Ongoing issues after root canal

[AJK64]

A long post but want to try and explain as best as possible.

Starting at the beginning of October 2017 I developed a constant pain in the left temple area of my head. The pain varied on the pain scale day by day between a 5/10 up to about an 8/10. It was ruining my life and was stopping me from sleeping a lot of the time. I saw a neuroogy consultant and had 2 MRI scans and was tested for Temporal Arteritis (even though I was out of the risk group). The MRI's didn't show anything and the TA tests were negative. My neurologist was at a complete loss as to what was causing my pain. I was near suicidal at one point the pain was so intense and constant.

Fast forward to February. Still having the same issues, still no answers. I register with a new dentist (hadn't seen a dentist in about 8 years and my old practice had closed down). The dentist took xrays and said that there appeared to be a bit of decay under my already filled upper left 1st molar. So he took the old filling out and was shocked to find extensive decay underneath. He removed the decay but it went very deep and he was worried the filling would aggravate my nerves, but tried anyway. Well the filling did aggravate the nerve. The head pain was now joined by extreme tooth pain. So he decided it needed a root canal.

So he did the treatment. He did the whole thing in one session (which I now understand is not usual) and fitted a permanent amalgam filling. After he finished he looked annoyed. He told me that he had never actually done an unsupervised molar root canal before. He told me that he could only find 2 root canals. He was clearly angry at something, and told me that he couldn't do anything more to help me.

Well the root canal was now 9 weeks ago. The tooth still hurts if I touch it (it is no longer sensitive to heat or cold at all, but if I try to chew on my left side and when I brush it aches like a bruise or something).

I was now pretty scared of that dentist. It took me ages to find a new one but 2 weeks ago I went to a new surgery. The new dentist took an xray and said that the other dentist had seemingly left infection at the root tip of the tooth, and he gave me 10 days of Amoxicillin (500mg). He also said that it looks like there is a calcified 3rd root canal in the tooth. I took these and within a few days the head pain that I had had for over 8 months completely vanished! To say this was a relief is an understatement. I finished the coarse of antibiotics and for about 4 days the pain was still gone. However it is now back and slowly increasing again.

I feel completely lost. I don't know what I can do. I feel at the end of my ability to cope with this pain. The new dentist said that it appears that my upper molar roots are very close to my sinus, so extraction could be difficult. He offered to refer me to a private endodontist (I am an NHS patient). I have very little money and I am now wondering, would it be even likely that this tooth could be saved now by a specialist endodontist? Would filling the calcified canal solve this? What on earth happens if I have the tooth removed and end up damaging the sinus?

Then to add further stress, I have been having to chew exclusively on my right side. Now my lower right molar, which is also filled is hurting every now and then when I bite on it. I am so frightened after what has happened with the left upper molar that I don't know whether to get this tooth treated or just ignore the occassional pain.

 

[AJK64]

Quick update. One week after the final treatment. I am still experiencing some pain...still unable to eat on the left side of my mouth and being careful when brushing. It's strange, the pain goes away for a few hours each day and I think that it must be over, but then it will creep back again. On average the pain is around a 3/10 spiking to a 5/10 after brushing at night (I'm still not brushing in the morning, instead just rinsing with salt water or corsodyl)

 

[Busybee]

That seems a bit more positive than before. Are you using sensitive toothpaste? Keep a diary of what you do each day so you can find out what triggers the pain. Did the dentist advise you to use corsodyl?

 

[AJK64]

I'm using sensodyne yep. A pharmacist recommended the corsodjl but said only use it every other day as it can stain teeth.

The thing that really triggers pain is brushing, but sadly that's one thing I can't avoid.

I see my regular dentist in another 2 weeks time so he can check how everything is going. Hopefully by then there will be further reduction of pain. It seems like it is very slowly getting better. I keep reminding myself that it's only a week since I finished a pretty intense surgical procedure...when I broke my toe a few years ago that didn't just stop hurting a week after treatment. But it's also annoying just waiting and hoping.

 

[AJK64]

As promised here is an update.
I was starting to really believe the root canal had worked. My pain level dropped to only a niggling feeling on Friday to the point where Saturday Iiterally cried with happiness at being free of pain for the first time in 9 months! My temple still hurt very slightly (around a 2/10), but relatively I was pain free.

BUT. The Monday morning I woke up and the entire left side of my face felt wrong. I had an aching feeling around my eye socket and the tooth pain had reverted back to around a 7/10 with my temple being a bit higher. I loaded up on anti inflamatories and waited to see if it would pass. The pain is still there, but has dropped again to around a 3/10 in the tooth, and a 5/10 in the temple and the eye still feels 'wrong' and I am getting odd itching feelings inside my left face...feels like inside the cheek bone.

