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Failed root canal at 1 yr. anniversary. Get a divorce or stick it out?
Stop me if you've heard this song before. Failed root canal on upper molar (#3).
History of that tooth is that 5 years ago, previous dentist replaced filling with a composite and set the filling too high. I was in incredible pain for a week until he ground down the filling. Tooth hasn't been the same since. I believe that's where it developed the stress crack on the side, but that's a best guess.
Flash back to 16 months ago: Current dentist (not the guy who screwed up the filling) noticed dark spots below roots on X-ray. Told me it would probably need to be pulled or have a root canal done. Warned me about crack and cautioned me that even a root canal might not work due to said crack. But I went ahead with the root canal because I wanted to do everything to save the tooth. Rest of my teeth in good shape and don't want to lose one. 44 years old . Root canal performed without issues by very reputable endodontist. Tooth was checked at the 3 month mark and dark spots were healing in nicely with new bone. Crown put on. No complications. Until a week ago, the one year anniversary of my root canal. Intermittent dull throbbing pain. Intermittent sensitivity to pressure. Sinus pain. Felt exactly like it did prior to root canal.
Re-visited endodontist Monday morning and had it Xrayed. Surprise, surprise, now looks very similar to pre-root canal condition. One of the roots looked okay, but the other had that dark spot underneath it. Endodontist says bacteria is coming in through that same crack and re-infecting it. Put me on a 10 day course of penicillin and told me to check back in 8 weeks.
After 2 days, penicillin seems to be working. Symptoms are largely gone and I'm able to chew on that side without any issues. So my dilemma is should I really give it 2 more months to heal or should I have it pulled? My dentist is keen to yank it and put in an implant. Of course, this helps pays for the next Ming dynasty era vase he puts in his marble foyer. Seriously, he's a good dentist but obviously motivated to sell me an implant.
I'm leaning towards cutting my losses with it because of the crack. I could probably keep the tooth going for another year or so, but ultimately I feel like the tooth would get re-infected and I'd be right back in this situation.
So, anyone here have an experience similar to mine? Is there any way to recover a molar when it has a crack?
He also probably doesn't want to see you in there in a year whining about how your tooth hurts - again. He probably also doesn't want to know that he's failed to do the most medically appropriate thing for his patient.
Your best bet, is to finish the full course of antibiotics - even if you feel perfect tonight, if you have any more, use it as directed, until there is none left.
And then, see him in 8 weeks to see if that actually solved the problem, or if it only delayed another episode.
If it delayed another episode, then you'll probably be better off just getting an implant (or a bridge, though I think an implant is better as long as you have the bone, or can handle a bone graft, to support it). It'll cost a whole lot less in the long run, than a root canal, followed by a failed root canal, followed by another root canal, plus "fixing" a crack with filling material, which may or may not fail or expand and make things worse..followed by repeated infections, followed by more days out of work, etc. etc. etc.
Implant is 3 visits, and if you get any grafting done on a thursday, you can just take friday off and be back at work on Monday with little to no pain at all. The false tooth that's put onto the implant involves just a little jerking motions, which is jarring - but no pain, no need for novocaine, no nuttin. It's a 10 minute procedure and you can have it done on your lunch break.
The implant itself takes awhile, and a couple of days of soreness.
The cost for a single implant is around the same as the cost of a bridge, these days. The upside of the implant, is 1) you don't have to grind down perfectly good teeth to fit a bridge, 2) you don't compromise the structure of the other two teeth, 3) if one of those other teeth needs a root canal, or even a filling, you don't have to destroy the whole bridge removing it just to get to the tooth.
I'm dealing with having a bridge removed, just to fill a simple cavity. Over $3000 just to get a cavity filled, because I chose to get a bridge instead of an implant. And I have already paid over $3000 for the bridge the first time around. So now, I'm paying almost $7000, for what amounts to one tooth and one cavity. When getting an implant would've cost me only $3500, and the cavity would've been covered by my insurance.
In summary: get an implant, if the dentist recommends it.
The other aspect for concern is what happened when I procrastined. Started having bone loss because of the constant infections which only reduces the corrective options chances of success. I'm no dentist, but I wish I had got it out. Now I can't even get an implant or bridge.
