One-week Post 2nd Root Canal of 1st Upper Molar, Pain w/ Pressure, Proceed with Crown?


Joined
Sep 19, 2021
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1
Hello,

I'm just seeking some advice here on how to proceed with treatment of my first molar tooth on the upper right. Dental numbering gets me a little confused, but it's not the very last molar, the one immediately adjacent to it. I've had my wisdom teeth removed.

Two Saturdays ago, I woke with extreme pain radiating from sort of "under" the tooth and going up my cheek to what felt like almost my eye! It was constant, but not as severe throughout the day. I took 800 mg of ibuprofen every 6 hours, and it did nothing to relieve the pain.

I scheduled to see an emergency dentist, who took an X-ray and noted a pocket of infection below the gum line near one of the tooth's roots.

The tooth had previously undergone root canal treatment, but only had a crown build-up, not an actual crown. So the emergency dentist prescribed an antibiotic, and referred me to an endodontist. I was able to see an endodontist within 3 days, and he again did x-rays and determined that the tooth needed a retreatment of the root canal because ... well, he didn't explain really what caused the first root canal to fail, but I assume it's because it never had a full restoration. The earliest available appointment with endodontist was about a week later. I continued on the antibiotic, and after about four days, the pain had subsided to where I could actually chew on the right side of my mouth without severe shooting pain.

I had the second root canal last Tuesday and the endodontist said it was a success. He replaced the filling material and resealed the canals with a temporary filling. I made an appointment to see a general dentist for a crown for tomorrow, which would be less than a week after this procedure.

I felt no discomfort or pain for about two days, although I still did not chew on the right side for fear of dislodging the temporary filling.

However, three days ago, on Thursday, I once again awoke to the same shooting, severe pain on the same tooth. It lessens during the day, but is SEVERE when I put the slightest pressure vertically on the tooth with my tongue. No pain increase if I press on the rear of the tooth. Only when I press downward vertically and if I happen to mistakenly chew on the right side. It is SEVERE.

So a long description basically with one question. Should I proceed with the crown tomorrow even though I can't even chew on the right side and it's severe pain with pressure, or should I call the endodontist?

I'm assuming the general dentist will take his own X-rays before the crown procedure and would be able to see any infection.

Would that be the only thing causing this pain? I can't feel anything in terms of hot/cold on the actual tooth, so I'm pretty sure the nerves in it are completely gone and sealed. The pain is more like "in" or "under" the tooth, and only with chewing or pressure. Otherwise it's a dull ache on the part of my gum line/jaw.

At first I thought it was just soreness/tenderness from the root canal since the endodontist had to remove the first root canal's crown build-up, unseal the canals and remove the filling material. He even said it was a difficult, complex procedure. But it's just odd to me that I felt no pain two days after the procedure, but then it began SHOOTING pain and severe pain with pressure that's lasted three days and doesn't relieve with 800 mg ibuprofen.

Any advice would be appreciated.

40yo male, nonsmoker.
 
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honestdoc

Verified Dentist
Joined
Jun 14, 2018
Messages
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Your case cannot be fully diagnosed through this platform. I would guess the the possibility of fractured tooth. Have your dentist perio probe the gums, use a tooth sleuth to check any internal cracks, and make sure it is not a sinus problem. The upper first molars are one of the most likely to fail due to the presence of a difficult canal called Mesial Buccal 2. According to an endodontic instructor/faculty, he could only instrument between 60-80% of them. What happens to the 20-40% or them uncleaned?

It is a difficult decision. If the dentist test the tooth good, quickly put a crown with no guarantees it will be pain or infection free. The other option is to consider implant with possible need for sinus lift surgery to accommodate it.
 

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