Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

My Dentist Said My Tooth Is Fine, But I Have A Horrible Toothache!

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I had a toothache about a month ago on my lower molar and ended up needing a root canal. My tooth felt a little better after but has not completely settled down. Last weekend the pain got much worse, so much so that it scared me, and felt like it was the tooth next to the molar that was hurting. I went back to the endodontist that did the root canal, and he took x-rays of my bottom teeth on the side that was hurting. He told me that there was nothing wrong with any of my teeth on that side, and even removing all of them wouldn’t help with the pain. He suggested that I see a neurologist. What would be your advice?

Sherri from North Dakota

Sherri,

It’s hard for me to give my advice without doing an examination, but I will help any way I can.

It is not uncommon for pain to feel like it’s coming from a tooth and for there to be nothing wrong with that tooth. Here are some possibilities for pain like this:

  • One of the possibilities is that it’s referred pain. For example, you can have an upper tooth infected, but it feels like it is a lower tooth that hurts. The referred pain doesn’t cross side from one side of your mouth to the other but can from upper to lower and can definitely feel like it’s the tooth next to it.
  • A second possibility is some type of neuralgia, a nerve problem that feels like a toothache. It can happen and isn’t rare, so your endodontist could be right in sending you to a neurologist.
  • A third possibility is some other type of pain. For example, a sinus infection can feel like a toothache. This is because the maxillary sinus is often close to the roots of upper teeth, and the infection puts pressure on those roots and, therefore, feels like a toothache. Again, it could be referred pain to the lower tooth as well. There are also other health problems that can feel like a toothache.

It is possible to determine that a tooth and its root are healthy from carefully examining the x-rays. The x-rays would show if the root canal wasn’t healing properly.

Again, it’s hard without personally doing an examination, but I would listen to your endodontist.

Another thing to keep in mind is that some dentists aren’t very sensitive to patients or good listeners. So, if you have the feeling like he doesn’t really care and is just trying to get rid of you, I would recommend getting a second opinion. It would be worth the drive if there isn’t another endodontist in your town. Also, make sure it is a blind second opinion, meaning DO NOT tell the second endodontist the whole story or the name of your original endodontist. You don’t want to say anything about the diagnosis you’ve been told other than you had a root canal a month ago, and now you have pain flaring up. If they ask you for more of the story, just be honest and say you want a blind second opinion. They don’t need anything other than the basics of the story, their eyes, their knowledge, and x-rays to come to a diagnosis. You also don’t want the complication of the endodontists knowing each other, which would color their opinion.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Root Canal Gone Wrong!

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My husband coaches my son’s basketball team, and while coaching, he fell, which caused his front two teeth to fracture. He went to the dentist and ER that day, but the dentist wanted to wait for 2 weeks before treating him. Within 2 weeks, his right front tooth was starting to discolor, but no pain. He wasn’t treated, just fitted for temporary crowns that were placed 3 weeks later.

He had an emergency root canal 2 months later because of his severe pain and was given amoxicillin for 5 days. This offered him some pain relief, but after 24 hours, the pain returned up to his nose with a cold sensation.

2 weeks later, he had a root canal on his left front tooth, which caused no pain relief and was most likely an unneeded root canal.

We went to an oral surgeon to get a second opinion, and he recommended Augmentin TID for 7 days with Medrol Dosepak. Within 5 days, the cold sensation had resolved, and he was pain-free for the first time in 3 months! However, within 24 hours, the pain returned at about 50%.

I am a Nurse Practitioner, and my pharmacist friend recommended a 2-week taper of prednisone and my neighbor thought maybe the tooth fractured at the gum line. The dentist did see a black spot on the x-ray but said it was nothing. My husband has been suffering from pain for months; what would be the recommended next step? Do you think it would’ve been better if the root canal had been performed right away? Could the tooth be saved, and should he need an extraction, would you recommend implant next to permanent crown or bridge?

– Jodi in Michigan

An adult male grimacing in pain has he holds his cheek

Jodi,

The nice thing about doing the root canal right away is that there is less chance of post-operative complications because infection wouldn’t have settled in yet. They would just need to clean out the dead tissue and leave the tooth open for a couple of days before sealing to ensure there aren’t any flare-ups. The dried blood would be an indication the tissue inside the tooth was dead.

I’m very confused on why they would prescribe Amoxicillin for only 5 days. Doing things the way you stated would leave a fairly substantial risk of a flare-up. Also, Amoxicillin would not typically be the first choice of antibiotic for this type of tooth infection, and a 5-day course would not be enough to clear up the infection.