Anon Chick's advice is spot on.
The other aspect for concern is what happened when I procrastined. Started having bone loss because of the constant infections which only reduces the corrective options chances of success. I'm no dentist, but I wish I had got it out. Now I can't even get an implant or bridge.
Anon Chick's advice is spot on.
Thank you both for relaying your experience and advice.
I am definitely doing the full course of antibiotics.
After reviewing my Xrays with my dentist, I have decided to follow his recommendation for an implant and have scheduled extraction + bone graft for this Monday. Ninety minute procedure, per my dentist. Then 4 months down the road, the actual implant gets placed.
When you think about it, only part of my original tooth is actually left right now. The pulp is gone because of the root canal and the top has been shaved to fit the crown. Given that the structure of what remains is already compromised, there is no point in waiting for another infection before having it pulled. I probably should have listened to my dentist's advice from the start but I focused in on the "93%" success rate quoted for root canals. I'm thinking there needs to be some fine print that goes along with that statistic.
Thank you both for relaying your experience and advice.
I am definitely doing the full course of antibiotics.
After reviewing my Xrays with my dentist, I have decided to follow his recommendation for an implant and have scheduled extraction + bone graft for this Monday. Ninety minute procedure, per my dentist. Then 4 months down the road, the actual implant gets placed.
When you think about it, only part of my original tooth is actually left right now. The pulp is gone because of the root canal and the top has been shaved to fit the crown. Given that the structure of what remains is already compromised, there is no point in waiting for another infection before having it pulled. I probably should have listened to my dentist's advice from the start but I focused in on the "93%" success rate quoted for root canals. I'm thinking there needs to be some fine print that goes along with that statistic.
93% success rate for root canals, is the rate that the procedure itself will be successful, and without complication. The long-range success rate would be lower, and perhaps significantly lower based on all kinds of things.
Such as - does the patient follow routine dental maintenence recommendations (such as brushing 2x/day with a soft brush, flossing 1x/day, using a medicated rinse such as Listerine 1x/day, 6-month dental checkups, not smoking, minimum drinking, etc. etc)? Does the patient have other risk factors (heart disease, chronic sinus infections, chronic ear infections, systemic yeast infections, bulimea, cocaine abuse, etc. etc)? Has the patient shown a pattern of tooth decay/root canal need in other teeth?
All of those factors have to be added into the situation when you're trying to figure out long-term success. The 93% only means, if the dentist does the root canal, it won't fall apart on your way out of his office when the procedure is over, OR he won't discover that the problem is worse than expected and the tooth needs to be extracted.
Don't knock yourself over the head about not taking the first bit of advice. Dental care is one of those things, it's hard to find one you trust, and sometimes it's hard to trust what you hear, because you want to hear something else so you -look- for something else til you find it. Even if what you find is the wrong decision. Yes, dental care involves guesswork. But it's guesswork resulting from many years of education, residency, apprenticeship in some cases, and hands-on experience. It's the mechanic who hears your car run and says "oh no doubt, it's your tailpipe" without even having to look under the car. It's a guess, based on a sound. But it's also based on the fact that every time he hears that sound, it's the tailpipe, and he's heard it more than 200 times in the last 8 years.
Update: Sooo glad I weighed the advice given here and had the extraction done today. Dentist discovered cycst at the base of the tooth. The extraction and cyst removal were very painful. I was fully numbed up but I still felt a lot. The jaw has a lot of nerves and they seem wired fairly directly to the brain's pain centers. Not blaming the dentist as he proceeded with caution and asked me every step of the way if I needed more novocaine. Afterwards, he showed me what he pulled out and had I waited any longer, it would have gotten really bad for my jaw and neighboring teeth.
So he packed it with bone grafting material and sutured it up. Only complication is that the hole left runs close to my sinus so there is pressure/sensitivity. He lined it with some sort of collagen tape to prevent any pass through. I'm really hoping I don't have complications and have to see an ear/nose/throat doctor. Gonna take it easy the next few days.
Again, I appreciate the advice of AnonChick and Pawporri.
