While all is not equal with x-rays and a cone beam, having both tools available is a priority for me. However, sometimes, even these tools don’t show the whole picture. Why?
Well, people always say “Don’t judge a book by it’s cover.”
I always say, “Don’t judge a tooth by its x-ray.” Also, don’t assume the worst. Give things a chance.
That’s how I practice endodontics. I never say “never,” and I always give teeth a chance. I won’t know if something is going to work until I try. Let’s look at a specific case that highlights the need for both tools!
Patient: 35 year old woman with pain in a tooth that had already had a root canal
Diagnosis: Previously Treated and Symptomatic Apical Periodontitis
X-Rays and a Cone Beam: I Do Both
My philosophy served a recent patient well. She came to me as an emergency case, experiencing lots of pressure and pain on a tooth that had already had a root canal. Usually, I try not to “meet and treat” my patients, because I need time with them — they have questions that I want to answer. I like to make sure the patient understands their treatment and treatment options, and I want to make sure I am treating the right tooth.
Getting the patient to understand the why is key, and that takes communication, transparency, and patience.
However, if the patient’s pain is characterized by intense pressure, and they are in tears, I reassess the situation and treat immediately. I know that their tooth is trying to drain, and I want to make that happen for them.
When a patient comes to me and their tooth already had a root canal, my protocol is to take not just x-rays but a cone beam as well. (Now do you see why x-rays and a CBCT go hand-in-hand? Or at least in MY practice, they do!)
Different Pictures: X-Rays and Cone Beams
Some dental professionals would have said that the cone beam was suggestive of a vertical root fracture… and that was possible (and most definitely a part of my differential diagnosis). But I could not be certain.
The x-ray imaging looked like the previous root canal had been done well. But since I had no history of the tooth — and the patient didn’t remember any details — I had to keep in mind that it was possible that the tooth had a new bacterial infection that had nothing to do with a crack. It can be easy to blame pain and infections on cracks when treatment isn’t working, but bacteria is a more likely culprit.
So Many Unknowns
There are so many variables I did not know about the initial treatment. Was a rubber dam used? Was full-strength sodium hypochlorite used? How long did it take the patient to get her crown?
I gave the patient her treatment options: retreatment with another root canal, or extraction with an implant. I explained to her that, even if she chose a second root canal, I could find a fracture in the tooth and it would still need to be extracted. She wanted me to try it anyway. Complete transparency before starting procedures is extremely important to me and to my patients.
When X-Rays and a Cone Beam Aren’t Enough
What I found surprised me. I opened the tooth to find black, black and black. I was so surprised to see the level of infection in the tooth. The gutta percha was so contaminated by infection that it turned black.
Once I removed the gutta percha, the infection started to drain. And THIS is the key to helping a patient feel better. Instant gratification for both me and my patient.
An Informed Decision
I understand that there’s a learning curve to reading cone beam images, and they can be misinterpreted. Some would have thought to take this tooth out because of a possible fracture (since root fracture can cause pain after a root canal).
If you’re not 100% definitive in the cause of root canal failure, then access the tooth for a visual assessment to be sure. Sometimes we don’t know the answer before going into the tooth. But if you prepare your patient for the potential outcomes, then you have given them the option to take the chance with you.
Thankfully, I had both the x-ray and the cone beam images to help inform me. Every tool and process plays an important role, and the more you stick to your gut and evaluate the different options, the better chance you have of saving teeth. (That said, don’t forget the “sticking to your gut” part, because your tools may not always show you everything.)
X-Rays and a Cone Beam Image: Each a Part to Play
The cone beam for this patient did not look good, but if I had judged the tooth by its x-ray, I would have done a total disservice to this patient. It would’ve been a complete misdiagnosis, because the root canal infection didn’t show up on the X-ray.
I was lucky that the patient wanted to try and save the tooth. It was the right choice for her and her health.
In Conclusion
Always be transparent with your patients. Give them all their options — and the “why” behind each option. If you rely solely on an x-ray to diagnose, you can make the wrong choice. Use all the information and clues you have.
Remember, a tooth can be contaminated, yet that won’t show up on x-rays and a cone beam. (In fact, I would recommend you assume that it’s contaminated over just trusting what the images say.) Be open to stepping outside your standard operating procedure if it allows you to better serve a patient… especially one who is in pain.
