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!

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

What are distant dentures?

Answer:

Not exactly sure of what you mean by distant dentures, however you could be referring to either immediate dentures or overdentures.  Either way, we will provide a thorough definition of each.

Immediate dentures are delivered the SAME day that your teeth are extracted (pulled) by the dentist.  The great thing is that you won’t have to suffer through a period of going without teeth.  However, the bad thing is that once your teeth are pulled, and as the bone heals, the dentures may not fit the same in a couple of months.  The bone underneath will shrink and the dentures will become too big, thus causing them to rock in your mouth or not fit properly.  When this occurs, you will have to visit your dentist for a reline (adding more material to the inside of your denture) or for a completely new set.

Overdentures can be implant retained, or retained by natural teeth.  If implant retained, the dentist will insert a minimum of 2 implants into your bone, and the denture will be designed around the implants so as to ensure a better fit.  For natural teeth, the concept is the same.  The advantage of overdenture is that in the long-run you won’t lose as much bone and overall the dentures will fit better.

Hope these tips help out and good luck,

SaveMySmile Team

Can a mature wisdom tooth be pulled out?

Answer:

Definitely!  However, the position of the tooth as it relates to the surrounding bone will determine whether the extraction will be surgical or simple.  Also, keep in mind that any extraction has some possible complications associated with it.  Being that wisdom teeth, or third molars, are so far back in the mouth, there is a possibility of damage to the surrounding nerve or even displacement (the tooth being pushed further back into the mouth), however these risks are minor and most extractions have NO complications whatsoever.  Also, to make it easier for the patient, you can request to be put asleep or administered nitrous oxide to reduce the anxiety oftentimes associated with extractions.

Good luck and we hope this helps

SaveMySmile Team

If we decide to extract the recurrent pericoronitis tooth [should we] give antibiotic before the extraction or after the extraction of tooth?
ThankYou

Answer:

Pericoronitis, infection of the soft tissue typically around the crown of an impacted tooth, usually has a tendency to recur if the causative agent (the tooth) isn’t removed.  The tooth should not be removed until all signs and symptoms of the pericoronitis have been resolved.  If not, incidence of postoperative complications, specifically postoperative infection and dry socket, are highly increased.  However, some sources indicate that IF the pericoronitis is mild, and if the tooth can be easily removed, than an immediate extraction may be performed.  In the end, the recommendation is to treat the pericoronitis, then proceed with the extraction.

Hope this helps and good luck,

SaveMySmile Team

After a tooth is pulled out (extraction) from the bone, a blood clot typically forms.  As with any other scar on the body, the blood clot is the first step to healing and serves as a framework for the replacement tissue (bone, etc).  But sometimes, this blood clot can be removed too early!  This condition, called alveolar osteitis, significantly delays healing and be an uncomfortable and painful condition.

Dry socket occurs in about 1-3% of extractions and 25-30% of surgical extractions (used if you had an impacted tooth).

Signs of Dry Socket

Most symptoms for dry socket occur a couple of days after the extraction and can last for up to 40 days if not treated.

Symptoms include:

• Severe pain in the area of the extraction
• Dull, aching pain that radiates to the ear
• Swelling around the tissues in the area
• Foul mouth odor (bad breath)
• Foul taste
• Swollen lymph nodes (only happens occasionally)

Causes of Dry Socket

• Most often unpredictable and not related to a specific cause
• Excessive trauma during the extraction
• Patients on birth control have a higher chance of dry socket
  • If you are on birth control, it’s best to have an extraction performed between days 23 to 28 of your menstrual cycle (days without estrogen supplementation)
• Smoking
• A history of dry socket in the past
• Not following the post-op instructions given to you by the dentist/staff

Treatment for Dry Socket

• Return to the dentist as soon as you experience this pain.  The following steps will be taken:
• The socket will be rinsed out to remove extra debris
• The dentist will insert medicated gauze into the opening.  The medicated gauze contains:
  • Eugenol
  • Topical anesthetic
• You will be advised to change the gauze every 24 hours for the next 3 days.
• Then change the gauze every 2-3 days until the clot forms and you do not experience anymore pain

Have more questions?  Feel free to leave a commit or submit a question to be included in our FAQ’s.