My recommendation would be to see a root canal specialist; it is always good to see someone who has the specific training needed. There are many of your dentist’s treatment choices that I disagree with, and it sounds like a lot of his treatments were guesses. It’s important to have an endodontist look at the x-ray and figure out what is really going on.

Your husband shouldn’t need his tooth extracted as there are several options for correcting the root canal if it wasn’t sealed properly. I would also recommend Clindamycin for antibiotic therapy.

I hope your husband’s pain is resolved quickly! Take Care.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

How Long Does Emergency Bonding Last?

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I had quite the fight with a flight of stairs and my teeth lost. Two of them were badly chipped. I went to see an emergency dentist and he put some kind of emergency bonding on them and told me to follow up with my regular dentist. The bonding he did seems to be holding up, even though it is a few days later.  How soon will I need to see my dentist before it wears out?

Caryn – MIchigan

Caryn,

I’m assuming  the emergency dentist used a composite bonding on your chipped teeth. It’s used in emergencies, but not soley. It’s a common treatment for chipped teeth and will last several years. He didn’t want you to follow up because it needed replacing right away.

Instead, it is to double check the tooth itself. When a tooth is traumatized, it doesn’t always give  symptoms right away. If the blood flow was cut off to the tooth it wouldn’t show up on x-rays. If this is the case, the tooth could be dead or dying, and it will eventually need a root canal. Unfortunately, the first sign this has happened is often pain or an abscess, though sometimes the person notices discoloration as well. Anytime you see an emergency dentist, he’ll refer you back to your regular office for a follow-up.

I hope this helps you. Do make sure you follow up.  It could save you a great deal of time and money, as well as unnecessary treatment.

This blog is brought to you by Dr. Ryan Noah.

What Should I do about My Gray Tooth?

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I’ve never had any cavities in my life but just over a year and a half ago, my dentist pointed out that I have a gray tooth. She wasn’t certain if I needed a filling or a root canal and said she wanted to see me again. I never went back because I was anxious about the outcome. The gray tooth is my bottom right molar and it’s partially gray. I have an appointment this week but I feel stressed and think the tooth might be dead. What do you think?
– Brad from Oklahoma

Brad,
When teeth begin to turn gray it can be a sign that the tooth is dying. Since your dentist was unsure if it was a cavity, this was probably not observed in the X-ray of the tooth.

Teeth can die for no reason, however usually dental trauma or decay is the main cause. Most patients experience pain and sensitivity when trauma or decay occurs. If you are not experiencing any pain, the nerve in the tooth could be dead. A tooth can die from a heavy biting force and clenching of the teeth because the blood supply to the nerve becomes reduced causing death to the tooth. Sometimes people think that if the tooth doesn’t hurt, don’t do anything but here may be dead nerve tissue in the tooth. Leaving this tissue gives bacteria a feasting ground to grow, which does lead to an infection.

It is recommended to have your dentist take another X-ray to see if there are any changes in the tooth. If you feel like she is unsure if the tooth is dead or not we would recommend you visit an Endodontist. An Endodontist is a dentist that had more schooling then a typical dentist who solely specializes in root canal treatments. They use more equipment and different techniques to determine if the tooth has died.

For more information about Dr. Noah, visit Region Dental.

 

Is a Root Canal the Same as a Root Filling?

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I was at the dentist today and I noticed my left front tooth is extremely sensitive to the touch. The dentist gave me an X-ray but didn’t see anything when the X-ray was reviewed. I was given Amoxicillan and I took this an hour ago and was told to take it three times a day, most likely every eight hours. This is supposed to take away my pain but the tooth still hurts a lot.

The dental office recommended I come back in six weeks as my tooth may need a root filling. Is this the same as a root canal? Should I continue to take Amoxillan every eight hours? What is the best protocol for my situation?

– Frank from Oklahoma

 

Dear Frank,

It sounds like the pain in your tooth is caused from a tooth infection. This may not be visible on an X-ray because it may take a couple of weeks before a dental abscess or infection is visible on an X-ray. Even though you have pain in a tooth, an infection may not be visible on a dental X-ray. Sometimes it takes a couple weeks before an infection/dental abscess is visible on an x-ray.

Amoxicillan, the antibiotic your dentist prescribed, is not just used to reduce pain but also to minimize the chance of a tooth infection. If you are in pain, we advise you to take 800 mg of Ibuprofen every four to six hours and not to exceed more than 2400 mg per day. Take your Amoxicillin three times a day, every eight hours. For example, you might take it at 7:00am, 3:00pm, and 11:00pm to make it convenient for you. It’s also important to note that antibiotics often upset the stomach so you may wish to have a small snack with your medication.

