I had a root canal with a crown 5 years ago on my right lower molar (#30). Everything went fine; no infection, hardly any pain during recovery...
Last week I started to get very strong ache in that tooth but ONLY when I ate or drank hot foods. If I chew a lot on that side it starts to barely get noticed but it's really only hot foods that make my tooth so painful I have to stop eatting. I can't even touch the tooth because of the pain. Drinking some cold water (which I usually have cold sensitivity in my other teeth) helps relieve the pain a little.
I went to my dentist and got an xray and he referred me to an endodontist. He saw the xray and said the root canal treatment 5 years ago looks good, but couldn't give a clear answer why I was having this pain, he thinks there may still be some nerve endings that was not taken care of originally but couldn't say for sure.
He said I could either 1- get another root canal and really clear everything out really really well, 2- do nothing and try to live with it. 3- extract the tooth. #3 is NOT an option, #2 is not a realistic option unless I want to live my life in misery whenever I eat hot or warm foods.
Is it common to get another root canal 5 years later? Has anyone had treatment for something like this other than getting a root canal? Should I get a third opinion?
It's not out of the ordinary for a tooth to have multiple roots. The most probable culprit is a missed root when the first root canal was performed.
When you get a root canal, the root is removed so you should not feel any pain at all in that tooth. So the fact that you are having pain is most likely due to the missed nerve like the dentist mentioned. You can try brushing with Sensodyn for 2 weeks (if you can bare it) and see if you feel better. But if there is a root in there, that is most likely what is causing you discomfort and you will not feel much better until it is out!
I know about cases where a root canal wasn't possible because there wasn't enough tooth left (as you know the tooth is filed down in order to fit the crown). Ask your dentist if you go with the second root canal, if there will be enough tooth left to actually place a crown. If they shave off too much tooth and a crown can't be place, you will need a bridge or a dental implant.
I had a 2nd abcess happen on the same molar about 6 years after I had a root canal done on it and crown put on. The x-ray showed in my case that one of the roots had cracked vertically which allowed bacteria to get to the base of the root and cause the 2nd abcess. I ended up having to have the tooth pulled due to the cracked root.
For several years before the 2nd abcess happened it hurt to chew on this tooth, and a couple weeks before the abcess went full blown the area around the base of this tooth was very sensitive to hot and cold.
Sometimes with root canals, if they don't get all the way down to the bottom of the root to clean it out, there can be a small amount of infection/gunk left there which can cause problems down the road.
As the other poster mentioned, you could always try a sensitivity toothpaste for a few weeks to see if there if any improvement, and if not then you could proceed with a 2nd root canal. Perhaps you could call the endodonist and ask if a 2nd abcess happened if that would automatically mean extraction or if they could do a 2nd root canal at that point.
I'm not a dentist. I just spent waay too much time at dental offices. But as far as I know, YES crowns can definitely crack!! And I believe that could cause a kind of pressure pain. Did the current dentist remove the crown, or did he just take xrays? It may be a good idea to just have the crown taken off for further investigation. I'm wondering if your dentist could do this before committing to the root canal... I'm not sure how your relationship with your dentist is, but if you've known him for years and feel comfortable talking to him and asking questions, just explain to him that a 2nd root canal at this point is the last thing you want to do. Obviously, if that's what's needed, you can go with it, but you would like to know if it could be something else (like an infection, or a cracked tooth, or if he sees inflammation, etc).
If you had an infection, you will have a bad smell in your mouth/ around the area... like a almost rotting smell. You may also have pus, and may also run a fever. If you feel like you have any of these, definitely go the antibiotic route. Personally, if you're in pain, I would hate to even suggest waiting for a round of antibiotics to work (because amoxicillan, which is most commonly use by dentist, has to be taken for about 10 days). You can always go for a second opinion somewhere else if you don't feel convinced. Also, at 1250 a root canal, I would ask about a dental implant!! Where I worked, we offered dental implants (that's including post and crown) at ~$1700. A lot of money, but a lot more permanent than a root canal. Oh! And something I just thought of... this may be sneaky and I don't know where you live, but a lot of practices offer free consultation for dental implants! (this does not include xrays, but if you have a copy of your xrays, you can bring them in, or take new ones upon the consultation). You can tell the dentist your story (had root canal done 5 years ago, now having issues, etc), and tell them that you heard that a dental implant may just be the best route given the circumstances. So for this free consultation, the dentist will look in your mouth and tell you if he sees anything out of the ordinary with the tooth. Yes, he will try to convince you to get the implant (it's all a business), but you don't have to feel pressured into it!! That way you'll get information about dental implants (which trust me, bad root canal jobs usually require dental implants in the future) and between $1250 and (a possible) $1700, the difference is not huge for receiving a permanent solution for your tooth.
