Through a routine x-ray my dentist noticed that a root canal performed on tooth #18 (second molar, bottom left) had only be partially successful: one of the roots was completely filled and another was 3/4 filled), so he referred me to an endodontist for evaluation.
The root canal work is over 20 year old, this tooth has never given me trouble since, and I don't have any symptom of infection (though I realize that some infections are asymptomatic). I am 46 year-old.
I went to the endodontist yesterday, and he said the entire root canal would need to be redone since a possible infection would have spread to the whole tooth. I asked whether he could tell that there was infection and he said he could not tell. He popped the crown, began drilling and after about 10 seconds he said: "there is not enough tooth left" and that the tooth needed to be pulled. He gave me the crown in a pouch and told me to go back to my dentist for extraction.
I am now asking, what was wrong with a wait and watch approach since there was no sign/symptom of any infection? From what I read a significant percentage of root canals are not completely successful, but this does not lead to infection necessarily.
My question is, is this worth a second opinion? Can I ask to have the crown put back on and monitor this tooth frequently? I think extraction is a drastic option for a tooth that has never bothered me since the root canal was done.
Any suggestion will be greatly appreciated. Thank you,
Incomplete canal obturation doesn't mean ablolute retreatment is indicated. If there is no radiographically identifiable lesion,no clinical manifestation of infection, retreatment of incompletely obturated canal is questionable. Seeing a competent endodontist and restorative dentist is advised.
You mentioned that the dentist noticed on a routine x-ray. Was this the first time you went to him?
Since there was no pain, nor sign of infection, it would be unnecessary to treat this tooth. I think it was completely unnecessary to sent you to the endodontist (unless there was pain, infection, or you request a consult).
My advice would be to go back to the dentist, have him put the crown back and watch the tooth with routine checkups and x-rays. It is no more necessary to watch this tooth specifically then any other.
If he refuses, then I suggest you change dentists.
Indeed, this is a new dentist for me. I will request that he puts the crown back, and--as you suggest-- I will change dentist or at least get a second opinion if he refuses. I do not want to rush into an extraction unless it is absolutely necessary.
Do you or does any one know what the signs of infection are on an x-ray? Comparing that x-ray with the ones of the other teeth (they now show them to you on a screen) I saw nothing unusual, but what should one look for?
As long as the roots were protected from bacteria (exposed to body and air)), it was protected from infection. It sounds like that was the case. However, you said the new dentist drilled. He could very well have now exposed the area to bacteria and you will wind up with an infection.
On the X ray, look for a dark shadow around/near the root of the tooth. If it's present, it is indictive of an infection.
An endodontist can look at an X ray to determine how much of the tooth is left. He did not have to take off the crown and drill. I think he blew it and exposed the sealed up root and left it vulnerable to infection. It was fine before...
There are no roots to expose, because I had a root canal done to both roots. He only drilled for 5 seconds, and all he exposed is the top of the root filling. Nonetheless, I do not understand what he meant by "there is not enough tooth left". I'll ask my dentist to take a third x-ray to find out if something happened during the drilling.
Sorry. I thought you said one of the roots was 3/4 filled. If he drilled and exposed that partially filled root, he opened the door for bacrteria. Even though it was only 3/4 filled, it had been sealed and protected from any bacteria entering.
The dark shadow indicating infection is sometimes hard to see. 'Shadowy' area is what to look for.
There was enough of the tooth left before he drilled, and the crown was fine, it still fit.....I would definitely question why there was enough tooth left before he started drilling.....
thanks for all your comments. The 1/4 unfilled is at the bottom end of one of the two roots. That is where my dentist was concerned that an infection may have begun. I looked carefully at the two x-rays (one done by the dentist and one by the endodontist) and compared them with the x-rays of my other teeth and later I looked at x-rays showing infect teeth on google. I noticed no significant dark shadows in #18, definitely nothing resembling the infected teeth on google. But then, I am no expert. The endodontist hardly drilled on top of the tooth. The one thing I noticed was a bad odor when he removed the crown, so he may have meant that the stump is decayed so much that the tooth can't be saved. But even that does not make sense entirely, as one could rebuild some of the stump to refit a crown. I also checked the stump at home and it does not looked decayed (though there is not much too see). My ultimate wish is to save the tooth and hopefully I'll be able to see my dentist tomorrow and discuss the situation (and have a third x-ray taken). Even now, with so much poking, I don't feel any pain or inflammation, but then again, that does not rule out an infection I guess. Thanks again.
I have been talking to (and getting the info) from my husband who has been a dentist for over 30 years. You are smart to do everything you can to save the tooth and not have it pulled.
You can't undo what has been done, so do what you can to save the tooth
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