For additional tips and resources, make sure to connect with me on Facebook, Instagram, or Linked In.
This. Everyday!♡♡♡♡♡
Thanks JM! I feel the same!
I’m in this situation. 19 times I have been to the dentist or sent to some specialist for my tooth pain. No one thinks anything is wrong. I can’t take pain medicine so I get steroids. Tooth #29 has had a root canal. It looks fine on X-rays and the cone beam. I have had it cleaned out. Eventually paid for the old crown to be removed and explored. Nothing at all wrong they say. Yet it is the only one hurting in my mouth. The dentist will not pull the healthy tooth and I have exhausted my insurance 8 months ago in this journey. It’s brutal
Laurie,
Perhaps you can see another endodontist. I have retreated several of these teeth and had some success. It’s not 100%, but 8 times out of 10, my patients feel better after I treat the tooth again. I don’t know you exact situation since I have not evaluated it, but this is just a thought. Hope this helps.
-Sonia
Omg I’m going through this rite now these dentist think I’m nuts I had a root canal 15 yess as Ed ago on number 19 then a root canal last year on 18 the dentist keep saying nothing is wrong I hope you get the help you need prayers 🙏
Gina,
If you haven’t seen an endodontist with a CBCT, then that would be my next step. There is so much we can’t see from an x-ray, but keep in mind your discomfort may also not be coming from a tooth. I hope you find the answers you need.
-Sonia
My dentist and hygienist have said repeatedly that a failed root canal has left me with an infection. However, I feel normal, and have no pain in my tooth at all. They want to pull the tooth and put in an implant. They are going by looking at the x-ray only. Should I go to another dentist and get a second opinion?
Barbara, just because you don’t have pain, does not mean that you don’t have a problem. It’s up to you if you want to seek a second opinion, but I would suggest seeing an endodontist for that. I hope you get an answer.
-Sonia
Can root canal rreatment cause tinnitus? Also I had a root canal done on another side and first two weeks it was fine but now after two weeks I “feel” the tooth. XRay shows everything is normal… What might be the reason? Thank you!
I am so sorry, but I would need to evaluate you personally to see if this could be related to your root canal.
-Sonia
Hi Sonia,
What would you say is the percentage of root canal treated teeth that never have any infection, and how can you be sure unless you’ve re-explored the tooth?
I had a root canal done once that required a retreatment. I should mention the dentist used biocalex on that one. Then about 2 years later the crown broke off and the tooth was a failure/was extracted. In my young twenties I also had two root canals and both of them fractured while wearing temporary crowns and I was waiting to be seen again, which had to be pulled.
Currently I have a tooth with a large filling and crown that look fine on x-ray and CT scan but still have a lot of pain and sensitivity on it lately. If it continues I am looking at extraction or RCT of course. But I’m hesitant to do the latter and also hearing so many other people’s issues.
John,
This is a hard one to answer without being able to evaluate you myself. There could be a number of explanations. One thing I would ask your dentist is why do you keep breaking your teeth, perhaps you need a nightguard or need to evaluate any parafunctional habits or your occlusion. And just because you have a root canal doesn’t mean that you can’t get new decay under a crown and, therefore, more bacteria in the tooth. Again, it’s too hard to tell you specifics without knowing specifics. You can have an asymptomatic problem, but usually symptoms and imaging will tell if your root canal is not doing what it needs to do. I hope this information helps you.
-Sonia
Hello,
I had 4 root canals on 2 molars 2 years ago in 1 week. The last 2 root canals, on each molar, were done by an endodontist. Fast forward to present time, I had one of those teeth extracted due to an infection that was still present and causing me to be dizzy and have headaches. My doc did not give me an antibiotic. The 2nd molar has been in pain since 2 years ago, but I was able to manage the pain. Now, I cannot manage it anymore. The cbct scan and x ray do not show any problems, but I also had to wait one year to get a crown due to covid shut down. I really feel if my tooth were extracted my problems would go away, but they will not touch a “healthy tooth”. I’ve had an MRI to rule out nerve damage. My tmj has been damaged as well due to the force of the extraction. I’ve been in excruciating pain for 2 months now and an oral surgeon, endodontist, general dentist, and primary doctor don’t have a clear path on what I should do. Please help me. Should I switch dentists? Should I try a 3rd root canal? Should I get it extracted and replace it with an implant? Please any advice would be helpful! I feel like this is killing me slowly!
