Still have pain after second RCT

[sudzs]

So following on from my saga about decay left under a new filling, root died, root canal treatment, decay eventually removed after that. Since the first filling was done I have had all sorts of pain issues from the tooth including of slight numbness in tip of nose and lip next to the tooth. Following a second RCT done by an endodontist I am still having pain. It's actually worse now in that I have a constant low grade niggling discomfort and then flare ups where it's a lot worse. When they happen I need to take ibuprofen which help as does applying cold from iced water or even ice.

I addition and I didn't mention this before, since this all started I developed a small patch of psoriasis on my scalp. I only linked it with the tooth discomfort a few months ago when I suddenly realised that it flares up whenever the tooth does so to my mind there is a definite link there. This all says inflammation to me.

But I went back to the endo as I am still in pain and they say that the tooth is fine, x-ray shows the apical granuloma is healing and only a small amount of it now remains. They don't agree with me that it is inflammatory. They think it's either neuropathic or atypical facial pain. They consulted with a colleague who had a quick look at me and wondered if there might be a low grad infection in the bone so I now have a packet of Doxycycline to try when i have the next bad flare up. So the endo has signed me off now and can't/won't do any more to help. They have sent a letter to my general dentist advising I see an atypical facial pain specialist.

I'm reluctant to go down that route as I'm convinced that there is some sort of inflammation in there. During a flare up I can feel the pain in my palate and up the gum at the front along where the tooth root is, it's worse towards the tip/apex. I can feel a fullness in my palate and it feels a little warm when at its worst.

I wonder if there is a little extrusion of the filling material (calcium hydroxide I think) and this could be causing an inflammatory response. Where that little diamond shape is at the tip seems to be outside of the tooth itself. I asked the endo about this and they said no, it's a highly tolerated material. Well I'm autistic and I understand we have all sorts of extra synapses that non autistic people do not and I've often had weird manifestations of different illnesses over the years so I am very much an atypical patient! I also asked if there could be any other channels in there and they said no. I asked what about a CT scan and they said no point.

So wondering if you can have inflammation going on in bone that does not show up on an x-ray?
Could there be a tiny crack somewhere?
Could that little bit of extrusion cause an inflammatory response, albeit unusual?
If this is the case, would I run into the same problems if I gave up on the tooth and got an implant?

I am thinking about going to a different dentist about all of this as I'm feeling desperate now and can't live with the pain and I can't keep taking so much ibuprofen. I'm terrified of losing the tooth and not being able to have an implant. I have a horror of removeable devices and would worry about the longevity of a bridge.

So any theories or advice greatly appreciated.

 

[sudzs]

...just to add, after the second RCT was done, 36 hours later I had a massive flare up of symptoms, worst ever. It was different to the discomfort from the local trauma which makes me think it might have been some immune reaction to the RCT

 

[Gordon]

...just to add, after the second RCT was done, 36 hours later I had a massive flare up of symptoms, worst ever. It was different to the discomfort from the local trauma which makes me think it might have been some immune reaction to the RCT

That's not unusual in the immediate aftermath of a root canal.

I wonder if there is a little extrusion of the filling material (calcium hydroxide I think) and this could be causing an inflammatory response.

Most likely not Calcium Hydroxide, it'll be Zinc Oxide and Eugenol. Never heard of an allergic reaction to it, ever.
There will be an inflammatory response its common after RCT, some of the bacteria and dead cells in the canal will get pushed out of the apex during treatment. It's actually quite desirable as it will clean up the rubbish and help things to heal.
It's why you commonly get symptoms in the first 48hrs or so after RCT.

If you can manage it, I expect things to settle down in a few more days.

 

[sudzs]

Thank you Gordon. Yes, maybe he said zinc oxide and I got it wrong. I'm sure he said that it's used in bone fractures too, would that be right?

And so sorry, I see now that I omitted from my post that the RCT was actually done last December. So 3 months later I'm still having this on and off pain and discomfort in my palate and gum and also some numbness in the tip of my nose and lip.

The original granuloma is healing but there is a little bit of it still there. Could that be causing the symptoms? Should I just give it all more more time to heal?

Or do you think that there's a little bit of extrusion there that could be causing the problems? I've attached the x-ray of the original root canal treatment to see the shape of the root tip. To me it looks like that little diamond shaped piece of sealant in RCT2 is outside of the root itself.

 

[Gordon]

The original granuloma is healing but there is a little bit of it still there. Could that be causing the symptoms? Should I just give it all more more time to heal?

If it's showing signs of healing on x-ray then it would be worth giving it more time.

Or do you think that there's a little bit of extrusion there that could be causing the problems? I've attached the x-ray of the original root canal treatment to see the shape of the root tip. To me it looks like that little diamond shaped piece of sealant in RCT2 is outside of the root itself.

No. The little bit of extrusion is actually what we want to happen. It shows that the canal has been cleaned out all the way and there isn't a small reservoir of infection left at the very apex. Assuming it's a regular Zinc Oxide root filling then it'll eventually get munched down a bit by your white blood cells.

 

[sudzs]

Thank you so much Gordon for the reassurance. I really appreciate it as I'm at the end of my tether with this tooth.

I'll give it more time and hope for the best. No implant just yet! But will keep saving up anyway!!