Any endodontists or experienced out there? I need help desperately please!?

Question

I've been dealing with something for 4 wks now. I prefer not to hear any horror stories please. I appreciate the help but I will obsess if I hear something horrid. Here's my story.

4 wks ago I had a root canal on the right upper #4. My friend who is an RDA and worked with the best Endodontist in the county for 10 years, she went with when I got my xrays. She said the root canal looked very simple and there was only 1 canal. My dentist performed the root canal in confidence. I was on antibiotics before and during the RC for 2 days after. When I had the RC I had an abcess on my gum. I still have that abcess. I went in to the dentist to have her take a look. She took the time to see me and said everything was ok. She said that the abcess will go away. I told her ok but I would not put the crown on until the abcess was gone. The abcess has not changed in size. I am looking for an experienced or professional opinion. I go back on 12/16/06. What if it is not healed by then? Help!

I'm assuming that you are trying to make me laugh if in fact you are a DDS. If you are not a DDS, I can't laugh at the humor...it isn't funny. My teeth are great...other than the RC concern I have...and that I need my wisdoms pulled. Thanks anyway!

Thank you Dr. Albert. I will try not to worry.

I want to thank everyone for your informative information. It is very resourceful. I'm thinking that this abcess taking so long now is not a good thing. I'm not confident that it is healing. I did visit my dentist and she seemed very confident that all was well. However, again, I am not confident. I read that an abcess is a pimple like swelling. This is not a pimple like bump but a white looking swolen dime sized bump. I am going to call my dentist a week before the 15th of December if the abcess is still present. In the mean time, it is depressing that I pushed myself through a severely anxiety producing procedure (RC), and here I am concerned about the same tooth. Thanks again for your information...it's more than I got from my friend and my dentist combined and some. You all have a wonderful Holliday!

Answer 1

I can only give you some general advice because there are some things about your treatment that I don't know, so don't take the following points as absolutes:
1. Over how many appts was the RCT performed? If you have an existing abscess, then the canal preparation should be done at one appt, and the root filling at the next appt after the sinus is seen to be healing up. Between appts the canal should be dressed with CaOH to kill remaining bacteria.
2. Why were antibiotics given? This might sound simplistic, but I believe antibiotics should only be given where there is pain and swelling, not as a measure to hasten the healing for convenience. The RCT treatment should be enough to help your body heal the sinus. If you just had a draining sinus with no pain, then the removal of bacteria from within the canal will allow normal healing. Then the RCT can be completed with some confidence.
3. How long have you had the abscess? The longer it has been present, then the more complex will become the bacteria in the abscess, and the harder to heal. Even endodonists have unexpected failures.
4. Maybe there is more than one canal? Some statistics quote percentages of 25-50% for 2 canals in tooth 4. It would not always be visible on an X-ray if it was taken at right angles. Sometimes another X-ray at a different angulation will help.
5. Is it definitely the correct tooth? Were adjacent teeth tested for abscesses? Was an abscess visible on the X-ray at the apex of tooth 4? Abscesses will sometimes "track" from adjacent teeth and appear above the apex of adjacent teeth.
6. We like to think that we can perform an RCT to the tip of the tooth, but studies have shown that what appears great on an X-ray from side-on can be misleading and inaccurate. The true tip of the canal may not correspond to the tip of the tooth as seen on the X-ray.
7. Maybe the tooth root has a vertical fracture?
If it has not healed up by the next appointment, then I would seek an opinion from an endodontist. Don't just take more antibiotics. Sometimes after an apparent failure general dentists will want to cut off the tip of the root apex in an apicocectomy. Apart from the difficulty of doing this on tooth 4, it is a more risky procedure.
The first action an endodontist would probably suggest is a re-RCT.

Answer 2

Doesn't tooth #4 almost always have 2 canals? Perhaps the dentist missed a canal, and there is some communication there. If the abscess is real big, then maybe he'll drain it. remember that healing takes some decent time. If it doesn't hurt. or the unless the swelling gets really big, you're fine to wait til the 16. If it's still there the dentist would hopefully refer you...But, then again...I don't know many of the details of the case.
Good luck.

Answer 3

Have the remainder of your "teef" pulled out and invest about $20 on some "Billy Bob" teeth and your friends will think you are the funniest person they've met... For about a week until the humor wears thin.

John Zonk DDS

Answer 4

AN ABCESS IS A TRACT FROM THE INFECTED TOOTH TO THE OUTSIDE. THE HEALING WILL OCCUR WHEN YOUR BODY'S IMMUNE SYSTEM TAKES CARE OF ANY REMAING LOCALIZED INFECTION. DONT WORRY!

Answer 5

Endodontic abscess
What Is It?
An abscess is a limited area of pus formed as a result of a bacterial infection. The body's immune system reacts to the infection, and sends white blood cells to the area to try to get rid of the bacteria. Pus is a mixture of live and dead white blood cells, enzymes and parts of destroyed cells and tissues. When there is no way for pus to drain, it forms an abscess.
Abscesses can form in almost every part of the body. In the mouth, abscesses form in gum tissue or in the roots of teeth and in the surrounding areas of the tooth. They can be caused by trauma (food or debris embedded deep in the gum), by bacteria that enters through a cavity and gets into the dental pulp, or from a deep periodontal pocket. People with a lowered resistance to infection are at increased risk of developing an abscess. At first, the abscess may cause a toothache, which can be severe. The tooth's nerve can become infected and the infection can burrow through to the gum, forming a visible boil that can rupture in the mouth. Once the abscess ruptures, the pain often decreases significantly, but dental treatment is still necessary. If the abscess does not drain, the infection can spread to other areas of the head and neck and can become life threatening.