Sara,
I am so sorry that you are going through all of this discomfort. I wish I had more knowledge of your story to give you a path forward. Without more data and being able to test you myself, I could misguide you. You are always welcome to come see me in my practice if that is an option for you.
-Sonia
I am going through a very similar thing myself except the headaches are severe and many other weird symptoms. Its hard being out there and feeling helpless. Everybody thinks your crazy while your sitting there in pain. If you need any advice email me. Jewls0314@gmail.com
Juliana and Sara,
It’s possible that your pain may not be from the teeth. Sometimes, I need to refer patients to an oral facial pain specialist when the symptoms don’t add up. You can try finding an endodontist in my trusted resources page on my website and maybe they can help guide you if they don’t think the pain is related to the teeth. I am so sorry that you don’t feel heard.
-Sonia
Well I am also going through the same ordeal. All scans appear normal after 3 root canals which all seem to feel off, one in particular if I eat anything hot and it hits above the tooth. I was told possible trigeminal pain but it only happens with hot foods. I have exhausted my doctors which I do think are all exceptional. Not their fault. I saw a facial pain doc who at first told me TMJ, then changed it up to orofacial pain after I declined his $1200 TMJ device. Said there is basically no hope it’s a doom and gloom situation. I have never had issues until really after the root canals. I personally feel that some people cannot tolerate them and that our bodies can reject the materials or the tooth or our immune system does not like them. I am torn to pull the teeth but told I should not. One thing that I would like to say if anyone is reading. One woman suffered 5 years in pain and had cone beams, multiple x-rays and specialists. Told neuralgia but doctors went back in and found massive infection. Don’t doubt yourself if your in pain. Don’t let them tell you its ok. dsneed@mail.com
Juliana,
It is really important to be an advocate for your own health, I totally agree. I think you may be correct, some people can tolerate some things and some people can’t. Just like my daughter and peanuts. She simply can’t eat them, but that doesn’t mean it’s the same for everyone else. Have you ever thought about getting your tooth re-treated? I say this because my own root canal needed a root canal and didn’t feel better until I redid it with the Gentlewave. Perhaps you can see an endodontist who has a gentlewave. I have done this with many patients and have had great success, but just like anything in medicine, nothing is 100% and it doesn’t work for everyone. I hope this helps you.
-Sonia
Sonia
I am going through a different situation. I have been dealing with coughing due to sinus drainage in my throat and wheezing in my throat. I saw my doctor who noticed a bump on my lympnodes on left side and she asked if I had a root canal on my there and I said nearly 40 years ago but I had no pain but remembered some swelling on gums. I also told her I was to go to my dentist to have a filling on tooth 21 next to it. She recommended they do X-rays to check for abscess. My dentist gave me a Panoramic X-ray. My dentist said she didn’t see a root canal there and that it must’ve been on the tooth before that which was extracted. She however said that she saw something on tooth 20 and probably was abscess and recommended a root canal . My thing is I know I had a root canal on the molar and it still has the crown. I have to wonder if it has failed and infection spreading to 20 and 21. . I have no pain for tooth 20 and wonder if I really need a root canal.
Marilyn,
Unfortunately, I do not have enough information here to give my 2 cents. I would see an endodontist in your area that help get you the clarity that you need.
-Sonia
How come medical relies heavily on x-rays to cover bill?
Mam so irrigation was at fault in this case?
Patrick,
Bacterial contamination is the etiology. I don’t know whether or not a rubber dam was used, nor how they instrumented or irrigated. These are things we may NEVER know on a retreat, so I just proceed knowing that bacteria needs to be eliminated.
-Sonia
Great case..
Every tooth need the 2nd Chance…
Thank you Dr. – I’m glad we agree!
-Sonia
Recently I went to a government hospital in Malaysia for lower right molar pain and had to chew on my left side.
Prior to this I had an infectious upper molar in 2014 and was given antibiotics and anti gum swelling. The private dentist offered two options
1) Root canal
2) Extraction
I tried clamping the upper molar and the immediate lower molar with a folded gauze. While the antibiotics cleared the infection and the clamping placed the infectious molar in its place. There is no pain since then.
