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9 months after treatment and the tooth gets infected again?

User Level:
Patient
Posted by: Lindsay_says  (8 years ago)
Hi there!

I had a badly infected upper molar which had caused me a very horrible pain. When I went to the dentist, he referred me to an endodontist who immediately performed a root canal to let the pain subside. He gave me strong antibiotics and pain medicines after the procedure. It was fine for 9 months but then it started to bother me again. My gums are swollen and hurt really bad. Could it be infected again? The endodontist said before that he's not sure if the root canal can save the tooth because it was in a pretty bad shape but he suggested a root canal re-treatment in case I still have problems. If it is infected again should I just get it pulled?

Another problem I have is the tooth below the root canaled molar. I started to have throbbing pain from this tooth. The gum around it is very sore. Is it possible that the infection has spread to this tooth also and it is now showing symptoms? The teeth beside the infected molar look fine. What do you think? Thanks a lot!
User Level:
Student
Posted by: ghnane  (8 years ago)
Hello,
Unfortunately a root canal treatment is the last resort to save a tooth if RCT fails next step is to extract the tooth and look into the possibility of getting an implant to close the gap and prevent teeth from shifting.

A reinfection is possible if the infection was bad and with some bacteria remaining your body mounts an immune response that results in pain, swelling, and redness.

The tooth in the opposite side may have developed an infection independent of the upper arch by bacterial infiltration.
Please consult with a dentist and have them evaluate all your teeth.
User Level:
Student
Posted by: Manchy  (8 years ago)
From what you have described above it looks like your tooth was not crowned ( had a cap put on) after the first root filling - I am not suggesting that every root filled tooth need a crown - but every root filled tooth need some sort of isolation for increased success rates of root filling treatment. Evidence-based articles show that isolation is a very important factor for the success of a root canal treatment. Another reason why a root filling could fail is u basically developed some decay in that tooth which could have transferred the bacteria to the canal and re-infected the root again, which is considered as a root canal failure. It is important to understand that root filled teeth do not stop decaying.
The very last end of a root canal contains some small tiny canals that cannot be cleaned directly with instruments (think of it like a tree with very small branches from the sides) and this part of a root is usually called "delta" and if bacteria has been left in these tiny canals there is a chance of re-infection of the main canal and failure of the root treatment.
Another common reason for root canal failure could be missing canals. For upper molars, there is a chance of an additional canal existing that did not show up in the normal xray and they r very tiny to be seen clinically. I once have read an article about a molar tooth having more than seven canals which looked quite interesting.
I would have to disagree with ghnane about extraction, because it is the cause of the root canal failure and how much tooth substance is left that determine the next step. so, for example if it was a missing canal, ur dentist can always open up the tooth and try to find additional canals ( if he suspected that failure is due to untreated additional canal) . If the length of the root filing was short then another root canal treatment aiming to disinfect the remaining of the canal and remove away any "possible" infected material from the canal system.
If the previous root canal treatment was of a perfect length and the dentist has excluded the prevalence of additional untreated canals then a minor surgical procedure which involves retracting a small flap that enables the operator to visualize the root end directly and cut just where that (delta) part is (the one that cannot be cleaned by instruments), do another root canal treatment and fill the tooth and assess the healing of that.
Of course this all depends on how much tooth substance is left there, and whether that tooth is deemed restorable or not. It is really difficult to say what ur treatment options r without assessing the tooth clinically and radiographically (xray).
For the other tooth, I would agree with ghnane that infection do not travel in this pathway but reasons for root canal treatment failure r pretty much the same and ur dentist should be able to assess the reason for failure.

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