Multiple root canals failed

Joined
Jun 27, 2022
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I'm wondering if I have some underlying problem that causes my root canals to fail.

I had a root canal done by a dentist on tooth #21 1.5 years ago and since that time that tooth was giving me pain. I went to multiple doctors to get opinions, they took X-rays and CBCT scan but could not find anything. At some point the pain lessened but after 2-3 months returned even worse. I went to an endodontist who suggested to redo the root canal. They also took another CBCT scan. The root canal was redone but the pain didn't stop, it was getting a bit better and then worse but no overall progress. After 2-3 months i decided to have this tooth pulled. Oral surgeon who pulled the tooth said I had an infection under the tooth, which was a cause of this pain. The tooth apparently was not cracked. I thought that redoing root canal would take care of the infection, but according to them, sometimes it doesn't.

Anyway, long story short, in 3-4 months after this I ended up needing another root canal on tooth #20. This time I went to another endodontist to do it. Unfortunately, after 2-3 days that tooth started hurting again. The pain got worse. They agreed to undo the root canal and put antimicrobial medication into the canal to see if this will help. That procedure did not seem to help. The other thing they did was to give me antibiotics. I tried several ones, Amoxicillin, Augmentin and Erithromycin which didn't do anything. The one that did help was Clindamycin, as I felt much better after couple of days. The pain never really went away completely, but it was minimal for couple of months however then it returned. The nature of the pain was very similar to what i had for #21, but not as strong though. The endodontist said there is nothing more can be done about it and suggested for me to get extraction and implant. This time i decided not to wait a year like i did for #21 and got tooth #20 extracted several days ago. They also let me take the tooth home, i examined it but didn't find any cracks.

My question is that what could be going on. Do i have some persistent infection that causes all my root canals to fail? I m afraid of the same thing repeating if i need another root canal. I'm planning to get an implant (or 2) to replace the missing teeth, but also concerned if an implant can fail too for the same reason (infection). According to the doctor, it is possible the infection was anaerobic, since treating with Clindamycin worked for a while. However since this also ultimately didn't fix the problem, something else is required. The root canals were done and redone by different endodontists so it's hard to believe that all did a bad job. This is a mystery for me. I asked oral surgeon if they can take a bacterial culture to determine precisely what antibiotic i need, so far they said they normally don't do this kind of thing, but perhaps i need to ask again.

Also, I had several root canals done in the past, about 20 years ago, and there was no such problem. Any ideas?
 

MattKW

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Mar 18, 2018
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The reason behind your problems can't be solved in this forum with minimal information, sorry. There is no such thing as a persistent infection that could spread to other teeth. Whether Clindamycin helped or not is impossible to say; maybe it was going to settle anyway, and coincidentally you started taking the Clinda at the same time. Oral surgeons would only perform culturing of bacteria where there was massive life-threatening infection, and they certainly won't do it now that the teeth have been extracted. Next time you need an RCT, consider going back to the 1st endo (at least they have CBCT).
 

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Joined
Jun 27, 2022
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I understand that it cannot be solved on this forum, I m just looking for clues. Has there been other cases where multiple root canals failed, even though they were properly done? If so, what are possible reasons behind those cases?
My 2nd endo mentioned that perhaps I cannot tolerate root canals, but what does it even mean? There must be some reason why they failed.
 

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Hi,

I had finally a culture test done, after yet another root canal failed and I had it extracted. They took both aerobic and anaerobic culture. Aerobic looks normal. For anaerobic though, the result says: "Moderate growth of Propionibacterium acnes". Also, above it, it says "Moderate white blood cells seen. Rare Gram positive cocci".

I m not really sure what this means, but the oral surgeon did confirm it is a sign of infection. Note that I didn't have any significant infection before the root canal, and the extraction was done a month after root canal, so it seems the infection remained.

I can't be 100% sure, but i suspect the same bacteria was responsible for my previous root canal failures as well.

Any advice? Would an endodontist know how to treat this? Oral surgeon also suggested going to infectious disease specialist.

I'm pretty sure unless something is done, any future root canal would fail as well.
 

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