Last week,  I had 2 teeth taken out by the dentist.  But today, there was some type of bloody-white “ooze” coming out of the area where one of the teeth came out.  I haven’t had any pain, just the ooze.  Is this dry socket?

Answer:

From what your describing, it definitely isn’t dry socket.  Dry socket is quite painful and occurs when you’ve lost the blood clot in your tooth socket and the bone is exposed.  This sounds like an infection.  After an extraction, for the first couple of hours you can expect some bleeding and some slight pain.  The dentist should have prescribed pain pills and antibiotics so as to avoid an infection.  Depending on the severity of the infection now, the dentist may just prescribe some more antibiotics.  But please visit your dentist right away and tell him/her that you have an infection.

Good luck!

Help!!  The tooth under my crown is hurting.  What does this mean and what should I do?  I’ve only had this crown for one year!!

Answer:

Sorry to hear that your tooth is in pain.  This can mean a number of things.  Let’s take a look at the many reasons for pain under a tooth crown:

Carious lesion/cavity under your crown

Sometimes, bacteria are able to find its way under the margins of crowns if not cleaned properly (see article on brushing).  If this happens, it could result in a painful situation, especially if the tooth nerve still remains in the tooth.

Bacteria not completely removed while preparing tooth for crown

In order to prepare a tooth for a crown, alot of tooth structure must be removed.  However, sometimes bacteria may still remain on the tooth structure that cannot be visibly seen by the dentist.  If this occurs, pain will occur at a later time.

Crown not being correctly adjusted in mouth

It could be “too high”, which means your bite could be off, and may need to be reduced by the dentist.  It could also mean that the crown isn’t adjusted to tightly “hug” the tooth and seal off the margins.  If the margins aren’t tight and snug, bacteria could easily creep in and eventually cause tooth crown pain.

Be sure to visit the Dentist to fix the problem

Your best bet is to go to the dentist to evaluate your options.  First, make sure the dentist runs a couple of tests to ensure that the pain is indeed coming from that tooth.  Sometimes, pain in one area is projected to a nearby area, this phenomena is called referred pain and occurs quite frequently.  If the dentist identifies this tooth as the source of the pain, then you’ll have a couple of options.  The crown may just have to be readjusted, which will only take a few moments, or it may have to be removed and the situation assessed from there.  Depending on the extent of bacterial invasion, you may just need the crown re-prepped, a root canal, or even an extraction.  Also, depending on your dentist’s office polices, he/she may offer to re-do your crown for free.

Good luck!

Type of pain

• Brief, short pain
• Pain when eating or drinking cold food/liquids or exposed to air
• Long lasting pulsating pain
• No sensation/tooth discoloration

Brief short pain:

If the pain only occurs occasionally, such as when drinking cold liquids, this is a sure sign of reversible pulpitis.  Depending on the extent of bacterial invasion and condition of tooth structure, this condition can usually be treated with pulp cap.  The good news is that the pulp of the tooth can likely be saved.

Long lasting pulsating pain:

Long lasting lingering pain is usually indicative of irreversible pulpitis.  This means the bacteria has invaded the tooth’s pulp and, depending on the extent of invasion, the entire pulp or portion of the pulp may have to be removed.  If the amount of bacterial invasion is extensive, or if a substantial amount of tooth structure has been destroyed, the tooth may have to be extracted.  The treatment options for irreversible pulpitis include:

• Extraction
• Pulpotomy/Pulpectomy
• Root Canal Therapy

No sensation/tooth discoloration:

If you noticed a major discoloration of the tooth in question, necrotic pulp is probably the culprit.  This means the pulp of the tooth is dead.  If the pulp is dead, the tooth is dead and it needs to be removed.  If substantial tooth structure remains, the dentist may be able to retain the tooth by performing root canal therapy.  The only treatment for necrotic pulp is extraction or root canal therapy.

Keep in mind that a series of tests must be performed by the dentist before a diagnosis can be reached.  Tooth pain can also indicate a fractured root, impacted tooth, gum disease, or even problems with the temporomandibular joint.  So, if you experience any type of pain with a tooth or any structure in your mouth, be sure to contact your dentist as soon as possible for the best possible treatment options.