Root canals just don’t work

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Pearly77

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Is this possible? Dentists, have you ever had a patient that they didn’t work on?

I have had two root canals in the past — both on teeth that were never infected but had old fillings too close to the nerve. Upper left—premolar and canine. Both root canals never settled and ended up needing apico s.

Last week I had a new crown placed on my #30. It doesn’t seem to be settling and Im worried it’s heading into that root canal territory. But I’m also terrified that it’ll be another situation when the root canal just won’t work.

Am i crazy? Or is this a real possibility?
 
Gordon

Gordon

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This is going to be a long answer, just what I need on a Saturday morning :)

A root canal is always a slight compromise, it's completely impossible to remove all of any infected material from every single root canal, some canals have little accessory branches from them and others have tight kinks and curves in them which our files and chemicals simply can't access.

Other canals have a sort of delta at the apex rather than a single large (relatively!) opening where the pulp enters.
Even with the best technique there are always going to be a few small amounts of bacteria able to colonise these areas.
There is also the question of the seal at the mouth end of the canal, a slightly compromised final restoration of the tooth can allow new bacteria into the canals and away it all goes again :(

HOWEVER, the idea behind root treatment is to reduce the bacterial load to such an extent that the host's own defences can mop up any bacteria which get out into the space between the tooth and the bone.
There are 2 things which can mess this up, 1; if the bacteria are particularly aggressive and reproduce quickly enough to overcome the host response and 2; if the host response is a bit compromised so the bacteria don't get killed off quickly enough. Or more likely a mixture of the two.

So that's a long way of saying that you're not crazy, but you also can't assume that every single root canal on all your teeth will be the same :)
 
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MountainMama

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I have also had two root canals on non-infected teeth and both failed. I had a root canal on my front tooth, which did have an abscess (childhood injury to tooth), and it also failed.
I also have had two apicos to try to save the teeth and those failed. Now I have three implants.
None of my dentists, nor my endodontist could give a definitive answer as to why root canals don’t work for me. Gordon’s answer is the best I have heard. My oral surgeon at the time did say that my teeth seem to be sensitive to work. I have just decided not to get root canals any more. Too much money to spend for it to fail.
 
Enarete

Enarete

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What a great explanation, @Gordon, thank you! :respect:
 
Lioness

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There are 2 things which can mess this up, 1; if the bacteria are particularly aggressive and reproduce quickly enough to overcome the host response and 2; if the host response is a bit compromised so the bacteria don't get killed off quickly enough. Or more likely a mixture of the two.

And @Gordon - if I've understood you correctly - can those two facts cause that also my tooth still hurts (sometimes stronger, sometimes weaker) after almost 5 years after root canal treatment?
And it also hurts stronger recently when I lie down or when I change my position from sedentary to recumbent...
Or maybe can it be just because of the changes of the weather? I suppose my tooth after root canal reacts to each of them... :(
 
Gordon

Gordon

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Thanks for the kind words.
@Lioness, yes that would explain it, it's a balancing act, so if something throws the balance off, it can cause symptoms to appear. I'm not sure that changes of the weather has much effect :)
 
Lioness

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Hmm... I'm not sure what to do if the tooth will be still quite painful in the future... Have it taken out...?:unsure:
 
Gordon

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Seems a bit drastic if it's been going for 5 years already?
 
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Sarah77

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Gordon, probably a silly question but is there anything a person can do to help their body accept a root canal — better their bodies response?
 
Lioness

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Seems a bit drastic if it's been going for 5 years already?

Yes, but... What else can you do? I'm more and more tired with quite often twinges or - sometimes - pain...
 
Gordon

Gordon

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Gordon, probably a silly question but is there anything a person can do to help their body accept a root canal — better their bodies response?
Nothing specifically, don't believe all the "woo" out there about boosting the immune response :) Obviously, eating a reasonably balanced diet and keeping as healthy as possible is likely to help a bit.

Lioness, need to see some x-rays, it might be that re-doing the root canal would help. Which tooth is it?
 
Lioness

Lioness

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It's number 7, bottom, on the right side of my mouth. OK, maybe I will have an OPG taken in some time. I suppose that having an X-ray taken with my gag reflex would be very problematic...
Besides, I guess, the OPG would be more exact and useful - it's the whole mouth shown at once, isn't it? It is also the same as panoramic radiograph, am I right?

Well, we'll see what will be... Anyway, thank you a lot for your interest and time, @Gordon.
 
A

Acheygirl

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Thank you for asking this question and Dr. Gordon you are amazing for answering. Pearly77, I think I am one of those who's body does not accept root canals. I had a premolar as well and that has given me tons of trouble. The only time in my life I have experienced unresolved dental pain is with root canals. I had one 16 years ago and it took some time to settle. I swore I would never get one again then in 2019 I had another. That did not do well, then the one next to it, that seems not to have done well. All done by an expert in the field. Very skill Endo.

