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Should apical granuloma be monitored by endo following RCT?

  • Thread starter Thread starter sudzs
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sudzs

sudzs

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Jun 25, 2009
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A few queries and sorry to be asking so many questions lately

I had a second root canal treatment (private endodontist) on an upper incisor a couple of days ago due to ongoing tooth discomfort, facial numbness (mild), headaches and most recently an apical granuloma on the tooth in question. I was traumatised after the procedure and could hardly speak so wasn't able to ask any of the questions I had planned. The endodontist didn't say that he wanted to see me for a follow up but the internet suggests that follow up appointments are the norm. Also, shouldn't he want to monitor the granuloma?? I have emailed the clinic asking if I should come in for a follow up and waiting to hear back but would appreciate an opinion here.


Also, the endodontist seems sure my numb feeling and headaches are neuropathic and if they persist I should see someone else about it, a facial pain specialist, and maybe take something like amitriptyline for a while to try to quiet down the nerve. However it is my feeling that my problems are entirely down to an inflammatory response to the decay left in the tooth 11 months ago and the resulting nerve death. Then poor RCT leading to an apical granuloma. The fact that when I take ibuprofen the symptoms ease so isn't it more likely that the root (pun not intended) cause is inflammatory rather than neuropathetic??

The symptoms were all worse today. Could that just be down to inflammation following the RCT? After 4 Ibuprofen throughout the morning they are easing considerably.

Any opinions on this as I feel that the endodontist doesn't really want much more to do with it all as my ex-dentist who left the decay there in he first place is a referring dentist and the endo might not want to be involved in the whole mess. Ex-dentist referred me to him in the first place as she couldn't figure out why I was having symptoms despite there being decay on the x-rays so I suppose he was kind of obliged to keep treating me. But I don't think he wants to see me again!

My new dentist and endodontist away until 6 January. Will I be ok??? :scared:
 
Does the root tip look ok? I'm terrified the filling material is outside the tip and causing my current pain.
 

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Does the root tip look ok? I'm terrified the filling material is outside the tip and causing my current pain.
Looks perfect to me.
You want a tiny "puff" of sealant through the apex, it's biologically inert and won't cause any issues, it should be resorbed in time as the bone heals, so don't fret about it.
It's common to have a bit of pain immediately post RCT, the treatment causes some local inflammation for a variety of reasons.
I wouldn't expect the endodontist to follow up on this, they've done their bit.
 
Thanks so much @Gordon. That's a big relief.

I thought that maybe the endodontist might have been able to say as much yesterday to reassure me but I only got a reply from the receptionist saying she wasn't qualified to advise and that a letter had been sent to my general dentist about it all. I just assumed it would be part of the after sales service so to speak, to address any pain or concerns. I wish they had just told me that in plain language as if it was just implied I didn't get it, I didn't know that once the RCT was done that was me signed off. So my general dentist will monitor the granuloma now. That's grand now I know.

I seem to have had a crescendo of inflammation yesterday and it's much better today thankfully. I was just worried that there was something very wrong as it was the worst it had ever been since it all started last January.

So many thanks again Gordon, your advice in invaluable. I hope you have a very Happy and peaceful Christmas. You deserve it! :xmas:
 
I wish they had just told me that in plain language as if it was just implied I didn't get it, I didn't know that once the RCT was done that was me signed off. So my general dentist will monitor the granuloma now. That's grand now I know.
It would have been nice of them to let you know, but yes, your GDP should keep an eye on it. As in, take another x-ray in a year or so.

I seem to have had a crescendo of inflammation yesterday and it's much better today thankfully. I was just worried that there was something very wrong as it was the worst it had ever been since it all started last January.
All the poking about with files etc in the canal seems to set off a fairly intense reaction at the apex.

I think we have it mentioned in a FAQ on here someplace...oh yeah here you go: https://www.dentalfearcentral.org/faq/root-canal/#pain-after

It doesn't always happen but it's not unusual.

I hope you have a very Happy and peaceful Christmas
Thank you very much and the same to you :-)
 
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