Question 1:

Why do root canal treatments fail?… What will be the solution to save the tooth again? [Are there] any good options?
Please share the good thoughts.

Question 2:

If root canal treatment failed – what will be next option to save the tooth?

Answer:

Today we had two similar questions from readers so we will address both.

Root canal treatments do not have a 100% success rate.  The success rate actually varies between 68% -95% depending on several factors involved including the presence of bacteria, the vitality of the tooth, etc.  A root canal treatment is just an alternative method to save a tooth when its pulp has become infected with bacteria.

Why do root canals fail?

They can fail for several reasons.  Some include:

• Bacteria left in the canal
• A “leaky” filling
  • This leaves pathways for bacteria to reinfect the tooth
• Missed canals
  • Sometimes teeth have extra or sneaky canals that aren’t easily found on an xray.  If the canal is missed during root canal treatment, there is a possibility of failure
• Systemic conditions
  • Other illnesses such as diabetes or complicated medical conditions can affect the success rate of treatment
• The tooth is fractured or have a crack

What’s the next step after root canals fail?

The reason of failure will determine the next step in treating a failed root canal.  Here are some options:

• Re-treatment
  • This includes removing the old root canal material in the canals (gutta percha), recleaning the inside of the tooth, disinfecting the inside again, and placing new material
• Apicoectomy
  • This is a dental surgery that involves removing just the tip of the root.
• Extraction+ replacement
  • If all else fails, the tooth can be removed and replaced with an alternative including a bridge, implant, or removable appliance.

Root canal treatments are a great way to treat a seriously infected tooth.  Unfortunately, some fail and other treatment modalities have to be introduced.  We hope this information helps in your understanding for treatment failures and alternatives.

Good luck,

SaveMySmile Team

Good luck!

Hi, I have been experiencing some weird tooth pain.  It comes as quickly as it goes and does not seem to last long( a few seconds) and has happened three times in the last 2 days.  It is not a throb pain, more a constant pain if that makes sense.  It feels like someone is touching ice cream to my tooth in the whole tooth but 10x worse, and is one of the worst pains I have ever experienced.  I am going to the dentist, I am just curious on your opinions.  Had a cavity filled in the tooth a couple months ago so not too sure why it would hurt all a sudden.  Thanks in advance.

Answer:

Thanks for submitting your question with us.  Now, the main piece of information that will determine the diagnosis of your tooth is:

Is the Pain provoked?

• Does the pain have a trigger point?  For instance, is it painful when you eat hot or cold food or drinks.
• Does the pain occur sporadically and unprovoked?  Does the pain come and goes as it pleases with no trigger point?  For example, the tooth becomes painful randomly throughout the day.
• Does the pain come when you bite down into food?  Or does the pain come when you open your mouth after biting down on food?

You’re probably wondering, why all the questions?  But believe it or not, answers to these simple questions can guide us down the right path to a correct diagnosis.  Let’s examine each answer:

Yes, the pain is provoked by eating cold/hot food or drink.

Then you have reversible pulpitis.  This means that you have slight inflammation of your pulp inside of your tooth.  This is caused by

• Bacteria/decay
• A recent deep filling without a protective base (Deep restorations need a protective layer underneath it to protect the tooth nerve/pulp)
• Recent deep cleaning

Reversible Pulpitis Treatment

Luckily, this can be easily treated by making a slight adjustment to the filling

No, the pain is not provoked by anything and occurs on its own

You may have irreversible pulpitis.  This means the pulp is damaged beyond repair.  This means that bacteria have leaked into your tooth nerve/pulp and are now irritating the tooth and needs to be removed to avoid serious infection.  Some signs of irreversible pulpitis include:

• Spontaneous, unprovoked pain
• On and off pain
• Continuous pain
• Pain lasts even after food/drink/or stimulus is removed
• Lying down or bending over produces pain

Irreversible Pulpitis Treatment

The treatment for irreversible pulpitis is a root canal treatment.

I feel pain when I bite down

Again, this indicates reversible pulpitis and can be treated by adjusting your filling.

I have pain when I open up after biting down

This indicates a fracture of the tooth.

Fractured Tooth Treatment

Treatment for this depends upon the extent of the fracture and can include anything from a new filling, or a root canal, or even an extraction.