Sometimes the tooth infection is only temporarily cleared up when taking medication. This means that when you see your dentist for a follow-up appointment in about six weeks, your dentist might not be able to determine if your tooth is infected. If it’s hard to have a diagnosis, it’s recommended to postpone any treatment.

The common cold or sinus infection may cause your teeth to hurt as well.

If you’re still suffering from tooth pain after a couple of months, you should make another dental appointment.  If an infection is present, your dentist will probably prescribe another antibiotic and recommend a root canal.

To answer your question, a root canal is the same as a root filling. If this is the treatment recommended following your root canal, you will need to have a porcelain crown placed over the root-canalled tooth to prevent it from breaking and decaying.

This blog brought to you by Dr. Noah, Region Dental.

Why do I feel pain after a root canal?

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Around three and half years ago, I had a tooth that needed to have a root canal and crown. Now, I’m experiencing pain with this tooth but my dentist says the root canal looks good. The dentist did not inform me of any cracks in the tooth so I’m not sure if that’s the problem or if I will lose my tooth. Also, the dentist said my tooth might need a new crown. I think the crown looks good and I don’t see any problems. What do you think?
– Brenda from Oklahoma 

Hi Brenda,
There may be many reasons why you’re experiencing discomfort with your tooth that has had a root canal and crown. One possibility for the pain you’re feeling is that the crown may be placed too high and it may need to be adjusted. If you’re biting hard on a crown tooth and it’s seated too high it can cause the tooth to ache even with a root canal. It’s important your bite be checked.

Did your dentist study your bite to see if the tooth needed adjustments? If not, have them check to see if it needs to be adjusted. If this isn’t the problem, it may be that you may grind or clench your teeth at night when you sleep and may not be aware of the issue.

Clenching and grinding can also cause teeth to hurt. Get your dentist to check and see if there are signs of grinding or clenching. If you have this issue, the dentist should create a night guard for you to protect your teeth and gums. There is a possibility the tooth has a crack within the root, however it is difficult to diagnosis. To confirm this, you will want to have a consultation with an endodontist who specializes in root canal treatments and would give you a better indication if the tooth actually has a crack or not. If your tooth has a crack, it would need to be extracted because there is no way to fix the tooth. If your tooth has to be removed, you have the option of getting a dental implant or dental bridge to replace your missing tooth.

Reasons why a root canal procedure may fail and cause discomfort:
■Sealers used to coat the filling material may wash out, creating a gap within the root canal, therefore causing infection
■If gaps are left at the base of the root and not filled properly, the tooth gets contaminated with bacteria which infects the tooth again
■If the tooth had multiple canals and exit points a spot may be missed and infection can set in
■If the root has small fractures the tooth may get contaminated with bacteria, causing infection which will lead to extraction
■If the tooth is not restored with a properly fitted dental crown then contamination may occur
■Inadequate cleaning, reshaping, or a lack of aseptic techniques of the root may cause root canal failure

As was mentioned before, there are multiple reasons why you’re having pain in your tooth. You should consult your dentist to determine if the bite is too high or to see if you have issues with grinding or clenching. These are two very common reasons for root canal pain. If your issue isn’t resolved, we advise you to see an endodentist who will inform you whether  the tooth is re-infected and needs to be retreated or if the root is cracked and the tooth needs extraction.

For more information about Dr. Noah, visit Region Dental.

How Long Can You Delay a Root Canal?

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I have a tooth that needs a root canal but I don’t feel any pain in the tooth. How long can my root canal be delayed before I get the procedure?
– Jonathan from Oklahoma

Jonathan,

It’s hard to estimate how long you can go without a root canal without seeing your tooth. If your tooth is causing you pain, you need to do the procedure right away. If your tooth hurts a little or hurt recently and the pain went away, you still need to have the root canal as soon as you can schedule it. Pain, past or present indicates an active infection that’s growing and when it comes to your teeth, the sooner you deal with it, the better.
If you notice a pimple in your gums or drainage in your mouth, the same applies. Active infections must be handled promptly. While it’s not an emergency, you want to schedule the procedure soon.

If your tooth hurt a long while ago, or never hurt at all, it may or may not be a problem to delay your procedure. Sometimes a tooth infection slowly eats away at the tooth root and will keep growing until the tooth is destroyed. If you are told the infection is latent and your tooth is fully intact with no active decay, you may be able to wait. Be sure you get expert advice.

This blog sponsored by Dr. Noah of Region Dental