Tooth heat sensitivity one year after root canal and crown

I had a small cavity in a top back tooth.  No prior problems with tooth.  After it was filled, I had such problems that the dent. & spec. said I needed a root canal, although the cavity was not near the root.  After the RC, I couldn't chew anything on the temp crown due to pressure pain and heat sensitivity-even green beans hurt.  I saw the den & spec. several x's to figure out source of problems with no avail.  They decided to go forward with perm. crown in hopes it would resolve the prob. It didn't.  After several more visits & months later they went back in & did a 2nd RC, found nothing that was missed.  They packed my tooth with cotton & crowned it again.  I had no heat sensitivity at all for a few months, however still had pressure discomfort, but was liveable.  Now it is extremely heat sensitive again.  Anything warm or hot, coffee, chicken, rice, vegies, etc. that touch the tooth cause extreme pain making it hard to eat. It is not cold sensitive at all.  I have not gone back to the dentist since the sensitivity has come back, I feel they won't know what to do again.  The x-rays showed no cracks, my gums are very healthy, only 2 other cavities in 29 yrs.  No prior dental work ever besides this RC.  I have NO sinus or ear problems, no pain in my jaw, we tried antibiotics prior to the 2nd root canal, but that didn't help.  I don't know what my next step is.  I do not want the tooth extracted.  Any suggestions on what I should do or tell my dentist to try?

[Jerome Bogin, D.D.S.]

The sensitivity to heat usually indicates the presence of gases that are caused by bacteria that expand from the heat. This is what causes the discomfort. It would seem to me that there is still an infection present. The only thing I could suggest is that you see another endodontist. Sometimes no matter what you do the problem remains. Possibly there is an accessory canal that the doctor can not get to.

[mike1105]

good answer by the forum doc. the other possibility is that there is a microfracture (that usualy cant be detected on films). but that scenario usually causes pain upon biting moreso than from heat.

[Ria-pain]

I may be wrong, or maybe just never exposed to "another" way of doing a root canal, but I don't believe cotton pallets are supposed to be packed into a tooth and left there while cementing a crown on top of them.  Are you sure they left the cotton in the tooth?  (because that's what you wrote in your email, and it sounds odd to me.)  They are supposed to place a putty-like, orangish filler (Roth's cement)into the tooth canals and seal it, not cotton.  It could be numberous things: you could have a tiny fracture not visible in the radiograph (only in special microscopes that specialists have... and sometimes not even then) in which case you would need an extraction.  A fracture down the root of a tooth can not be saved with a root canal and can only be extracted due to the constant flexing of the tooth apon pressure.  It could be you have an extra root that was not detected on the radio graph, which is not that rare.  In that case you should be able to still feel cold, too.
Honestly, there's no true way to diagnose unless you are seen and numerous tests are done to rule out possibilities.  If you do go to another dr. for a 2nd opinion that's fine, but I would go back to the original dentist (unless that's just out of the question) since he's the one who started the treatment because at this time he is more knowledgable about your situation than anybody else.
Let us know how things go.  Good luck!

[neb8246]

Thank you all for your responses.  I really appreciate it.  Yes, they specifically packed it with cotton, the reason was because when the temp crown was in place (the 2nd time) and packed with cotton I didn't experience any heat sensitivity, because of this they (general dentist and endodontist) decided to pack new cotton in when putting the perm. crown on.  I thought this was odd too.  

Next, the endodontist did find a total of 4 canals on the original root canal, she did the 2nd canal to see if there was a 5th she missed by chance, no 5th found.  

Also the endodontist treated me more than one time for infection trying to clear up the problems, with no avail. prior to the 2nd RC.  When she went in to do the 2nd RC, she said that it didn't smell like there was an infection present either.  

During the 1st root canal, I did feel pain one time during the process.  The endodontist said that it must have been the end of the root then because I had feeling.  Is it possible that she could have poked through the end of the root which could contribute to this problem?

[painintheapex]

I had 5 amalgam (29 year old) fillings replaced with composite restorations. Two of the 5 were sensitive. The doc replaced based the tooth with fuigi 9 and layered composite on top. One by one and two by two, my teeth have been bombing out. All have had to have root canals. I know that two of the molars were deep but the others? I am baffled. The doc is baffled too. I am a grinder and a clencher. I had an accident 20 yrs ago landed on my left side of my face. That could be catching up to me, who knows. I also had an underbite. I had braced for 5 years to correct. I am wondering if the bonding materials didn't site right with me and caused some kind of reaction? The other amalgams were not deep. Or it is a combination of all of the above. Does anyone have any ideas? I have talked with several endontists and dentists. Basically, they say it just is. I am not a smoker or do drugs. I am rapidly getting bankrupt with all of this dental work, yikes. plus, I had two other root canals that needed to be done 10 years ago but the doc felt it was a different tooth. NOT. I had a canine moved surgically and ortho.and the gums did not attach. It makes sense but it didnt hurt. It is getting hard to chew on 4 teeth as my teeth are still recovering from the trauma. HELP.
Thanks

[vij123]

A related discussion, Clove Smell from root canal tooth was started.