For more information on tooth pain, check out our article here.

Also, see below for a descriptive chart of how to diagnose tooth pain.

We hope this helps and good luck,

Save My Smile Team

My teeth are yellow in color.  I brush twice a day but [there is] no change.  I consulted the doctor and he cleaned my teeth, but the problem remains.  Please help

Answer:

Well believe it or not, somewhat yellow teeth are actually NATURAL.

Why are teeth yellow?

Your teeth are composed of enamel, dentin, pulp and cementum.  The enamel is the outer layer and is translucent.  The dentin underlies that enamel and is actually yellow in color.  Sometimes, as we age or as our enamel wears, the teeth appear more yellow.

Teeth can also appear yellow if they are holding stain.  If you are an avid coffee, wine, or tea drinker, or even a smoker, your teeth will readily hold more stain.

What should you do to whiten your teeth?

Being that you just had a cleaning; the next step can be to visit your dentist for professional whitening services.  Depending on whether the stain is external (i.e. from coffee or tea) or internal (i.e. disease/ailment or dead tooth) will determine the process that the dentist will use to whiten your teeth.

Also, there are plenty whitening systems that can be used over the counter and readily available at most stores.  But be careful!!  You may experience some sensitivity after the procedure and, for a couple of days after the treatment, your teeth will more readily capture stain so be sure to avoid certain foods and beverages shortly thereafter.

Remember, yellow teeth are natural, and only the media has portrayed ultra-white teeth as healthy and normal.  This is not actually true.

Hope this helps and good luck!!

Hello, I have a tooth on my lower level that is further back from the rest.  I don’t love that but I can handle it.  The problem I have is that, with its placement, it stands taller than the other lower teeth.  This is very obvious…at all times…when I’m talking.  It makes me very self-conscious.  I’m not interested in braces but I am interested in lowering that tooth’s visibility, if possible.  Is it possible to file a tooth down shorter?  I am interested so that this tooth can be the same visible height as the other lower teeth.  It would help me to feel more comfortable smiling, talking and just living day to day.  I am a single mother and do not have the funds to do much for myself, which is why I’m looking for a “simple” solution which does not require a huge financial commitment.  Please reply.  I can’t tell you how much this affects my day to day life.

Answer:

Thanks for submitting your question with us.  And we completely understand the huge link between teeth and self-confidence.  First we will explain exactly what’s going on in your mouth, and then we will examine several options for its correction.

Throughout life, teeth continually grow and move.  For instance, if you have a missing tooth, notice that over time the tooth adjacent to it will slowly drift into that open space.  From what you are describing, it looks like that tooth in the back of your mouth does not have a tooth above it (opposing it) and that is why the tooth continues to erupt, or “grow taller.”  Until there is a tooth, or prosthetic device (partial denture, implant, etc.) placed above it to oppose it, the tooth will continue to erupt.

So, what are some immediate and cost effective options:

• Have the tooth adjusted – To answer your specific question, yes, you can have the tooth filed down.  However, keep in mind the anatomy of a tooth (please see our article here on tooth anatomy for more details).  The dentist can take away tooth structure (in dental terms, adjust the occlusion) so that the tooth can appear more in line with the surrounding teeth.  This is the most cost effective option.  However, there is a drawback.  There is only so much tooth structure that the dentist can take away before encroaching upon the dental pulp.  Once near the pulp, the health of the tooth will be jeopardized.  Also, as stated before, the tooth in question will continue to gradually grow taller if there is not a tooth opposing it.
• Have a crown placed on the tooth – This option involves a little more money.  But with this option, the dentist will reduce the tooth so that it is aligned with the surrounding teeth, and then place a crown over the tooth so that the tooth will no longer continue to erupt.

Several other options include extraction and replacement with an implant, or extraction and replacement with a cantilever bridge, or even extraction and partial denture.

The best treatment really depends on how much the tooth has erupted.

We hope this advice helps and good luck,

Save My Smile Team.

In June 2009 a dentist performed the advanced cleaning procedure they
identified as a full mouth debridement. The dentist also measured the
distance between the bottom of the enamel and the top of the gum. This was
painful as the measurement device pressed into what I assume was soft enamel
or dentin.