I rang the endo, and his secretary said I could get a review appoiontment this Saturday, but I would have to pay a £90 fee, which I simply cant afford after all of this money. I am seeing my Dentist next Wednesday (4th) so will see if the pain subsides again befroe then. I really don't want to get the damned tooth extracted now as I am in debt from the loan to pay for the root retreatment and having it taken out now would just feel like I threw money I didn't have away.. I am starting to think root canal might have been an expensive mistake.

 

[Busybee]

Sorry to hear that AJ, but perhaps you should insist that the endo waive his fee seeing as he must have missed something. He should be seeing you as part of his fee follow up. What you should do is make a formal complaint about the dentist who did the faulty root treatment and seek compensation.

 

[AJK64]

Another week another update. I am really confused by all of this. The pain seems to go very low for a while (a few days at the end of last week), to the point where it is an annoyance rather than something I focus on. And then...Absolute agony again. It started aching Sunday afternoon after the afore mentioned few days of relative ease, and then by yesterday afternoon I was in absolute agony (a 9/10). I wake up this morning and the pain has gone down again to around a 3/10. I didn't do anything different when the pain shot up. I am still not eating on that side of my mouth at all, and still only eating soft foods anyway. I am still very carefully brushing that area too, and only brushing in the evening to avoid over irritating it.

I am seeing my dentist tomorrow and am trying to figure out if I should ask for extraction. This brings up a whole host of fears for me as I am terrified of the extraction causing a hole into my sinus (one of the roots in my xray looks like it runs into the sinus itself). I am trying to figure out if I can live with this pain to avoid the extraction...trying to figure if living with pain is better than risking a complication like sinus perforation (which I have been told is a really unpleasant and long lasting thing to have to deal with).

 

[MattKW]

Another week another update....
I am seeing my dentist tomorrow and am trying to figure out if I should ask for extraction. This brings up a whole host of fears for me as I am terrified of the extraction causing a hole into my sinus (one of the roots in my xray looks like it runs into the sinus itself). I am trying to figure out if I can live with this pain to avoid the extraction...trying to figure if living with pain is better than risking a complication like sinus perforation (which I have been told is a really unpleasant and long lasting thing to have to deal with).

If you go for an extraction, don't be so concerned about a sinus perforation. They are rare. I have only had 2 in 35 years, and are easily repaired, usually on the spot, or by an oral surgeon.

 

[AJK64]

In your experience MattKW, what do you think could cause continued pain post root canal? It looks like a well done job from the xrays, and I was told by the endo that all infection had been cleared, and that he could see absolutely no sign of cracks in the tooth or roots (plus I understand that the pain of a cracked tooth would only occur on biting, and as mentioned I am not biting at all with that tooth). Is it likely that tooth ligaments could still be damaged from the surgery or duration of the infection? Is 'bruised tooth' a real thing? If I had ideas of what might be casuing it and if its likely to resolve in time I would know more what to do.

 

[AJK64]

Just seen my dentist. He said that the x-ray appears to show a 'text book endodontic treatment' and he said that the endodontist seems incredibly skilled. He said that he would not feel comfortable removing £1000 of seemingly perfect dental work without giving it longer to settle. He also said I should phone the endo again and insist on free aftercare as 'responsibility of service'...even if it is only a telephone conversation.

He also told me that if the tooth does not settle then he will have to refer me to an oral surgeon due to the sinus/root proximity. But I should wait a while longer before making that decision. His nurse told me that her own root canal had taken 6 weeks to completely settle.

 

[Busybee]

You should definitely insist on free aftercare. I can't believe they are charging for aftercare. A lot of these arrangements are made without any explanation of terms and conditions if something goes wrong. Private practices just assume that patients won't sue because it's so difficult to do so in the UK.

 

[AJK64]

Managed to speak with the endo over the phone (was the best they offered for free). He said that he believes it was a good case and that it just needs more time to settle.

I am really at my wits end with this pain (over 9 months now). I would be okay if I just knew if waiting would fix the pain, but no one seems to know for certain how long or even if it definitely will work. How long is reasonable? Could I still be in this situation by October (A year since it all started) with dentists still saying to give it longer to settle?

I don't blame the endo. He was fantastic and did everything right. I am angry and disappointed at the original dentist for being arrogant and thinking he could do such a hard job in such little time allotted. I am also starting to feel that dentistry isn't so much a science as a gamble :/

 

[Busybee]

AJK I've heard dentistry described as palliative care. Once you have work on a tooth it is always at risk of dying. Having a root canal is just a way of keeping a dead tooth in situ. It doesn't always work but when it does it's like a miracle. It's always better to try to keep the tooth there because it helps preserve the bone structure and prevents over eruption on opposing teeth. Also helps your bite remain stable and promotes better digestion etc.

Wait a bit longer. It can take a while to settle.

 

[AJK64]

Well it never rains...
Just got back from the Drs as been getting bad pains in the side of my torso and feeling sick. Been diagnosed with gastritis and possibly a stomach ulcer due to long term ibuprofen use from my tooth problem

I've been given a drug to reduce stomach acid production and told to hold off on NSAID use for a while. Really hoping codeine and paracetamol will keep my tooth pain low enough.

