Beauty & Wellness

same tooth needs treatment again (root canal done twice)

  • Last Updated:
  • Oct 12th, 2017 1:51 pm
[OP]
Member
Jun 28, 2011
229 posts
32 upvotes
VANCOUVER

same tooth needs treatment again (root canal done twice)

I went to see my dentist today for my annual cleaning and check up. He wanted to get some panoramic x-rays as it had been several years since the last set.
One of my back molars (tooth #36) is a problem child. I had root canal done on that tooth a number of years ago and 7 years ago, my dentist referred to me to an endodontist as it looked like an infection in that area.

The endodontist re-did the root canal which my insurance covered, thankfully. Three years after that was done, I went to see the same endodontist as I was concerned and he said that area may never fully heal but as long as I'm not in pain, then there's no point in doing anything.
Fast forward another four years and there's a definite issue in that area again. My dentist couldn't make a proper diagnosis and said I'd need to see the same specialist.
It looks like an infection of some kind (I'm not in any pain, thank goodness) and I may need an apicoectomy. (this is my own educated guess from googling and I could be very wrong)
The endodontist mentioned this as an option when I last saw him if I wanted to go that route but declined as I didn't have any issues then.

Needless to say, I'm not at all pleased about this, especially as I don't think my insurance plan will cover this.
Anyone else experienced this? Of course, there's no guarantee that I won't have further problems with this one. I'm guessing an apicoectomy is the last stop before extracting the tooth. Crying Face
12 replies
Deal Addict
Apr 5, 2016
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Calgary/Vancouver
Get a second opinion. You may need to go to another dentist to get another referral to a different specialist unless you still trust your dentist and he can get you a different specialist.
Current Fido customer.
Ex Koodo customer. Beware of their tactics.
Sr. Member
User avatar
Jul 11, 2011
854 posts
500 upvotes
Ontario
Simple solution would be to just extract the tooth.

It's only a back molar, many live without molars.
Deal Addict
Jul 26, 2004
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A different specialist might have a different view on the problem. You can request a cone beam CT scan of the tooth to make sure no canals were missed, but that might not be covered by insurance. That way you'll also get a clear picture of the anatomy of the tooth. Apicodectomy is always an option if the tooth just can't be treated conventionally. It's not that invasive of a procedure and your endodontist should be able to handle it fine.

Other reason for recurrent infections of previously root canal treated tooth could be there is a fracture somewhere in the root, if that's the case the tooth is done. Again a cone beam ct scan should be able see it.
[OP]
Member
Jun 28, 2011
229 posts
32 upvotes
VANCOUVER
coilz wrote:
Oct 4th, 2017 1:15 am
A different specialist might have a different view on the problem. You can request a cone beam CT scan of the tooth to make sure no canals were missed, but that might not be covered by insurance. That way you'll also get a clear picture of the anatomy of the tooth. Apicodectomy is always an option if the tooth just can't be treated conventionally. It's not that invasive of a procedure and your endodontist should be able to handle it fine.

Other reason for recurrent infections of previously root canal treated tooth could be there is a fracture somewhere in the root, if that's the case the tooth is done. Again a cone beam ct scan should be able see it.
Thanks for your input. I don’t think my insurance would cover the CT scan although my dentist did say the endodontist would have better x-ray equipment to make a better diagnosis.
I’m hoping that an apicodectomy will resolve the issue (my insurance may cover this) and you’re right, if there’s a fracture somewhere, I’ll need an extraction because it’s beyond saving. Although I would suspect that I’d be in considerable pain but who knows.
Fingers crossed when I see the specialist next week.
Newbie
Aug 15, 2017
40 posts
6 upvotes
I would not recommend a CBCT. I think it's absolutely ridiculous that endodontists take CBCT's to root treat teeth. Yes, I can see the need for oral surg or when a periodontist wants to plan implant placement, but to check for missed canals on an endo??? There is a risk with any amount of radiation, and a CBCT provides the most radiation of any dental exam. Especially when you consider, endo's do high resolution.

OP, it is common to not have resolution after RCT. It does not mean there is a problem and I would highly recommend seeing the same endodontist. An apicoectomy is something an endo does frequently, and again, a treatment option. Extraction should be a final option as there is no going back.

