mark? Also sometimes, people are just “wired” different and therefore, a different injection approach needs to be used.

The important take away here is that just because one tooth could not be numb, does not mean that you will run into that problem with every tooth. I have had teeth that would not go numb even at the more superficial layers for fillings while other teeth were fully numbed for root canals or extractions.
 
Not a dentist either, but I know a little about it as I had a dead tooth, and one that was dying. The one that was dying was sensitive to heat and cold and I felt pain in the actual tooth, and around the tooth in the gums. I don't numb easily either, so I was terrified to get a root canal as well.
I actually had a dead tooth for many years and did not know it! It was my front upper tooth that had been chipped as a kid. Apparently it stopped "growing" from age 9 (the canal did not narrow as adult teeth do). I had no idea, as the tooth was only slightly discolored yellowish, which I thought was due to the filling where it was chipped. Never had any pain until the abscess was large, then the pain was all in the gums around the tooth. I had never really noticed until it started hurting around the tooth that I did not feel hot or cold sensation on the tooth at all.
 
Yes I once had a discoloured tooth from an infection and knew it was dead.
 
Hi,

Thank you for sharing your story and thoughts. I have the feeling we not only talking about the question whether a tooth was dead or not but also whether your second dentist was more competent than the first one or was he simply “lucky” having to treat a dead tooth. I will try to answer both questions: how do you know whether a tooth is dead and how do you know a dentist is competent.
For me as a dentist I never make a root canal treatment without anesthesia (well, never say never, but it has to be a unique situation not to use one for a RCT) for two reasons: first of all, it is better to have the tissues around the tooth to be numbed as well because patients can feel discomfort from them. Secondly, even if the tooth shows all the sign of being necrotic, there is always a hypothetical chance of having islands of alive tissue somewhere along the canals so it is safer to plan the anesthesia as if the tooth is alive.
Regarding the dentist’s competence: here results count. There are situations when it is more difficult to anesthise, for example having a RCT for a lower back molar which is alive and flared-up that is more difficult than other clinical situations (still possible but more difficult).
Competence should be measured according to results over a long period of time. That is why it may take some time for a dentist to earn a patient’s trust but if the dentist manages to deliver a good treatment time after time , real trust is built. It usually does not happen instant.
 
Hi,

I believe there is a good chance the lump will lessen and maybe disappear within a few days. These things take time to change and heal. I suggest you wait 48 hours and see.
 
Thanks. I thought the first dentist was good because I went to her as an emergency because a previous dentist attempted to do a filling and did not drill out the decay properly and left me in agony. I went to another dentist who said to me "I cannot do anything to help you and you should go back to the dentist who did the filling". I was desperate and said I do not want to see that dentist ever again and I was told but I cannot help you. I said don't you even have any advice for me and he said ok I will take an xray. He took an xray and he said he could not see anything wrong and the tooth should settle down. I left the practice and on the advice of my friend went to her dentist who said she could treat me. She said not all issues show up on an xray so she drilled the tooth and said the reason why I was left in so much pain was because the dentist left decay in the tooth and sometimes problems only become apparent when you look with the naked eye. She drilled out the decay that was left and refilled it and the pain was gone. I then complained to that dentist and got a refund plus a refund for what I paid out at the new dentist to put matters right. That is why I thought the dentist was good because a) she was willing to help me and b) she knew how to solve the issue. Then when it came to the root canal I lost confidence in her. Perhaps its just as well because she was a private dentist and wanted to charge me £300.

I also want to ask why some patients who need root canals get referred to a specialists who specialise in root canals because I thought all dentists are capable of doing root canals or they should be
 
Thanks. I thought the first dentist was good because I went to her as an emergency because a previous dentist attempted to do a filling and did not drill out the decay properly and left me in agony. I went to another dentist who said to me "I cannot do anything to help you and you should go back to the dentist who did the filling". I was desperate and said I do not want to see that dentist ever again and I was told but I cannot help you. I said don't you even have any advice for me and he said ok I will take an xray. He took an xray and he said he could not see anything wrong and the tooth should settle down. I left the practice and on the advice of my friend went to her dentist who said she could treat me. She said not all issues show up on an xray so she drilled the tooth and said the reason why I was left in so much pain was because the dentist left decay in the tooth and sometimes problems only become apparent when you look with the naked eye. She drilled out the decay that was left and refilled it and the pain was gone. I then complained to that dentist and got a refund plus a refund for what I paid out at the new dentist to put matters right. That is why I thought the dentist was good because a) she was willing to help me and b) she knew how to solve the issue. Then when it came to the root canal I lost confidence in her. Perhaps its just as well because she was a private dentist and wanted to charge me £300.