 

[AJK64]

Another week, another update. Gastritis is clearing since I started the omeprazole. No change in pain level of the tooth. Still can't eat or brush on that side without intense pain. Pain level at rest is still around a 3 or 4/10. Spoke to my dentist again and he told me to wait longer to see if it settles. Haven't eaten real food now since October 2017, just noodles, mashed potato etc. Lost around 8 kg in total now (only weighed 67 kg to start with). Spend most of my time on my own as the pain makes me irritable with other people. Not really sure what's going on or if this is all considered normal consequences of a tooth abscess. I don't know if the infection is still there and I'm worried that the infection might spread given how long it's possibly been in my skull now.

 

[Busybee]

You're not the only one with gastric problems due to use of ibuprofen. That's how mine started and it was at a time when I was having dental problems a few years ago. I was on omeprazole on and off. I hope you are on a temporary course because Omeprazole is very difficult to come off and I found it had side effects. I'm much happier on a H2 blocker.

It sounds like the pain is less severe than it was but I'm wondering are you still wearing a temporary crown? What's on the tooth? My experience with rct on my own teeth is that if a tooth isn't sealed properly you end up with pain. This has also happened to me with just fillings. I had constant symptoms from a couple of root treated teeth until I had crowns replaced. The new crowns had a nice snug fit and no exposure of dentine. The symptoms disappeared completely. Maybe the temp crown is moving around at night or when you bite. I've had pain in a tooth with a temp (not root filled) but only when it's pushed in a certain way. My tooth has settled more and more since the dentist adjusted the bite down slightly.

Or what you have could be unrelated to the tooth and either a tmj or trigeminal issue. Jaw joint pain can hurt in the same area. If you had a major infection the dentist would see it on x ray. You'd also have swollen lymph nodes on and off as your body fights it. I am not sure whether there is a nerve that may have been damaged by your original RCT, but maybe worth checking with your dentist if that can happen. If that's the case extracting the tooth may not solve the problem.

Your diet sounds poor and it's not helping you heal. Are you getting enough vit C & vit D?

 

[AJK64]

Thanks for the reply.

I'm taking a multivitamin supplement to try and compensate for my limited diet.

I have a permanent filling on the root canal. Not going to get it crowned until I know if it needs extracting or not.

The pain is only in that tooth and is made worse when touching that specific tooth in any way (My tongue brushing it, or toothbrush etc).

The endo trimmed the tooth down so it isn't touching the opposing tooth at all.

I haven't had any xrays taken since the root canal was finished 6 weeks ago, but the gland on my neck in that side has swollen several times over the course of the last several months. The endo also said that the original infection was pretty nasty and I'm worried that infection has started to build and spread again since the root canal was completed.

I had a root canal on a lower tooth back in my teens and that one didn't hurt at all after it was finished so I just don't understand what's happening with this one.

I'm hoping this gastritis issue will heal up so I can stop taking the omeprazole quickly. I hate having to take meds.

 

[AJK64]

Another weekly update. No real change in the tooth. Still painful to touch, and a general low background pain.

Have started getting more pain just under the eye socket on that side of my face and the pain in my temple seems to be increasing (more often above a 6/10 now) and I get a weird pressure pain in my temple now too that seems to radiate all the way down that side if my face.

I'm considering asking the neurologist if I can get another MRI when I see him next week to see if there's any sign of spread of infection into the bones of my face from the tooth (not even sure if that's possible). The gland on my neck is prominent every so often but then goes down again.

I would make another appointment with my dentist but all he says is "give it more time" so I don't really want to waste his time.

 

[Busybee]

You can end up with all sorts of symptoms if you have a leak somewhere because of the temp crown. If you get the go ahead then I hope the MRI reassures you that the infection is under control.

By the way I checked and if you are in severe pain with a dental infection there are two options on the NHS. Firstly your dentist should be able to refer you to a specialist in the community dental service. This is now the referral pathway. If you are in agony (as you were) you can go to the A&E of a dental hospital and demand treatment there and then.

 

[AJK64]

I don't have a temp crown. The endo sealed the tooth with a permanent filling until I get the crown later.

I'm hoping the neurologist will have ideas next week on where to go next. I'm even considering finding a different dentist for a fresh, second opinion on everything, while also hoping this root canal finally starts to settle or at least show some sign of settling.

 

[Busybee]

But it's still not sealed with a filling. The enamel should be protected by a crown because it's not the same as the enamel on a live tooth. I would try another dentist for a second opinion. It's taking a long time to settle, but then you did have a really bad infection. With my root treatments the teeth settled straight after the root treatment. It was such a relief. But I still had niggling symptoms & ghost pain for years and it was only after the crowns were changed that they felt just like my other teeth. Before that I was always thinking the root treatment had failed.