My recent episode on 07/11/22 was a trying one. I told the dentist of my 2014 experience but it fell on deaf ears. She sent me for x rays and showed me infection in the 2014 molar and the lower molar and gave me an option of either root canal in the private sector or extract. When I suggested oral intervention she said”I don’t prescribe antibiotics”
Then I told her “Are you a professional?” Thanked her.
My contention is to give oral intervention a chance to remedy a condition . Failing,then only the dentist should suggest surgical intervention.
Thanks for lending me your ears
Have a good day.
Gurdeep, Thank you for your response. I am sorry that I don’t feel that I have enough information to properly respond to your comment. I would need to evaluate you myself to feel comfortable to give my opinion here. I really hope you find the care that you need.
-Sonia
My main frustration with my Endodontist friends is when they tell me a tooth is fractured and hopeless, and I don’t agree. I am all for saving teeth. Sometimes I can see the reasoning behind the diagnosis, ie: difficult patient, questionable prognosis. It always pleases me when you do give the tooth a chance.
Thanks for all you do!!!
Hi Robert, I will be one of your Endodontist friends who agrees you can save a tooth!
I don’t think a difficult patient or a questionable prognosis should ever stop you. I think as long as you’re transparent with your patient and explain the possibilities, and then if they are still willing to try, then it’s worth the exploration.
Thanks for following!
-Sonia
Many years ago a dentist told me there were 3 types of lies;
1) Lie
2) Damn lies
3) Xray lies!
He was correct. we just cannot see everything and sometimes we just get fooled. I once saw a 3rd molar with a PERFECT looking 3 canal obturation done by a specialist. It was absolutely killing the patient. Upon extraction, I saw that each canal had 2 to 3 mm gutta percha overfill- but it looked perfect on the X-ray.
Most of my patients would have opted for extraction due to the cost of retreatment. This person already had the cost of RCT and crown in this tooth.
Was this case one where there was a temporary filling inside the access opening and they never had it sealed permanently?
Wayne,
I love the 3 types of lies! In this case, there was no temporary filling, it was permanent buildup. But they didn’t place the buildup all the way down to the gutta percha.
Thanks for following!
-Sonia
Thank You for the case study.
Thinking outside the box after “ listening “ to the patient and what the tooth is trying to tell you is often missed in a hurried, fast paced practices. Every day in practice we have opportunities to do good for the patient and walk away feeling gratitude and happiness.
Keep up the good work Sonia !
Hi Dr. Kamodia! It means so much that you’re reading these! Stay tuned for much more…
-Sonia
Dr Sonia thank you for constant updates….
Your blog gives me constant check and support to what all I decide as treatment plan, which is almost same way you do to much extent.
I keep myself up just to read your blog and that gives me strength, support and confidence as many of my fellow Endodontist colleague here in India differs.
Keep Up the good work !!!
Regards
Dr. Shanin Farista
MDS – Conservative Dentist and Endodontist
Laser Diplomate
Divas in Laser
India
Thank you so much for reading Shanin! This is my mission – to help spread knowledge that we all need to practice better everyday!
-Sonia
I just had my second opinion from an oral surgeon that they don’t see anything on my x-ray. First opinion was of my dentist was they don’t see anything on the x-ray. I don’t have the pain but a pulsating sensation and what I describe as nerve sensations up the left side of my face. It seemed as if the surgeon was thinking since I already had a root canal on the tooth I think is causing the problem that I would have these nerve sensations. I am so frustrated because I feel like whatever is happening is spreading to my ear and whoever knows where else and I am over it! I would have gladly let him pull the tooth but now I am taking matters in my own hands and finding anyone that will listen!
I’m so sorry you’re going through this, Michelle! I’m glad you’re advocating for your own dental health. You are empowered to make the right decisions for you!
-Sonia
I bottom fromt teeth drilled down for crowns and temps put on. Two days later I’m in excruciating pain. Went in and they did 4 root canals without a damn. Still in pain. That was November. Nothing is showing up on X-ray. Also, still in temp crowns because mouth hurts too bad. Any advice?
Jennifer,
My teeth are super sensitive for 8 weeks after I get them filled. Sometimes, the sensitivity is part of the normal recovery. Unfortunately, I don’t have enough information to guide you though. Please seek out a second opinion or ask your provider again if you still have questions. Best of luck.
