Root Canal Molar Still Sensitive after 2 months

[postendo]

Greetings, I had a root canal done about 2.5 months ago but still feel a low level of discomfort in the tooth when I floss it or wiggle it with my fingers. Should the pain be completely gone or does it sometimes linger for a long time ?

 

[Dr M]

It does sometimes take some time for it to settle, especially if there was a large abscess or infection prior to starting the root canal. Do you have any post treatment x-rays you could share?

 

[postendo]

Thanks for the reply. There was no abscess/infection at all. The way I found out I needed a root canal was by having a routine set of x-rays done. The xrays showed the #18 molar had decayed in the front part of the tooth. So I tried sticking a fingernail into that front part of the molar and that was the only time I could feel a little discomfort. Will check to see if I can access the post procedure xray...

 

[postendo]

Took a while to get these. I believe they are "before" and "after" root canal pics...

 

[Dr M]

The root canal looks good. Sometimes the tooth takes a while to settle. I would give it 6 months. If the sensation is still there after that amount of time, other investigations might be needed in order to rule out missed accessory canals or cracks. Try not to wiggle it too much. Every tooth still has ligaments around it,even if the nerve is removed, and excessive wiggling can contribute to inflammation of this ligament, resulting in pain.

 

[postendo]

Thanks again Dr. M. I came to a similar conclusion last week-just leave the tooth undisturbed. My dentist believes it highly unlikely that the root canal failed but never explained why he thinks that to be true. About a month ago he shaved down the crown because he thought it was too high but that did not help. My endo says to give it more time. My endo did do a high tech/expensive/3D scan before the root canal. The office is unable to email me that scan but wondering if the pain persists, would that scan be helpful in figuring out what the issue is ?

 

[Dr M]

If the pain persists, you are more than welcome to send screenshots of the scan if possible.

 

[postendo]

Okay I will wait and see.

 

[postendo]

Hi Dr. M I'm back again. It's the 6 month anniversary of my root canal procedure so I wanted to update you. Nothing has changed-still have this low level pain/sensitivity to pressure at the site of the root canal. I feel it only when I floss or wiggle the tooth. I'm already past due to go back to my dentist (who did the crown) for a routine cleaning/exam. And the endo that did the root canal asked me check back in at the 5 month mark if the sensitivity persisted. I've been putting them all off hoping this thing would fade away. Would appreciate your thoughts...

 

[Dr M]

I would go back for the follow-up with the endo and hold off with the crown. It is not normal to have pain at this stage. A new x-ray and scan might be indicated.

 

[postendo]

My dentist took another x-ray of the root canal last week and says it all looks good.. He asked me if the discomfort started before or after he installed the crown. I told him it started before the crown. His advice is "leave it alone" and he mentioned immune system functioning dictates the healing process. Scheduled to see the endo next week to get his take on the situation.

 

[Dr M]

I agree. Go see the endo. Make sure there is no issue with a CBCT scan preferably. A normal x-ray does not give enough information.

 

[postendo]

Hi Dr. M, saw the endo yesterday for the 6 month old root canal pain. He did both a periapical and a 3D/Cone beam xray. He says it all looks good and he would leave it alone because tearing it all out could cause further damage. His best guess is a hairline crack hidden under the crown where he can't see it. On the bright side, he mentioned only 75% of root canals are successful at the 1 year mark but the rate climbs to 90% at the 2 year mark. On the downside, if the pain persists at 2 years then I may have to just live with it. He says I'm welcome to circle back at the 2 year mark for another 3D xray.

 

[Brause]

Hi Dr. M, saw the endo yesterday for the 6 month old root canal pain. He did both a periapical and a 3D/Cone beam xray. He says it all looks good and he would leave it alone because tearing it all out could cause further damage. His best guess is a hairline crack hidden under the crown where he can't see it. On the bright side, he mentioned only 75% of root canals are successful at the 1 year mark but the rate climbs to 90% at the 2 year mark. On the downside, if the pain persists at 2 years then I may have to just live with it. He says I'm welcome to circle back at the 2 year mark for another 3D xray.

My endodontist said a priori that a successful root canal could leave me with a permanent 2/10 pain.

 

[postendo]

That is one honest endodontist you have. I'd say I'm at a 2-3 out of 10 on the permanent pain scale. The discomfort doesn't get worse, doesn't get better.

 

[Brause]

That is one honest endodontist you have. I'd say I'm at a 2-3 out of 10 on the permanent pain scale. The discomfort doesn't get worse, doesn't get better.

Hence, in my case, tooth 36 will have to go. No endodontic treatment...as it is a time bomb at best.

 

[postendo]

I was thinking the same thing this afternoon. If the tooth is cracked and will last another 10-20 years before it fails due to the protective crown, then do I even want the tooth ?

 

[Brause]

I was thinking the same thing this afternoon. If the tooth is cracked and will last another 10-20 years before it fails due to the protective crown, then do I even want the tooth ?

A friend of mine went through two (cracked) crowns on tooth 36, then had it pulled...and replaced by an implant. There is one big advantage, though: no more periodontal ligament (PDL).

The PDL has two primary functions: 1) to transmit and absorb mechanical stresses, and 2) to provide vascular supply and nutrients to the cementum, alveolar bone and the PDL itself [3]. The PDL is a connective tissue and shares certain similarities with tendons and other ligaments in the appendicular skeleton [4].

I picture travelling through the African hinterland and an endodontically treated tooth starts coming on...strong.

My personal experience with RCT is so negative (success rate ZERO) that I will decline the endodontist's forthcoming suggestion of doing another one...mandibular molars carry much stress and are prone to cracking.

On the other hand, Moral & Ahnemann published in 1921:
"It is only humanly understandable to finally give in to the wish of the patient, who is always complaining about toothache, by removing the tooth that is labeled as the culprit. However, experience also shows that such attempts at healing are as useless as they are harmful, because either the pain is not relieved by the procedure or it is localized elsewhere."

And surgeon Christoph Partsch wrote in 1925:
"Above all, with such neuralgic pain radiating into the face, extractions of healthy teeth should be avoided. The teeth should only be removed if they are demonstrably diseased. If the patient states that the pain is located in one tooth in particular, one should never be pressured into extraction. The pain will not disappear despite extraction, the patient's dentition will only be mutilated."

These assessments are still fully valid today (I am told), though I don't know what treatments they suggested.