Ok, I've said enough! LOL. If you feel it's an infection, take antibiotic. Take Motrin (ibuprophen) 800mg for the pain in the meantime. !
Last edited by Administrator; 02-14-2011 at 05:41 AM.
I was doing a search on this board from previous posts on heat sensitivity and there was one post with EXACT same situation (root canal done 5 years before but now hurting with hot foods, posted 5/14/2004.) It was mentioned that there may be an abcess.
My endodontist said all four roots were visable. IF there is a fifth root and it abcesses what are the symptoms? Would a fifth root that was missed on a RCT be difficult to see on an xray? Are abcessess visable on xray?
I called the endodontist again today to please explain to me if another RCT would slove my problem. He wasn't sure. that wasn't comforting. I asked if there was a fracture in the root if that would cause pain with heat, he said possibly, and extraction would be the solution.
I just don't know what to do. I could wait and see if the pain eventually goes away. There was a previous thread from 7/11/05 where this same situation happened and the poster said the pain eventually went away after doing nothing for a few months.
I cannot afford dental implants, and dont want it if I don't have to. But then I don't want to hdo the RCT if I don't have to. I'm not afraid of the procedure, it's the cost I can't deal with.
When a root canal is done, in theory, no pain should be felt in that tooth. Because the nerves are supposedly removed. Is it possible that a root was missed during the initial treatment? It IS possible. But xrays should show any extra root (margin of error- correct xrays weren't taken and maybe an angle was missed so a root was missed- purely hypothetical though). This is probably why Doc wasn't sure if RCT would help. Because he doesn't seem to believe there is another root in there (is my guess). Again, there shouldn't be a fracture in the root cause you shouldn't have roots (going with the theory that all roots were removed). But what I'm thinking is that you hurt the crown and that is what is apply pressure and pain to the gums. Because something like an inflammation in that area can cause maybe the roots of the surrounding teeth to hurt and it could feel like the pain is in the RCT tooth?
Try and describe the pain. Is it constant? If you jump up and down, do you feel the pain more when you jump down (throbbing pain)? Or is the pain consistent? Do you feel any sensitivity to hot and cold liquids? And has the dentist examined you? Or is the communication via phone? When did you last see the endo? When was your last xray taken?
If there is a 5th root was left, I think RCT is your only route (don't extract!). I can't say anything about an abscess tooth because I've never seen that situation first hand. So I really can't help you there. The poster from '05 probably had some inflammation which is probably why it eventually subsided.
If you don't have recent xrays, I think you should definitely start there. The xray should tell you if there are any roots left. If the xray doesn't reveal extra root, we're going to have to find the root (no pun intended!) of the pain. I wonder if your dentist can just remove the crown and inspect the tooth. Maybe there's something going on in there that can explain the pain like an infection. Do feel feverish at all?
I really don't know what to say . At this point, I don't see a reason for either a RCT or a dental implant. But that assessment can only be made by your endo upon examination. If you fully trust what your endo is saying, I would suggest seeing a general dentist. They are the ones who usually refer you to the needed specialist. Maybe it's a gum issue in which case you would need a periodontist, or maybe even a prosthodontist who specializes in the teeth restoration (maybe fix the crown if it's a fitting/ cracked issue). There's so many ways to take this, and none, I'm sure, are answering your questions. But if you answer the questions in blue, I can try and think of something else.
Curly fry- you are the best! Thank you for taking the time to reply and think about my situation. I hope you are blessed in return some day.
Ok, to answer the questions in blue:
The pain only occurs when I eat hot foods/drinks and it is sharp yet throbbing pain that does not easily go away. I haven't tried jumping to see if it hurts but when it does I can't even touch the tooth with my tongue.