The reason for my concern and my question here follows. Before the cleaning,
my gums completely filled the gaps between my maxilla 7, 8, 9 and 10(top front teeth). After
the cleaning, between 9 and 10, a 1.5 millimeter gap exists. And, between 9
and 8, and between 8 and 7, a 0.5 mm gap exists. In other words it appears
that the dentist created gaps during the cleaning process. I definitely had
a lot of blood when I rinses after the cleaning. Did the dentist make a
mistake?

The dentist recommended that I come back for the second part of the cleaning
including having the undersides of my gums cleaned. Another dentist during
another previous appointment recommended the same. Based on the apparent
damage to my gums, I have ignored this. I have not had my teeth cleaning
since.

Answer:

Wow, your ability to relay the information in dental terminology is quite impressive

So first we will explain exactly what happened and then we will explain the reaction of your gums to the procedure.

A full mouth debridement is an extensive cleaning procedure that involves cleaning the surfaces of your teeth including the tooth surfaces (root) located under the gums.  A dentist performs a periodontal probing to determine if a patient needs a debridement.  Based off of your information, it looks like the dentist recorded your probing depths, meaning he used a probe to measure the depths of the pockets around your teeth.  This information tells us whether or not your gums are inflamed, meaning that you are experiencing gingivitis (please see our article here for more information on gingivitis).

It looks like you had inflammation of your gums.  The major factors in your situation that point us in this direction are the following:

• Bleeding during a cleaning or probing indicates inflammation of gums/gingivitis
• Shrinkage of the gums after the cleaning was performed indicates that the gums were inflamed and are now healing

So now, the dentist performed the debridement and you see spaces that didn’t exist before.  Let’s explain fully why this occurred.

• There is a possibility that you had calculus deposits.  Calculus is a hardened buildup that can accumulate, over time, on teeth.  Sometimes, it appears as tooth structure, but is actually harmful to the teeth.  Calculus usually accumulates around the gumline.  If the dentist removed calculus, spaces can now appear in those newly cleaned areas.
• Your gums are now healing.  Before your gums were inflamed.  Gums become inflamed when there are bacteria, food deposits, plaque, or calculus that remains on the teeth near the gums.  The body’s defense system attempts to fight the foreign invaders resulting in inflammation and tenderness of the gums.  Some signs of inflammation include the following:
  • Red gums
  • Puffy gums
  • Gums that bleed when flossing

Healthy gums should appear coral pink (or slightly pigmented based on ethnicity), firm and tight.

So don’t worry, the dentist definitely didn’t mess up.  Your gums are now healing after the extensive cleaning was performed.  If the spaces in your teeth concern you, return to your dentist and he/she will be able to better assess the situation from this point.  More than likely, once the gums return to full health, the spaces will resolve.  Or, if you had periodontitis, meaning bone loss accompanied the gum inflammation, there are procedures the dentist can use to solve the problem.

Hope this helps and good luck,

Save My Smile Team

I seem to be getting blood blisters in the inside of my mouth and on/under my  tongue.  I get about one or two a week.  They are painless. What are these? I visited my dentist who claims there is nothing to worry about.

Answer:

This can be a number of things.  However, to get closer to an accurate diagnosis, we would need a lot more information from you, including such factors as your age, habits (i.e. smoker), size of the lesions, whether they leave a scar, if your lymph nodes are inflamed, etc.  There are soo many ailments that appear as red lesions in the mouth but here are a couple of suggestions that can possibly lead you down the right path.

Some of the most common red lesions that appear in the mouth are either recurrent herpes, also known as a cold sore.  Please see our article here for more information on cold sores.  Or, these lesions could result from trauma or rupture of a blood vessel (hemangioma), an allergic reaction, lichen planus, or could even be leukoplakia or erthyroplakia which both introduce serious threats.

In summary, it’s hard to reach a diagnosis with such limited information.  It would be best to visit your dentist and stress your concern about these lesions.  If he/she brushes it off, don’t be afraid to seek the opinion of another dentist or medical professional in the area.  In the end, it’s your health and you have every right to take it seriously.

Hope these tips help out and good luck,

SaveMySmile Team

I am having pain and bleeding from a tooth.  Also, anything that I eat sticks between by teeth.  Do you have any advice or suggestions for medications?

