Root canal treatment ongoing for more than 6 months.

[Ktulu]

Hi.
For more than half a year now, one of my lower premolar is giving me troubles.
It was cleaned and applyed fillings with medication for countles times since.
The doctor subscribed antibiotics, anti-inflamatory for a couple of times without results.
He tried numerous "medications" and some "disinfectants" as he calls them in temporary fillings. One of this disinfectant (about 1 month ago) made a slight change. That evening I felt some very sharp, stabbing pains, like lightning strikes. They lasted only fractions of a second, repeating every ~5-10 minutes. This went on for 2-3 hours than stopped.
Since than the tooth is slightly better, but far from good.
Every time the doctor cleanes the root canal (once a week) and changes the medication, it gets much worse for a couple of days. I guess from the stabbings while cleaning the tip of the root canal. However he's using an apex locator tablet-thingy. (Last time i saw some red coloration on the absorbant paper point he was using)
Especially during the night and in the morning, I feel the tooth being high and very sensitive. Even to slight touch, slight pressure, sideways movement etc.
Later in the day it becomes less sensitive, I can eat softer food.
I've also noticed, that stickyer food, (similar to chewing gum) that pulls on to the filling is painful.
What is your opinion, what should I do?
I feel like the doctor has ran out of ideas and medications to try. The nurse sometimes loudly laughs at me in the background when I arrive and tell the doctor that again nothing has changed.
Thank you.

(the x-ray was made 2 months ago)

 

[Dr M]

I would suggest maybe seeking a second opinion in a case like this. It is not normal to have the 1st phase of a root canal to be done over several months. I would also suggest taking a CBCT scan in order to rule out additional canals or cracks in the tooth.

 

[Ktulu]

I would suggest maybe seeking a second opinion in a case like this. It is not normal to have the 1st phase of a root canal to be done over several months. I would also suggest taking a CBCT scan in order to rule out additional canals or cracks in the tooth.

Thank you.
I forgot to tell, that I always feel pain when the doctor reaches the bottom of the root canal while cleaning it. Especially when he uses the absorbant paper points to dry it out.
Is this normal?

 

[Dr M]

Could be chronic infection. Difficult to say for sure. I would still suggest more advanced radiography in a case like this with a second opinion.

 

[Ktulu]

Eventually I went for a second opinion. The doctor wanted a new x-ray. I asked if I should bring a CBCT for more detail, but he asked for a regular one. See attachment.
He thinks the first doctor performed the root canal washings incorrectly, and the fluid exited the canal around the tip.
He now changed the temporary filling to Calcium 2 weeks ago. I should return in a week.
It helped maybe a little, but it still has the sensitivity to bite and lateral push. Especially in the morning.
Doctor sais, there is nothing more to do, but maybe a permanent filling, and if more problems arise, it needs to be extracted.
My question is, could it be left the canal open, or with temporary filling/cotton/medication, and the exterior closed with some harder filling that would last 5-6 months? And changed every now and then?
Or any other solution?
Half of the crown is missing, so curently a temporary filling only lasts around 1,5 month.

Thank you.

 

[Ktulu]

Dr M, what do you think?

 

[MattKW]

A CBCT - up to 18% of lower premolars have a 2nd canal. And there could be lateral branches from main canal or bifurcation at apex.
Also, there should be no bleeding unless the apical constriction has been breached; very unusual.
You feel pain when the paper point is inserted? Are you having the dressings changed without LA?

 

[Ktulu]

Yes, I feel pain when the paper point is inserted. Last time when the Dr. filled the canal with calcium, he explicitly asked me to signal when I feel a stabbing pain. And I felt a pretty sharp and strong pain. Than he stopped.
He told me, that it is even better if the calcium exits the apex into the surrounding area.
He also said that the canal is already very wide. If I'm correct, he used a size 60 needle? He mentioned that this rarely happens.
Yes, I never ask for any type of anesthesia.
Aren't lateral branches from main canal visible (if they exist) on the x-rays I've posted?
I should mention that there are days when it feels much worse. Very sensitive. When I do some cardio, I feel pressure or even pulsating feeling.
Thank you.

 

[MattKW]

It's not better if the CaOH exits the apex; sure, it can go up to the apex, but not be forced beyond that point. So he packs it in until you feel pain? - an interesting technique.
Size 60 is very large. This and the idea of pushing CaOH beyond the apex suggests that there is no natural apical constriction anymore. Not ideal - it makes success a bit harder, but still possible.
You won't see lateral canals on a standard Xray.

 

[John Morgens]

It sounds like you've been experiencing persistent pain and discomfort with your lower premolar despite multiple attempts at treatment. Here are a few steps you could consider taking:

Seek a Second Opinion: If you feel that your current dentist has exhausted their options and you're not getting relief, it might be a good idea to seek a second opinion from another dentist or an endodontist (a specialist in root canal treatments). They might offer fresh insights or approaches to resolving your issue.

Consult a Specialist: An endodontist specializes in treating issues related to the inner structures of teeth, including root canals. Consulting with a specialist could provide you with more advanced treatment options and a higher level of expertise.

Imaging: If your current treatment isn't resolving the issue, your dentist might consider performing more advanced imaging, such as a cone beam computed tomography (CBCT) scan, to get a clearer picture of the root canal system and the surrounding structures.

Possible Re-Treatment: In some cases, a root canal treatment may need to be redone if there are persistent issues or if the infection wasn't completely resolved during the initial treatment.

Consider Extraction: If all other options have been explored and the tooth continues to cause severe pain and problems, extraction might be considered as a last resort. In such cases, discussions about possible replacement options like dental implants or bridges could also be initiated.

Effective Communication: It's important to maintain open communication with your dentist. If you feel that your concerns are not being taken seriously, you might want to express your frustrations and discuss your options. If the behavior of the nurse is affecting your confidence in the treatment, you should address this issue with the dentist as well.

Remember, your oral health is a priority, and it's crucial to work closely with a dental professional to find a solution that addresses your pain and discomfort. Always consult with a qualified dentist or endodontist who can provide personalized advice based on your specific situation.

 

[Ktulu]

It's not better if the CaOH exits the apex; sure, it can go up to the apex, but not be forced beyond that point. So he packs it in until you feel pain? - an interesting technique.
Size 60 is very large. This and the idea of pushing CaOH beyond the apex suggests that there is no natural apical constriction anymore. Not ideal - it makes success a bit harder, but still possible.
You won't see lateral canals on a standard Xray.

Hello Dr. MattKW.
I've taken today the CBCT scan of my tooth.
Could you please take a look?
Thank you.

export

MediaFire is a simple to use free service that lets you put all your photos, documents, music, and video in a single place so you can access them anywhere and share them everywhere.

www.mediafire.com

 

[Ktulu]

Hello Dr. MattKW.
I've taken today the CBCT scan of my tooth.
Could you please take a look?
Thank you.

export

MediaFire is a simple to use free service that lets you put all your photos, documents, music, and video in a single place so you can access them anywhere and share them everywhere.

www.mediafire.com

Here you can find a small and free 3D DICOM (.dcm) viewer if you don't have one:

3DimViewer - Browse /3DimViewer/3.x at SourceForge.net

3DimViewer is a lightweight 3D viewer of medical DICOM datasets.

sourceforge.net