-Sonia
What was the outcome? I am going through similar situation
Hi Bua, the patient did not come back for a recall, so I don’t know for sure. But I did this over a few visits and she was completely asymptomatic. Hope that helps!
I just had a root canal in May. Still in pain with cold and aching jaw pain. My dentist doesn’t see a failed root canal, so she sent me to an Endodontist. He did X-rays and endoice test. Endo says root canal was done well; however, says that there could be an infection inside the tooth, and that options would be to re-treat with a root canal, or extract the tooth. He says that there should be no pain or feeling in the tooth right now, so encouraged the root canal. Is this accurate? Can there be an unresolved or trapped infection? My dentist did give me antibiotics (maybe a month after the root canal), and that didn’t help. I feel like we doing another root canal as a shot in the dark, but I guess there isn’t another option?
Hi Liz, thank you for your question. It’s possible the root canal needs to be redone, or it’s a different tooth that needs to be treated. The answer depends on your symptoms and how your teeth test. I would trust your endodontist. In my own practice, I have had to retreat some of my patients’ root canals; they healed well afterwards. Wishing you the best. -Sonia
I have been having a toothache for the last 3 months. That tooth had root canal treatment. My dentist took xray and didn’t show anything as it is in your case. I was prescribed 3times antibiotics (amoxicillin then metronidazole) there is no progress on the healing. Still having the pain. I am just wondering if I am the same case as yours.
Ian,
There are many reasons why you may still be having pain. More antibiotics are NOT going to help. It sounds like you may need your root canal retreated. I would start there and perhaps see an Endodontist. I hope this info helps.
Best,
Sonia
I had a root canal done on mt tooth D30 in april. It’s been 7 months of pain, discomfort, sensitivity. Even my ear and my neck hurts and some noises even bother me.
Visited 3 endo specialist, 2 oral surgeon and 1 dentist.
All i got is the fillings are a bit overextended and a bite adjustment. Everything else is looks fine or it’s too early to tell.
I am literally desperate. Any ideas?
Antonio,
I am so sorry to hear that you are in pain. Has it gotten any better? It’s so hard to be able to give you advice when I can’t personally evaluate you. I hope that you understand. If it still hurts, then I would request that the tooth be re-treated, but again, I don’t have any imaging or anything to give you proper advice.
-Sonia
A good case for study Dr Chopra ! Those who have no access to a cone beam hopefully would’ve done the retreat .
Michael,
Thanks for reading! Yes, I always assume possible contamination.
Sonia
Hi had Alot of pain after root canal treatment,, After 8 months of messing around I got the Tooth extracted by another dentist, and he confirmed that the cone filling in 1 of the canals was 5mm longer than the root!!! Can this cause pain in Tooth ?
John,
It definitely could make you feel like something is off, but my guess is that there was also still bacteria left in your tooth.
-Sonia
Hi Sonia I had a root canal treatment on my bottom back tooth on my right side in 2008. this was done after my crown came off, When the crown was put back in place with the paste or glue that was used I was in instant pain it affected my nerves somehow, I was put on amitriptyline to help with nerve regeneration. I then had root canal done apparently it was a success. My crown was refitted. About 2 years later my crown fell off one night so after hearing my story my new dentist put back with what he said was temporary paste. Twice over the coming years I was in pain with no infection or swelling but my dentist give me antibiotics anyway and the pain went away that I think in about 2016. This year the the intense pain came back but my dentist was closed due to COVID lockdown in the UK but he prescribed me antibiotics twice when the first didn’t seem to work he suspected an infection my pain went away again. Now in the last month the pain is back so I had an appointment and my examined me and took an X-ray and compared to the one taken in 2008 and could see no real difference but did put me on one round of antibiotics but this time the pain has not gone. Does this fit with the patient you had that showed good X-rays ? I apologise t’s such a long story but I would be interested in your thoughts if you have time. Thank you
Alistair,
Unfortunately, without xrays and a full clinical examination, it is so hard for me to give you feedback. I don’t want to misdirect you. I hope you understand. Please find an endodontist near you.
Best,
Sonia
Hi Dr. Chopra,
Great case !!
What conc. of sodium Hypochlorite do you use for irrigation ?
Thanks 🙂
Richa,
I do not dilute anything, so 5.25% to 6% works best!