Answer:

Based off of your description, it looks like you are suffering from pain from your gingiva (gums) and not your actual tooth.  However, please read our article on Toothaches to further assess the situation involving the actual tooth itself.

Usually, when food, bacteria, plaque, calculus, or anything else accumulates around our gums it causes an inflammatory response.  This means that the gums are sensitive, red, puffy, swollen, and bleed very easily.  It sounds like your gums are inflamed, thus causing the bleeding and pain.  This condition is called gingivitis.  A more advanced form of this ailment is called periodontitis if bone loss is involved.

So how can you treat this?  Well, your best bet is to visit your dentist for a thorough cleaning.  If severe, he/she may prescribe you antibiotics to help solve the problem.  However, here are some suggestions to help you with the situation now.

• Rinse with warm salt water to deal with the pain and sensitivity
• Use a mouthwash with chlorohexidine gluconate.  This is a mild antiseptic that is used to kill harmful bacteria in the mouth thus helping to eliminate plaque, calculus, and gingivitis.
• FLOSS EVERY DAY.  This is key to maintaining the health of your gums/gingiva.  Flossing eliminates the bacteria or food trapped under the gums.  This step is also very important for you being that food packs between your teeth.  In areas such as that, you must be sure to brush thoroughly and floss to remove all irritants.

Hope these tips help out and good luck,

SaveMySmile Team

What is a snap on obturator?

Answer:

As related to dentistry, an obturator refers to a replacement prosthetic device that is used to replace upper teeth or associated structures (palate, gingiva, etc) that may have been damaged in surgery, trauma, or altered development.  This device is only used for the maxilla, and depending on the individual’s needs, could resemble a denture.

Hope these tips help out and good luck,

SaveMySmile Team

Dear Doctors,

Could extraction of upper tooth cause blindness? I had my upper tooth on the right side extracted and I went blind on my right eye.

Answer:

Not likely.  However, there is a slim possibility IF THE TOOTH WAS INFECTED.  There is a condition, called Cavernous Sinus Thrombosis,that stems from bacterial infection.  As a result, the bacteria causes inflammation of the cavernous sinus (located in the head and is a pathway for many important nerves and blood vessels).  This inflammation can cause pressure and result in blindness and other serious life-threatening side effects.  This is a possibility and requires IMMEDIATE MEDICAL ATTENTION.

Infection is the only possibility that could result in blindness, though cavernous sinus thrombosis is rarely associated with infected teeth.

Please seek medical attention immediately and follow up on this matter.

Good luck,

SaveMySmile Team

I am going on a mission to Malawi, Africa.  We will be handing out toothbrushes to 1000 children.  Do you have any step by step posters to help illustrate how to brush your teeth? Also, what common products could they use when toothpaste is not available? Thank you any help would be appreciated.

Answer:

Feel free to check out our article on Brushing for a step-by-step guide on how to properly brush.  There is a graphic included with the article that illustrates the correct way to effectively brush.

Now, in response to a toothpaste alternative, let’s first discuss the purpose of brushing your teeth and the role of toothpaste (dentifrice).  The ultimate goal of brushing is to remove bacteria and debris (i.e. food debris) from the tooth surfaces.  We want to eliminate food, more specifically sugar, from our tooth surfaces so that bacteria won’t have the opportunity to grow and create harmful substances which could eventually damage our teeth.  This process of removing the above mentioned substances is accomplished with the toothbrush alone!  A toothpaste only adds to the experience of brushing our teeth.

A toothpaste is composed of several parts to enhance the toothbrushing experience and to encourage individuals to brush.  These parts include:

• Abrasive –used to more effectively clean the teeth.  For example an abrasive sponge is used to more effectively remove dirt and grime from a kitchen countertop.
• Detergents
• Flavoring agents – makes the toothpaste “taste good”.  The tolerable taste encourages individuals to brush more.
• Caries (cavity) preventive substance – some toothpastes contain Flouride or Triclosan.  These additional substances are used to strengthen the tooth enamel to aid in preventing cavities or gingivitis.

In a worst case scenario, if no toothpaste is available, baking powder can be used.  If this substance is not available, you can still effectively brush your teeth with just WATER!!  Remember, the goal is to remove bacteria and debris.  Toothpaste just adds to this process.

Hope these tips help out and good luck,

SaveMySmile Team