Root Canal x 3?

[Ctaylor16]

Since January I’ve had two root canals done and scheduled for my third one tomorrow. My second one was done on tooth 18 10 weeks ago and is still painful, after consultation with two dentists and two endodontists they believe it’s still settling. I was also recently diagnosed with atypical Trigeminal neuralgia and was told to be careful with dental work as I might be getting it done unnecessarily. Tomorrow I am supposed to get a root canal on tooth 30, it was filled 6 weeks ago and still has extreme sensitivity to temperature and pressure. My neurologist is concerned it might not be necessary but my endodontist believes it is. Scanning showed inflammation but no infection. Tapping test and endo ice test both came back as necessary but my TN pain is the worst in my teeth so my neurologist thinks it is possible to test positive for a root canal test but not actually need it. Any thoughts? I am absolutely petrified because tooth 18 took 3 visits just to get me numb enough to be able to proceed with the root canal and I wonder if this was an indication that it was unnecessary or it was just extremely inflamed. Any input on how to decipher root canal treatment vs TN pain? My anxiety is through the roof and I’m barely able to sleep with this nonstop dental work

 

[MountainMama]

No advice but I am curious as to what answers you get. I am in a similar situation. I had a series of teeth have nerve issues last year, after never having had a root canal before and ended up at the end with four extractions. One was legitimately an issue, from a childhood injury, but my oral surgeon now thinks I have atypical facial pain and that two of the extractions could possibly have been from that, as they were not presenting as a typical nerve issue. They reacted strongly to the endo ice but did not hurt with pressure or tapping. Still have random pain after implants were put in.
I have one more “painfully sensitive” tooth but I am too scared to get work done on it for fear of losing another tooth!

 

[Gordon]

What about an electric pulp test? That's far more reliable than tapping or cold, has anyone done that yet? I'd hope a specialist endodontist would be able to do that at least.

 

[Ctaylor16]

I’m not sure if I’ve seen that, I’ve been to 2 endodontists and think I wouldn’ve recognized that if it was used.

 

[MountainMama]

What about an electric pulp test? That's far more reliable than tapping or cold, has anyone done that yet? I'd hope a specialist endodontist would be able to do that at least.

@Gordon Would you mind explaining how that works? Does it help differentiate between actual tooth nerve issues and neuralgia issues?

 

[Gordon]

Basically it sends a low power electric shock through the tooth, it gives a lot more accuracy than cold or hot as you can vary the electric current, so you can measure different degrees of response. It does require careful technique and a co-operative patient for best results.

You can't just use a single mechanism for diagnosis, for the more "subtle" cases, you need to use a variety of methods, EPT, thermal stimuli, x-rays etc.

 

[MountainMama]

Basically it sends a low power electric shock through the tooth, it gives a lot more accuracy than cold or hot as you can vary the electric current, so you can measure different degrees of response. It does require careful technique and a co-operative patient for best results.

You can't just use a single mechanism for diagnosis, for the more "subtle" cases, you need to use a variety of methods, EPT, thermal stimuli, x-rays etc.

Thank you for the explanation. I have never had that done but I think I will ask about it if they tell me the endo ice indicates that I need a root canal.

I know my endodontist has that testing capability since she mentioned it. It irks me a little that she didn’t use it on the two questionable molars that I ended up having extracted. My oral surgeon has told me that those two may have been hurting due to the Atypical facial pain and not irreversible pulpitis. I know it doesn’t change anything as no one knew I had the AFP at the time but still. If it didn’t hurt with tapping and had no infection present on x rays it seems like it would have been worth another test.