[Xrays and 3D] Apicoectomy, continue RCT, or close tooth? Lymph nodes

Joined
Oct 10, 2022
Messages
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I have a tooth (mandibular right first molar) that had a tiny bit of pain when biting on it for about 2 years. The reason I didn't do anything about it sooner is because the pain was barely noticeable. But about 4 months ago I went to get it checked out, and the dentist did a root canal. I was told the nerve had died, that's why it wasn't hurting.

The tooth was cleaned mechanically and iodine was put in. About 1 month later the tooth was opened again and cleaned with a laser, and calcium was put in. About 12 hours later when I woke up, I felt a hard and a bit painful bump (lymph node) under my ear. A few days later I noticed the one on my neck is enlarged. Then I noticed the one under my jaw bone is a bit sensitive. Since then the tooth was opened up and cleaned out a few more times, and for the past 1,5 month I've had calcium sitting inside. Laser was not used anymore.

When the tooth is opened, there is no pus, there is no bad smell, and the walls of the canal are calcified correctly (according to my dentist). I have no pain on hot/cold, and the only pain I can find on the tooth is if I tap it horizontally. It's barely noticeable, but it's there.

But here I am 3+ months later, and my lymph nodes are still inflamed. They're only inflamed on the right side of my head/neck/ear, the left side is perfectly fine.

Here are the Xrays and 3D:

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I went to an ENT and had an ultrasound done. They didn't find anything, but the ultrasound confirmed that my lymph nodes are a bit enlarged. Still, the person who did the ultrasound was not worried. I also got my vitamins tested, and everything is perfect. And I feel good and healthy (other than what this is doing to me mentally).

I had gotten opinions from a few dentists. One said to continue the RCT. Two said that they would close this tooth up. And one said he would do an apicoectomy (when I pressed him, he said we can continue the RCT for another month, but if it doesn't help, then he would do an apico).

So here I am, and I have no idea what to do. And I'm kinda scared.

If there is any dentist on this forum who can look at these xrays and give me his or her opinion, I would be forever grateful. And having said that, please help me with your opinion, I'm begging you.

Thank you :)
 
Joined
Oct 10, 2022
Messages
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Finish the RCT ASAP. An apicectomy is definitely not a sensible option.

Thanks for the reply. I really appreciate you taking the time to take a look and respond :)

I would finish the RCT, but the reason I haven't is because the tooth is a bit painful when tapped with a harder object. And because of the enlarged lymph nodes.

If it was just the tapping pain, I would close it. Because it doesn't bother me when I eat, and I don't eat rocks.

But the inflamed lymph nodes worry me. They got inflamed 12 hours after the second cleaning of the tooth, and the only cleaning that was done with a laser. And this was 3+ months ago.

Although, I guess, if I finish the RCT and then the tooth starts acting up or something, I can always get an apicoectomy later. Right?
 

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MattKW

Verified Dentist
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Mar 18, 2018
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No, if the RCT fails, then it is best to do it again but try an endodontist. Lasers have not been shown to be significantly better (or even equal to) standard chemical disinfection techniques. And apicos are best reserved for teeth which cannot be easily re-RCTd, e.g. have a crown and post in them.
 

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Joined
Oct 10, 2022
Messages
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No, if the RCT fails, then it is best to do it again but try an endodontist. Lasers have not been shown to be significantly better (or even equal to) standard chemical disinfection techniques. And apicos are best reserved for teeth which cannot be easily re-RCTd, e.g. have a crown and post in them.

I talked to another dentist yesterday, a really good one. He told me we will continue the RCT, and eventually close the tooth.

I explained to him how my lymph nodes got swollen after the laser root canal, and how they're only swollen on the right side. He told me they must have hit a nerve with the laser, and that's why my lymph nodes are swollen. He said I shouldn't worry about it.

Does this sound plausible?
 

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