Sonia
Hi there I was told i require a rct
Have you ever had cases where upon second X-rays it’s found an rct is not required and the patient could instead have an inlay or onlay
Hi there. Since I am not sure of the exact clinical situation without doing a full work up on you, it is hard for me to answer this question. Thank you for understanding.
-Sonia
Hi Dr. Chopra,
I had a root canal about 4 years ago. Occasionally I feel my gum tissue is slightly swollen around this tooth. There is no pain or discomfort.
I went back to my endodontist and had a cone X-ray. He said it looked fine.
My question is can I get this retreated with gentle wave even though it shows up as being uninfected? I feel it still has some lingering bacteria.
Collins,
I had to redo my own root canal since it hurt after treatment, and it got better with the GW. It also looked fine on the x-ray, but it was hurting me. It was also a bit of my bite too, which I have gotten adjusted with my prosthodontist. Now I have no more pain. Trust your gut, it is probably correct.
-Sonia
I have no root canals. However, my front tooth (24) suddenly began to throb and kept me awake at night until I took some Tylenol. The pain went away permanently. I went to my dentist and he took an x-ray and saw a very slight discoloration around the root of the tooth. He wants to do a root canal. I presently have no symptoms of pain, redness, or swelling. I went to another dentist to get a second opinion. The slight discoloration was barely visible and they didn’t diagnose me as needing a root canal proceedure. Instead, they noted to recheck the tooth in 6 months. This is a young dentist and is somewhat inexperienced. Now I am considering going to a third dentist, an older dentist known to be a “let’s wait and see” dentist. Am I being silly? Should I just go ahead and get the root canal because eventually I will need it or should I wait and see what happens?
Hi there. It is very hard for me to give you clinical advice without seeing you or being able to see your radiographs. If you are looking for another opinion, you can also reach out to an endodontist. I have a list of endodontists that I love on my website. Hopefully, you can find one that is close to you!
-Sonia
I had root canal on one of my tooth 10 years ago. Few month ago my dentist did an X-ray and it showed that there is something wrong with my tooth that I did tooth canal on it.
He referred my to another dentist forThe 3D image and he said that I need another tooth canal
My question is: why I don’t have any pain or sensitivity !
What happened if I just continue without doing anything!
Hi there. You don’t need to have pain to have a problem. Since the tooth has already been root canaled, you will not have that much pain because the nerve is out. However, that doesn’t mean that there isn’t a problem. I would trust the dentist that says you need treatment. You probably have a shadow in your bone which is bone loss and that bone loss will get worse if you don’t address it. Leaving it alone could result in an abscess or loss of tooth. Hope this helps.
-Sonia
Hi there. I had a root canal on my 4.6 10 years ago. No problems until the last few months when I started noticing a feeling of pressure (not quite pain) on this tooth. My dentist took a single PA and said everything looked fine and that my problem was that I was a grinder thus the pressure feeling. He prescribed a nightguard which I received a week ago. I wore it twice during the past week, and woke up this morning (did not wear it last night) with a gum boil. Could this be irritation from the night guard I only wore twice, or does this indicate that my dentist misdiagnosed my problem?
Kathleen,
It sounds like your root canal needs another evaluation. Have you seen an endodontist?
-Sonia
I had a root canal in my front left tooth #9. I immediatley had an infection. No dam was used during the procedure. During the last 2 years I have gone back to the Endodonist, a regular dentist, and the dental clinic due to the fact I have pain and can’t bite down. I have taken tylenol off and on several times a week . The pain is slight and not only is around #9 and #10 but radiated up my left side of my face and down my neck. I’m 71 yrs. old now and healthy, otherwise. I have a bridge on the other side. #9 has shifted back and #10 is very senstive and I could never floss between the 2 right after the procedure and even now because it hurts when the floss touches them. Now, the transition between my bridge and #9 is not even. I believe as my ligaments were trying to heal, my tooth pulled inward and now is even closer to #10, which I can’t touch without it hurting. Everyone has said my occlusion was probably off and have tried shaving off different teeth and this had definetly not helped. The dental clinic added filling to my top partial to raise my bite. Nothing is helping. What is my next move.
Linda,
I am so sorry you are having so much trouble. I would try another opinion, unfortunately, I don’t have any real information to give you any sound clinical advice. Best of luck.
-Sonia
Hello Sonia,
Thank you for such an informative case study. What if a patient has no symptoms? Can a root canal require re-treatment after 20 years of success?