Abcess is a major serious pain, my sympathies. Been there, done that. The -good- news, is that the pain from the abcess is now gone. You -should- be feeling some relief from that. The bad news, is that sinus issue is still dicey so you need to be -extremely- careful for awhile.
If he suggested salt water rinses, run the water so it's -just slightly- warmer than tepid/lukewarm. You want it cooler than your natural mouth temperature, but you don't want it cold because you're going to be -excruciatingly- sensitive for the next few days.
Conversely, you might find some sinus relief by applying ice to your face, right at the edge of your cheekbone directly under your eye. Your best ice pack is going to be a cheap bag of frozen peas. It will conform to the contours of your face without you feeling any sharp edges like ice cubes cause.
If you use a waterpick, do -not- use it on the affected area, and in fact, you might want to just stick with a small-head toothbrush. Definitely rinse though, after each meal, gently at first, then as usual.
You might be tempted to poke at the packing with the tip of your tongue. Please don't give in to temptation for at -least- the next few days. You need the tissues to start to mesh, while the stitches are intact.
Drink lots of water, don't smoke or chew tobacco, go easy on the coffee, avoid sweetened sodas or sugary juices, and no alcohol til 24 hours after those antibiotics are all used up.
Also avoid sugary desserts like cake with chocolate frosting or canollis. Not for the reason you would think - but rather, the teeth on either side of the packing are going to be pretty sensitive for awhile, and sugar can trigger pain in sensitive teeth.
Caffeine is a bad idea for now, because of the blood constricting. For the same reason, if you get migraine headaches, don't take cafregot without letting your dentist know.
This is all to help that bone-pack become absorbed and promote growth, and not inhibit that healing action.
After around a week, if everything is progressing as it should, you will be able to relax and enjoy your coffee and a slice of cheesecake. Just remember to rinse after you eat!
Abcess is a major serious pain, my sympathies. Been there, done that. The -good- news, is that the pain from the abcess is now gone. You -should- be feeling some relief from that. The bad news, is that sinus issue is still dicey so you need to be -extremely- careful for awhile.
If he suggested salt water rinses, run the water so it's -just slightly- warmer than tepid/lukewarm. You want it cooler than your natural mouth temperature, but you don't want it cold because you're going to be -excruciatingly- sensitive for the next few days.
Conversely, you might find some sinus relief by applying ice to your face, right at the edge of your cheekbone directly under your eye. Your best ice pack is going to be a cheap bag of frozen peas. It will conform to the contours of your face without you feeling any sharp edges like ice cubes cause.
If you use a waterpick, do -not- use it on the affected area, and in fact, you might want to just stick with a small-head toothbrush. Definitely rinse though, after each meal, gently at first, then as usual.
You might be tempted to poke at the packing with the tip of your tongue. Please don't give in to temptation for at -least- the next few days. You need the tissues to start to mesh, while the stitches are intact.
Drink lots of water, don't smoke or chew tobacco, go easy on the coffee, avoid sweetened sodas or sugary juices, and no alcohol til 24 hours after those antibiotics are all used up.
Also avoid sugary desserts like cake with chocolate frosting or canollis. Not for the reason you would think - but rather, the teeth on either side of the packing are going to be pretty sensitive for awhile, and sugar can trigger pain in sensitive teeth.
Caffeine is a bad idea for now, because of the blood constricting. For the same reason, if you get migraine headaches, don't take cafregot without letting your dentist know.
This is all to help that bone-pack become absorbed and promote growth, and not inhibit that healing action.
After around a week, if everything is progressing as it should, you will be able to relax and enjoy your coffee and a slice of cheesecake. Just remember to rinse after you eat!
And here I thought frozen peas were simply a delicious way to spice of my casseroles.
Some great advice there. Hardest part will be laying off caffeine.
Also, he put this gummy material around the whole area he called a "tooth cast". It feels exactly like a wad of gum packed around the tooth. He said to leave it on as long as I could tolerate it. It really feels alien and unnatural. I'm going to to my best to keep it on until bedtime but I don't want to sleep with it on and have it come out at night and risk choking. But it does prevent poking at the packing material as you pointed out.
I have a followup Thursday and stitch removal Monday. I'm hoping to check back in here with good news.
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