I also want to ask why some patients who need root canals get referred to a specialists who specialise in root canals because I thought all dentists are capable of doing root canals or they should be
Every practitioner has limits to his/her clinical abilities and if this care giver is a responsible one, they should not perform a treatment which is too difficult for their abilities. Studying how to perform a root canal treatment in dental school is not enough for making a good root canal treatment. A dentist has to invest time and money to know how to do a RCT. It is a complicated procedure.
Furthermore, even if a dentist has experience, knowledge and equipment, some cases are more difficult from the others and it is better to refer to a specialist.
 
Hi,

I believe there is a good chance the lump will lessen and maybe disappear within a few days. These things take time to change and heal. I suggest you wait 48 hours and see.
I had the root canal done on Thursday. It is now Tuesday and the lump is still there and still slightly tender to touch and so that would indicate to me that there is still some infection. I have my next appointment on the 3rd June. The good thing is that I am not in pain but that does not alter the fact that things are not right. I should not have a tender lump on my gum after root canal and the lump first appeared in February when the infection first started.
 
I had the root canal done on Thursday. It is now Tuesday and the lump is still there and still slightly tender to touch and so that would indicate to me that there is still some infection. I have my next appointment on the 3rd June. The good thing is that I am not in pain but that does not alter the fact that things are not right. I should not have a tender lump on my gum after root canal and the lump first appeared in February when the infection first started.
It goes without saying that I am guessing here since I cannot see you.
Obviously, this a very difficult situation for you because there is something wrong but you don’t know what it is and what the proper treatment is. I call that the “uncertainty factor” and would like to invite you to watch a video I made about this component of dental anxiety:

What you need is a diagnose. I would suggest seeing your dentist or another dentist for a second opinion.
I believe the tooth will not be painful for the next couple of weeks, that gives you the time to get the answer you need.
 
It goes without saying that I am guessing here since I cannot see you.
Obviously, this a very difficult situation for you because there is something wrong but you don’t know what it is and what the proper treatment is. I call that the “uncertainty factor” and would like to invite you to watch a video I made about this component of dental anxiety:

What you need is a diagnose. I would suggest seeing your dentist or another dentist for a second opinion.
I believe the tooth will not be painful for the next couple of weeks, that gives you the time to get the answer you need.
I am not anxious. I am perfectly calm but I want answers so I will wait until my next appointment and see what he says. I doubt anything will happen to the tooth/gum because it has been like this since February and not got any worse and in all honesty if it was going to get worse, it would have done by now. We are going round in circles here so until I see the dentist again in June I will just have to forget about it for now. I can drink hot and cold foods, I can brush the tooth and gum. It does not throb. However I was a little surprised that when he found oozing inside the tooth (his word not mine) and told me, I asked if he could drain it and he said no. Good grief don't you drain an infection? I have had an infection drained before and was led to believe that draining was normal procedure and antibiotics. I am going to have a frank discussion with him about it and find out what he intends to do next. I am an adult in fact I am older than him and I am not some pushover that can be fobbed off with words. I may not be a qualified dentist but I have had infections before and they were cleared. When he asked me to make another appointment to fix this tooth I said if it is still infected do I need to leave a gap to enable it to settle down and for the infection to clear before coming back and he said no. The only reason I have the next appointment in June is because he is fully booked until then. I had high hopes about this dentist. At least he was able to do the root canal which is something I suppose.

The holiday dentist said it was a tooth infection

The previous dentist who could not numb me up said it was not a tooth infection but a gum infection because of the pimple on my gum.

Anyway I have phoned the surgery and got the receptionist to pass a message to the dentist to say the lump is still tender and still not gone and what can he advise. As I said I am not anxious but I want it sorted
 
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Dental surgery called me back and said as long as the tooth/gum is not painful then to go at the original appointment on 3rd June and I guess we will discuss the situation then
 
This pimple or lump or whatever you want to call it is still on my gum. As explained before, it was slightly tender when pressed with my finger. I suspected it was to do with the infection that was still present at the time of the root canal. Dentist wants to revisit the tooth again at next appointment but the lump no longer hurts when pressed so I guess whatever infection was there has now gone. Maybe the lump will always be there even though you should not have lumps on your gum but it does not cause me any issues so it may be one of these unexplained things and makes me unique lol
 
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