I had a root canal on a lower molar 20 years ago without further complication. The endodonist did such good work that my dentist marveled at how much tooth structure was left intact and said a crown might not be necessary. I waited several years but decided to put on a crown as a precaution.
20 years later I had a very painful abscess near that tooth. After a course of antibiotics the abscess healed completely without any sensitivity and pain free for several months. To be sure, I followed-up with an endodontist who is suggesting re-treatment based only on x-ray. Cone beam was not performed. Can a root-canal fail after 20 years and require re-treatment without any symptoms (except for that scary abscess)?
Joe,
Anything is possible. Many infections can be observed from the x-ray alone and and it won’t need a CBCT. If you have more questions, I would definitely ask for a more detailed explanation from your endodontist.
-Sonia
I’m dealing with pain issues months after a root canal and crown were performed. My dentist recommends seeing an endodontist to determine if there is a cracked root. Is it primarily just the x-ray and CBCT that are used to detect this issue? Should I be asking the endos if they have a CBCT scanner? Are there any other tools I should make sure they have? Is the CBCT the latest technology?
Jerome,
I am so sorry that you have this issue. I would definitely see an endodontist for an evaluation. A CBCT will always help, but don’t expect to see the actual crack all the time on an x-ray or 3-D scan. It’s all in the interpretation of the data actually and this takes training to learn. I would see your endodontist for more answers. Best of luck.
-Sonia
If a tooth has had a root canal and showed signs of a crack or fracture to the root, does this mean the tooth needs to be extracted or is there an alternative? My dentist told me the tooth needs to be pulled as I came in and was in a lot of pain. However, after taking antibiotics the pain has gone away and now I’m having trouble understanding why the tooth needs to be extracted? Should I get a second opinion from an endodonist? I’m scheduled to see an oral surgeon but I’m not sure that’s the right person to ask.
Lynn,
That is a hard one to answer without being the one to personally examine you. Every situation is different. I have saved many cracked teeth, but also there are some that I have said that need to come out. It really depends on how big it is. I wish I could be of more help, it’s just not easy to diagnose it without properly evaluating you.
-Sonia
Heather,
I am so sorry that you are uncomfortable. I am sure that your dentist is listening, they just don’t have an answer and don’t want to treat you until they do. Have you thought about seeing an endodontist or getting a second opinion. I really wish that I could help you myself, but without getting to evaluate you in person myself I can’t give you a valid answer on treatment. I really hope you get what you need.
-Sonia
I have a wicked infection (BIG black area on the x ray that even I could tell was bad news despite a chemist with no formal medical training) in a tooth that had what the technician I saw today said is the worst root canal she’s ever seen. I’m on antibiotics and was told by the dentist that the tooth can’t be saved and I’ll need an implant. I’m in my mid 30s with no other dental problems; the original root canal seven years ago was needed due to an injury.
Do you think I might just need a better root canal and not the whole extraction/implant procedure?
I wish that I could give you more detailed advice, but unfortunately, I don’t have all of the information. See an endodontist, I am always hopeful that teeth can be saved. I have saved many with very large black areas on the x-rays.
-Sonia
Hi Dr. Choirs, I had a root canal done on my last upper right molar seven weeks ago. I had constant pain, made worse by pressure. Afterwards, the pain increased. I returned to the endodontist and he gave me clindamycin. After finishing the coarse the pain is reduced about 70%. He wants me to see an orofacial specialist. I’ve only had x-rays taken and he has no other diagnostic tools. He will not entertain the idea that the root canal may have failed. Before I spend money going to another specialist I was wondering if I should see another endodontist, one who has alternate diagnostic tools such as you use. I like your compassionate attitude and I noticed you list an endodontist you trust at UCSF which is within my area.
Nina,
I think that your tooth needs more time. Some people get post-operative flareups and that is just the normal part of healing. Sometimes I have to give a steroid as well as an antibiotic after treatment for those patients that need a little extra help in the healing phase. If it’s only the tooth that is tender, then it’s the tooth. So, without knowing your symptoms and being able to evaluate you myself it is hard to say. If this happened to my patient, I would offer to retreat the tooth. It’s up to you if you feel you need a second opinion. I hope you come to a resolution.