BTW, if your dentist does OPG's (pan's) on a regular basis, seek a new dentist. That is NOT normal practice unless you have a reason to have an OPG done. Radiographs serve their purpose but should not be relied upon.
[OP]
Member
Jun 28, 2011
229 posts
32 upvotes
VANCOUVER
TheSpandexSuplex wrote:
Oct 7th, 2017 5:08 pm
I would not recommend a CBCT. I think it's absolutely ridiculous that endodontists take CBCT's to root treat teeth. Yes, I can see the need for oral surg or when a periodontist wants to plan implant placement, but to check for missed canals on an endo??? There is a risk with any amount of radiation, and a CBCT provides the most radiation of any dental exam. Especially when you consider, endo's do high resolution.

OP, it is common to not have resolution after RCT. It does not mean there is a problem and I would highly recommend seeing the same endodontist. An apicoectomy is something an endo does frequently, and again, a treatment option. Extraction should be a final option as there is no going back.

BTW, if your dentist does OPG's (pan's) on a regular basis, seek a new dentist. That is NOT normal practice unless you have a reason to have an OPG done. Radiographs serve their purpose but should not be relied upon.
Thanks for your input. It sounds like you work in dentistry or have extensive knowledge in the field.
I will be seeing the same endodontist and based on his exam from a few years back, his recommendation was that if there were an infection, to retreat the tooth. (whether or not it will be an apicoectomy will be based on his assessment)
And yes, it does seem common for RCT's to have issues come up down the road so at least I'm not alone.
I'd rather not extract the tooth and yes, there's no going back after that.

My dentist doesn't do panoramic x-rays on a regular basis; probably every few years to see if there are any issues and he did mention the need to keep an eye on that problem area.
Good to know about the CBCT.
Deal Addict
Jul 26, 2004
2048 posts
262 upvotes
If it is the 3rd time this tooth is being treated, I wouldn't rule out a CBCT scan just due to radiation concern. Besides they do not need to scan the whole jaw, just focus on the area of the tooth in question which will lower the radiation dose significantly. I believe the newer CBCT machines with small Field of view setting for endo purposes is similar in radiation dose as a panoramic radiograph depending on machine.. setttings etc etc.

But the point is one CBCT scan won't kill you since this will be a one time thing, and it should give you more information as to what is wrong with that tooth so a proper course of action can be decided. Yes we should all be concern about lifetime radiation accumulations, but unless you've been exposed alot already via other means,, you should still be at an acceptable level. Apicoetomy works cause the whole apex of the root is removed to eliminate any possible accessory canals or missed canals, but wouldn't work if the tooth is fractured. I am sure the endodontist wants to give a proper diagnosis too by gathering all the diagnostic info that's available. It's upto you and your dentist to weigh the risk and benefits of whatever procedure that you decide, and if he/she is confident of the course of treatment with the information that's currently at hand.
Newbie
Aug 15, 2017
40 posts
6 upvotes
coilz wrote:
Oct 8th, 2017 2:02 am
If it is the 3rd time this tooth is being treated, I wouldn't rule out a CBCT scan just due to radiation concern. Besides they do not need to scan the whole jaw, just focus on the area of the tooth in question which will lower the radiation dose significantly. I believe the newer CBCT machines with small Field of view setting for endo purposes is similar in radiation dose as a panoramic radiograph depending on machine.. setttings etc etc.

But the point is one CBCT scan won't kill you since this will be a one time thing, and it should give you more information as to what is wrong with that tooth so a proper course of action can be decided. Yes we should all be concern about lifetime radiation accumulations, but unless you've been exposed alot already via other means,, you should still be at an acceptable level. Apicoetomy works cause the whole apex of the root is removed to eliminate any possible accessory canals or missed canals, but wouldn't work if the tooth is fractured. I am sure the endodontist wants to give a proper diagnosis too by gathering all the diagnostic info that's available. It's upto you and your dentist to weigh the risk and benefits of whatever procedure that you decide, and if he/she is confident of the course of treatment with the information that's currently at hand.
There is no acceptable level. Period. And yes, one radiograph "can" ultimately kill you. Cancer is believed to be caused by one single cell having undergone extensive genetic damage, and in theory, that single celled mutation could be caused by anything radioactive, including a single radiograph. This idea of cummulative dosage is nonsensical; it's an odds ratio. One person could develop cancer from one radiograph while another person could be exposed to multiple radiographs and be fine. The point is, no one knows. And it's a risk either way. Im not suggesting that no one should be radiographed (because we clearly need it) but we accept the risk. I personally would never accept a CBCT for a RCT. It's insane and I would rather risk another RCT failure and extract the tooth if need be.