I'm healthy, fit and in good shape all round. Could some of us have strange curvy complex root systems and that is why some of us are root canal failures? I can see one failing but having issues with many does not make sense.

Could this be more common then what the statistics state on the Endo Association?
 
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Sarah77

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Achy Girl, yes! I am wondering the same thing myself.

I have had THREE failed root canals after never having any dental work other than fillings. The first, tooth 13, was root canaled twice by an Endodontist with one of those fancymicroscopes. We ended up extracting at doing an implant when it never settled. The other two ended up in apicoectomy. It took FOREVER, like months, and they finally seem to be settling. None of the teeth had infections. Just sensitivity to pressure and cold.

now I have my molar, #30, that was crowned two weeks ago. It is achy all the time and sensitive to cold. Sensitive to bite on hard things, too, although that gradually disappears as I chew. My dentist is at a loss and the endo said he won’t root canal it — yet — because there is no infection and the CBCT x Ray looks totally normal. But I am at the point where if they tell me it’s time for a root canal I think I will just extract. I’m not doing too well with the root canal track record here...
 
A

Acheygirl

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Achy Girl, yes! I am wondering the same thing myself.

I have had THREE failed root canals after never having any dental work other than fillings. The first, tooth 13, was root canaled twice by an Endodontist with one of those fancymicroscopes. We ended up extracting at doing an implant when it never settled. The other two ended up in apicoectomy. It took FOREVER, like months, and they finally seem to be settling. None of the teeth had infections. Just sensitivity to pressure and cold.

now I have my molar, #30, that was crowned two weeks ago. It is achy all the time and sensitive to cold. Sensitive to bite on hard things, too, although that gradually disappears as I chew. My dentist is at a loss and the endo said he won’t root canal it — yet — because there is no infection and the CBCT x Ray looks totally normal. But I am at the point where if they tell me it’s time for a root canal I think I will just extract. I’m not doing too well with the root canal track record here...

So weird! When you had the extraction how did the tooth look did they say? Any cracks or anything? And if you don't mind my asking, did the pain go away or feel better once that tooth was extracted? I had #12 and #13 root canaled. I am having a problem with hot foods causing a shooting pain in one or both of those teeth - I can't tell for sure but only hot foods or liquids.
 
Gordon

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It's number 7, bottom, on the right side of my mouth. OK, maybe I will have an OPG taken in some time. I suppose that having an X-ray taken with my gag reflex would be very problematic...
Besides, I guess, the OPG would be more exact and useful - it's the whole mouth shown at once, isn't it? It is also the same as panoramic radiograph, am I right?

OPG is handy for a quick snapshot of the mouth but less useful for precise stuff like checking on a root canal, but if it's all you can manage then it's better than nothing.
 
Gordon

Gordon

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I'm healthy, fit and in good shape all round. Could some of us have strange curvy complex root systems and that is why some of us are root canal failures? I can see one failing but having issues with many does not make sense.

Absolutely some people have strange root canal systems, I think I wrote that already? The statistics are based on pretty wide experience, it's only very small numbers that seem to fail, but like everything else biological there's a wide variation. I've seen x-rays that look pretty rubbish (especially if I've done the RCT!) but the teeth are fine and others where the x-ray looks perfect but the tooth never settles.
 
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Squashface

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This is interesting. I had a root canal on my front tooth back in June 2020. I thought it finally settled down in late Jan and Feb. Out of nowhere I had a glorious 5/6 weeks of no pain. Then I had a very stressful house move early in March, and pain has come back as before! I did wonder whether it could be that my immune system was compromised from stress. So any remaining infection got the upper hand again. It’s still not awful pain, just annoying. It’s also problematic because I now live 1.5hours from my endodontist :(
 
A

Acheygirl

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This is interesting. I had a root canal on my front tooth back in June 2020. I thought it finally settled down in late Jan and Feb. Out of nowhere I had a glorious 5/6 weeks of no pain. Then I had a very stressful house move early in March, and pain has come back as before! I did wonder whether it could be that my immune system was compromised from stress. So any remaining infection got the upper hand again. It’s still not awful pain, just annoying. It’s also problematic because I now live 1.5hours from my endodontist :(

Can you go and get a cone beam CT dental scan? I would do that if it were me. I find solace in these posts not because others are suffering but because I am not alone and apparently this is not as uncommon as they say it is?
 
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Squashface

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Can you go and get a cone beam CT dental scan? I would do that if it were me. I find solace in these posts not because others are suffering but because I am not alone and apparently this is not as uncommon as they say it is?

I had a CT scan back in December. He said the actual root canal filling looked great. But there was still a dark patch above the end on the root. No signs of a crack at least. My tooth is weird because I have very little root above the visible tooth. The root ends without a point, it’s wide and flat. I wouldn’t be able to have an apico.

The endodontist thought that I’d just had such a bad infection before the root canal it was going to need a long time to heal basically.

Yes I find that useful too. This particular thread was interesting because no one had ever explained root canals the Gordon did!
 
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