-Sonia
I’m not sure if this forum is still active but I’m going to post anyway, if nothing else as therapy for me. First, this was an excellent, interesting article, thank you, Dr. Chopra. Second, I’m sorry for the pain and trouble all of the responders have had. Ugh. My turn to complain: I went to my dentist for my 6 month check up. Routine x-rays taken. They show some swelling in the area of a previous root canal from 13 years ago. Dentist recommends sending to an endodontist who agrees that retreatment/new root canal should be done. I had no pain leading up to this. Procedure is done, all seems to go well. Leave with antibiotics. Pain is tolerable with Advil the day after the procedure. On the 2nd day I wake up with intense pain that the Advil helps but doesn’t completely help. Same thing on the 3rd day. As the 3rd day goes on the pain gets worse and worse, until finally I can’t move my tongue inside my mouth with out feeling like my jaw is being stabbed with a needed. Pain radiating in my head, jaw, neck. Call doctor, who changes antibiotic and gives me a 5 hour steroid treatment which helps immensely. Phew. But why did this intense pain begin and get so bad on the third day? This was unexpected and, like, not fun! Any thoughts are more than welcome!
Bill,
This is a very common scenario. What you experienced was a post-operative flare-up. In fact, it is so common that I never let a patient leave my office without letting them know that this can happen. I do this so that they don’t panic and think that something is wrong. It’s even on my post-operative instructions written out. It is more common in patient’s who need a redo root canal and have a “dark shadow” on their xray. So, have no fear, all should be good with your tooth. Thank you for sharing your experience.
-Sonia
I had a root canal in tooth 5 and less than a week later in 4. 5 did show infected pulp while 4 showed nothing but was extremely painful.
I went 2 weeks feeling great and now for two weeks, I am in such horrible pain on that side of my face. xrays look great. Dentist took out temporary fillings and replaced with a more permanent filling until I can afford the crowns. But two weeks of this pain and not being able to pin point the pain is getting old. I get dizzy and my eyes are twitching. Do I bother going back to Dentist or Endo? My dental insurance has been exhausted.
Kel,
Unfortunately, I do not have enough information to guide you properly. I would ask your dentist. I don’t want to send you someplace that you don’t need to go and then it cost you more money. Please refer back to your dentist on this one. Thanks.
-Sonia
Dear Doc,
I had undergone root canal treatment 10 years back, recently i have been experiencing pain and swelling around that region.
Dentists say there is an infection in the root canal and they have prescribed a courses of tabs, after taking the tablets, I’m very much comfortable with no pain.
Doc pls suggest me if i have to go for re root canal? And there is 0 pain or swelling as of now!
Riya,
Unfortunately, I cannot give you any medical advice without evaluating you myself. However, antibiotics are very good at masking pain and infections. So, it is very likely that you still have a problem even though you no longer have any pain. I would see your dentist.
-Sonia
Quick question – I have had tooth pain after a deep filling, which got better after bite adjustment. There is no pain now. The dentist did a endo ice test (no response) and is recommending root canal. Percussion test normal, I consulted another dentist and he doesn’t recommend root canal now since there is no pain. What’s your opinion?
Varun,
Unfortunately, without testing you myself, I cannot make a diagnosis. However, typically when a tooth has no response to cold, the nerve is dead and the tooth needs a root canal. Did the second dentist do the cold test? You will not know the answer without this test and the interpretation is also important which is why I cannot make a diagnosis without getting my hands in there to do my own testing.
-Sonia
Hi, I noticed a hard dome shaped lump way below tooth #30. Way below the gum line. It feels as if it is attached to the bone. I saw my dentist who has referred me for a root canal. He said it didn’t look like a bad infection. I have been taking Pen.VK for 3 days w/no change. The lump doesn’t seem to move. The area is not red/swollen, or painful. I have had a number of root canals done, but never on a tooth that has no pain. I don’t know how long it had been there but apparently wasn’t on a pan. X-ray in June 2022. Is the lump likely to be associated w/root canal ? I was hit in the lip and mouth area when playing racketball back in March of 2022, and it was very painful in that area /ear/Tmj,but cleared up and i thought no more about it-could the injury have caused the lump?
Tina,
A trauma injury to the mouth can definitely cause a lump or abscess if the trauma was severe enough. Please visit your dentist for a comprehensive evaluation, I do not have the capacity to give you my opinion here without evaluating you myself in person. Thank you for understanding.
-Sonia