root canal issue

I had a root canal about 1 month ago on #14, and still have a sense of pressure above that tooth. There's some pain if I bite or tap just right, but no evident swelling or redness in the gum area. The pain seems to be a dull burning ache that radiates to my inner ear and even behind the ear into the neck area. I haven't done the crown prep yet because I'm waiting for it to be pain free before putting a $700 crown on it. My real concern is this: Is it possible for there to be infection just festering around up in there, or could the filling have extended too far past the apex and be causing inflammation? It seems to be getting worse rather than better. If it is residual infection, the root canal would need to be retreated, and I can't take a bunch of antibiotics because I ended up with colitis caused by the Clindamycin that the endodontist gave for the first root canal. I'm worried this could be spreading into the bone and or possibly even further. Would there be a lot more redness and pain before it would travel to the brain and abscess? How could I know if this were happening? My general dentist said I'm not giving it enough time and that it might just be sinus related. It's been a month...and the endo is almost 3 hours away, so I can't just run back to him. Is it possible for a root canaled tooth to Re-abscess? I'm sorry for all these questions, but no one around here seems to know much. Also, can an upper tooth infection lead to mediastinitis, or is that only possible on the lower teeth? I would really like to know the answer to that one.
Thanks alot!

[Jerome Bogin, D.D.S.]

I do not think that the infection you had in this tooth will lead to a brain abscess etc. etc. That is very very rare. Firstly I would not restore this tooth until it becomes totally asymptomatic.It is still possible that there is an infection present and you must realize that this can take sometime to resolve. I do not believe that the antibiotics are the answer. I would give it more time. I am not going to say that it would not have to be retreated but that remains to be seen.

[mike1105]

firstly, root canal treatments are not always successful, and the procedure is very technique sensitive---some are done well, some are not-- depends on who does it-- I personally am a general dentist who does many root canals, and I thinkmy post op films look better than those of a large percentage of root canal specialists.

filling the canals even a little past the apex can be a problem, especially on #3 or 14 due to the proximity of the sinus in some, but not all, patients. what I would do if I were you is get another opinion from a new endodintist who is close to you. to get a purely unbiased opinion, dont ask your general dentist for a referral---- do this thru a friend or family member or the local dental society You should not in my opinion have pain. Pain means something is wrong. It could be an overfill, an underfill, a crack in the tooth, an abcess (abscess), a sinus irritation-- could be a number of things. get another opinion-- ask the new endodntist to take a new film and explain to you what he sees. You are correct in not having a crown placed until it is asymptomatic.

[robyn77]

Thank you Mike, I agree with everything you said. I did have a new dentist take a new film and he thinks there may be some translucency at the tip of one root and that the canal may not have been fully navigated and is abscessing again. Also that I may need an apico. My problem is this: Do I just lose the $700 to the first endodontist, especially if I'd rather go to a NEW endo for further treatment? Do most endo's stand behind their work, or if a person chooses to go elsewhere, do they get any recourse for the fact that the initial work has failed? I know I need to ask the actual dentist this, but am just trying to arm myself a little before calling them up.

Had I realized this endo did NOT utilize newer technology, I may have gone elsewhere. There was no magnification or ultrasonic used...more of an old fashoined approach from what I could tell. What a bummer.

Thanks again!!!

[mike1105]

the most technologically advanced endodontists these days do their work under a microscope. It is an expensive piece of equipment, but i can tell you the cases I've seen that were done under a microspcope are generally superior. I would go to an endodnotist who has one, and get a diagnosis as to what is wrong. If indeed you need to have the root canal redone (i would not recommend an apico if it is possible to redo the procedure-- apicos have a significant failure rate especially on molars-- and the treatment at that point is usually to extract the tooth) becasue the original endodontist could have done better, then you may ask your new endodntist to put down in  writing why he thinks it failed, and back his opinion up with pre and post op films. Ethically, you would be entitled to your money back in my opinion as when it was originally done it was not done well enough. However, I'm sure you signed a consent form that bascially said this might happen. He probably does not HAVE to return your money, but if you approach it correctly and professionally, he may.

[kindness goes along way]

Read all the posts concerning you tooth.  I was curious as to how you have proceeded and the out come.  What kind of pain are you having or is it resolved.  Lots of Luck

[kindness goes along way]

Read all the posts concerning you tooth.  I was curious as to how you have proceeded and the out come.  What kind of pain are you having or is it resolved.  Lots of Luck