OP, yes, I am in the profession. And I think it is wise to go back to the same endodontist. He is familiar with your case, so keep us posted! :-)
Deal Addict
Jul 26, 2004
2048 posts
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TheSpandexSuplex wrote:
Oct 8th, 2017 11:03 am
There is no acceptable level. Period. And yes, one radiograph "can" ultimately kill you. Cancer is believed to be caused by one single cell having undergone extensive genetic damage, and in theory, that single celled mutation could be caused by anything radioactive, including a single radiograph. This idea of cummulative dosage is nonsensical; it's an odds ratio. One person could develop cancer from one radiograph while another person could be exposed to multiple radiographs and be fine. The point is, no one knows. And it's a risk either way. Im not suggesting that no one should be radiographed (because we clearly need it) but we accept the risk. I personally would never accept a CBCT for a RCT. It's insane and I would rather risk another RCT failure and extract the tooth if need be.

OP, yes, I am in the profession. And I think it is wise to go back to the same endodontist. He is familiar with your case, so keep us posted! :-)
If there is no acceptable level, then why is a normal radiograph acceptable, where do you draw the line? Radiation is all around us, you can get radiation exposure taking a plane ride... radon gas in your basement can give radiation. You're putting it a little extreme for saying one dose from a CBCT is unacceptable and can kill you, however small the odds are. If you're doing the odds ratio, then is also chance that a recurrent/chronic infection from a failed RCT can spread into fascial spaces within the head and neck and kill OP in a short time due to airway restriction. So a RCT failure "can" kill ulitmately kill you too just like a CBCT. If you put things into such extremes then people will be scared to do anything. I am not advocating CBCT for every RCT, but in OP's case, the answer to why endo can't treat his tooth properly can be determined with the proper diagnostic tools.
[OP]
Member
Jun 28, 2011
229 posts
32 upvotes
VANCOUVER
This is kinda scaring me with all this talk about infections, radiations and going into my head and neck, etc. Astonished FaceCrying Face
I really don't want to think about an infection killing me and this is why I'm going to see the specialist to see what the issue is before it gets worse.
I have no idea what kind of equipment the specialist has and I'm sure it's equipped to do the job.

As for why I'm having an issue with the same tooth, I have no idea why although I will say that the left side of my body seems to be more sensitive to things. I have no idea why but the human body is not perfectly symmetrical.
I'd like to save the tooth because with extractions, it means getting a bridge or implants ($$$) to prevent the other teeth from shifting.
Anyways, I'm going by what the specialist wrote to my dentist a few years back when he examined me and I'll see what he says when I see him. My main concern is the money but I've got it figured out.
I want to have healthy teeth and I'm fortunate that my gums are in excellent health.

Many thanks to TheSpandexSuplex for your great feedback. I figured you work in the field and I'll update after my visit/treatment.
Deal Addict
Jul 26, 2004
2048 posts
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travelandshoppingwoman77 wrote:
Oct 8th, 2017 2:41 pm
This is kinda scaring me with all this talk about infections, radiations and going into my head and neck, etc. Astonished FaceCrying Face
I really don't want to think about an infection killing me and this is why I'm going to see the specialist to see what the issue is before it gets worse.
I have no idea what kind of equipment the specialist has and I'm sure it's equipped to do the job.

As for why I'm having an issue with the same tooth, I have no idea why although I will say that the left side of my body seems to be more sensitive to things. I have no idea why but the human body is not perfectly symmetrical.
I'd like to save the tooth because with extractions, it means getting a bridge or implants ($$$) to prevent the other teeth from shifting.
Anyways, I'm going by what the specialist wrote to my dentist a few years back when he examined me and I'll see what he says when I see him. My main concern is the money but I've got it figured out.
I want to have healthy teeth and I'm fortunate that my gums are in excellent health.

Many thanks to TheSpandexSuplex for your great feedback. I figured you work in the field and I'll update after my visit/treatment.
No need to be scared. Was just trying to make a point that getting any bad effect from CBCT radiation is very very remote. Chances of infection spreading is also very remote. Shouldn't let fear of remote events dictate what you do or not do. I am sure the chance of you getting into an accident driving to the dentist is higher than either of the previously mentioned events, does that mean you shouldn't leave your house at all ? Keep your options open and gather all the information you can so you and your dentist can come up with a proper course of treatment for the tooth.
[OP]
Member
Jun 28, 2011
229 posts
32 upvotes
VANCOUVER
Update:
I saw the endodontist today and the tooth needs to be extracted. It’s quite infected and he said there’s no way to save the tooth. It seems there is a fracture somewhere so the tooth is done for.
I was somewhat prepared for this and I’ll be scheduling an appointment with my regular dentist and discuss options.
Thanks to all who gave feedback.

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