I can't imagine it being a fractured root because when I bite down on cold or lukewarm foods that are hard, it doesn't hurt. The endodontist placed a q-tip on the molar and told me to bite down as hard as I could. I squashed the q-tip and cracked the wood stick of the q-tip and it didn't hurt. He did another test where he placed a hot instrument on a specific spot and it hurt a little but i think it hurts when hot foods SURROUNDS the tooth. There's no pain to cold.
I first saw the dentist and he referred me to the endodontist. I had an X-ray done at both places. My last endodontists appt was this past few days where I had a consult and he suggested rct. I have never met him before, seems nice, he's been practicing as long as I have been alive! What I don't understand is he said he doesn't know what would cause a tooth to hurt from hot foods after rct. You mean he's never had this situation in 37 years of practice??? I'm thinking what did he do for his other patients that had heat sensitivity after a rct tooth?
I'd be very surprised if there was a missed root. The. Dentist didn't say anything about a missed root and neither did the endodontist.
I almost feel like he automatically wants to do a rct to get the business, but his practice doesn't seem like they're hurting.
As far as gums hurting, I don't feel any pain on the gums, only the tooth.
This is so typical of me. Whenever I have health problems it's always a mystery, it's never a clear answer of what's wrong and it's always something rare.
As I am sitting here I haven't had any hot foods and the tooth doesn't hurt yet it doesn't feel quite normal.
yea, I'm happy to help. But I am no dentist!!! I guess I just play one online .
I find it odd that you feel sensitivity to hot and not to cold. Sensitivity to hot and cold usually means root canal. And actually, it is extremely rare to feel sensitivity to hot/ cold after a root canal (assuming it was done correctly and all roots were removed). And then to just be sensitive to just hot is probably even MORE rare. It's like phantom pain or whatever when you feel pain in a leg that's been cut off. The leg in your tooth has been cut off! Sorry for the light humor. Work makes me crazy .
if the dentist didn't see anything in the xray, the next thing to do is remove the crown to make sure there's not an infection. you may have a cavity on your natural tooth. But then again it should have appeared on the xray. Do you have any white fillings around the area? While white filling are aesthetically pleasing, they suck. They're not durable and they're more expensive then the silver ones! White fillings tend to over react to things, such as hot liquids or foods. So if there is a white filling around the RCT tooth, this could be a reason.
If there's no white filling... . Thing about dentistry is that it is not an exact science. There's no real black and white. A+B doesn't always equal C, and what works for D may not work for E, even though they're twin brothers!!! At this point, I would insist to have the crown removed. This does not mean get another RCT. This is just to remove the crown, look around make sure there's not an infection, clean it out and replace it. At this rate, it seems like it has to be an infection, or inflammation (for whatever reason) caused by the adjacent teeth or surrounding nerves.
And I'm not sure why current doc wants to do another RCT?! Did he mention what tooth he wanted to do it on??? Cause you don't have any roots in that tooth!!! Would you be comfortable treating it like an infection and go through antibiotics to see if it helps?
I'll try and think about another possible scenario. But in the meantime, I would try some ambesol or some other dental anesthetic for temporary (very temporary) relief and Motrin/ ibuprofen. And stay away from soup!!
Last edited by Administrator; 02-14-2011 at 05:48 AM.
Well I've had some new developments, not sure if it's good or bad.
Since last night my tooth doesn't hurt very much when eating hot foods, some very mild tenderness. But today I've noticed that when messaging my gum where my root would be, it's very tender. A strong dull ache. Does that make sense??? The gum very low, where my cheek joins is where it hurts, but not on the side where my tongue is at. I think it is swollen slightly compared to the tooth on my left side.
Could this be an abcess? I don't have a fever, there is no pus, I don't think I have bad breath- my husband hasn't complained
Well, I ended up having the repeat rc this morning. As of yesterday there has been no heat sensitivity but my root has been sore when pressing on my gums.
The endodontist this morning said there was no fracture but couple of the roots did not seemed to have been cleaned out very well, leaving tiny pockets of space and the material used wasn't as dense as it should be. He thinks my pain came from fluid seeping into the pockets and expanding with the heat, hence the pain.
We shall see if this solves the problem. I go back in two weeks.
I hope this solves your problems . I really couldn't think of anything else that could be wrong. But I am happy they went in there and removed the tooth and looked around!!! Seems like you are a little better. And the soreness is probably just due to the procedure itself and you may still be healing. Keep us posted.