Symptoms
The main symptom is persistent, throbbing pain. At first, the tooth will be sensitive to heat and pressure while chewing. Later, you may develop a fever. Swollen lymph nodes under the jaw or in the neck can be tender and you may feel pain in the sinus area. If the abscess ruptures, a sudden rush of foul-smelling and foul-tasting fluid will spill into the mouth.

Diagnosis
Usually, your dentist can diagnose a tooth abscess by examining your mouth. He or she may push on the swollen area of the gum and do a pulp test on the affected tooth to see if it is still alive. A pulp test can involve:
Gentle tapping (percussion) on the tooth
Temperature testing
Using an electric tester on the tooth
Your dentist also may take an X-ray to look for bone erosion around the tip of the tooth's root.

Expected Duration
Once the abscess is drained, most symptoms go away immediately or within a few days, but the abscess will not be cured unless the cause is eliminated.

Prevention
Good oral hygiene can help prevent abscesses by keeping teeth and gums free of food and debris. Regular dental checkups are also important. If you have a weakened immune system because of medication or another condition, let your dentist know before every appointment. You may receive antibiotics before the appointment to reduce the risk of infection.

Treatment
Saving an abscessed tooth begins with draining the infection, which usually relieves pain and removes much of the infection. Root canal treatment may be necessary and should be started as soon as possible to remove diseased tissue.
If the abscess involves gum tissue, your dentist may suggest that you rinse with warm salt water (1/8 of a teaspoon of salt in 8 ounces of water) a few times a day for several days. You may be prescribed antibiotics to help make sure the infection has been eliminated. Have dental X-rays performed six months later to confirm if healthy bone and tissue are filling the area of the abscess. If the bone does not fill in after the treatment, you may need to visit a periodontist who can surgically reshape the gum so that it is easier to keep clean, or an endodontist who can surgically remove a persistent abscess.

When To Call A Professional
If you have a toothache or notice evidence of an abscess on your gum, visit your dentist. Even if the abscess drains and the pain decreases, a visit to the dentist for complete treatment is crucial.

Prognosis
The outlook is excellent if detected promptly and treated appropriately.

GENERIC ORAL ABSCESS
When tissues in the mouth are injured or get irritated, bacteria may get into the area and cause an infection and a painful, pus-filled swelling. If the pus can't drain, the area will get more swollen and painful. This is known as an abscess. An abscess is your body's attempt to contain an infection and prevent it from spreading to other areas.
Abscesses can form very quickly, often within 24 to 48 hours of when the infection starts. There are two main types of abscesses:
A gum, or periodontal, abscess is usually caused by an infection in the small space, or pocket, between the teeth and gums. This may happen when food particles get trapped between the gum and tooth. In more advanced cases of periodontal disease, bacteria can build up in deep pockets under the surface of the gums.
A tooth-related abscess, called a periapical abscess (located at the tip of the tooth root), occurs within the tooth itself when the nerve is dead or dying. This type of abscess can spread to the bone surrounding the tip of the root.
Most abscesses are painful, which means that people usually get treatment right away. In some cases, however, the infection causes little or no pain — or people ignore the discomfort and wait for it to go away. This can result in a chronic abscess, in which the infection lasts for months or even years.
When abscesses aren't treated promptly, the infection can damage nearby tissues or teeth. The buildup of scar tissue caused by the infection may result in the development of a hollow tunnel of tissue called a fistula or "sinus tract." Pus from the abscess may drain through this "artificial" tunnel to an opening on the surface, and may be seen in the mouth as a pimple that comes and goes. People with sinus tracts may feel a small bump in their mouths, or may have a strange taste in their mouths due to the drainage of pus.
In some cases, a chronic abscess can form a cyst in the bone. The cyst has to be removed surgically. There also are rare instances in which the infection spreads to the surrounding tissues and causes serious health problems.

What You Can Do
Abscesses are always serious because the infection may spread to other parts of the body.
If you can see or feel a pimple-like swelling on the gum, you may want to try rinsing your mouth several times a day with a mild salt-water solution (1/2 teaspoon of salt in 8 ounces of water). This may help draw the pus toward the surface and allow pressure in the area to be relieved temporarily. In all cases of abscess, you need to see your dentist as soon as possible.

What Your Dentist Will Do
Most gum abscesses will heal quickly once the area is cleaned thoroughly, the trapped material is allowed to escape, and the source of the infection is treated.
If a sinus tract has formed, your dentist will need to trace it back to the source of the infection. He or she will insert a probe into the tunnel and take an X-ray to see where the infection started. Once the source of the infection is identified and cleaned out, the sinus tract usually will close on its own.
If the infection started inside a tooth, your dentist may start root canal treatment by making a small hole in the tooth to allow the abscess to drain. This type of abscess typically occurs only when the tooth nerve is damaged or is already dead. The tooth will need a filling or a crown following successful root canal treatment.
If the abscess is severe or the tooth is badly damaged, you may need to have the tooth removed.
Superficial abscesses in the gums usually can be treated by cleaning out the debris or bacteria that has become trapped and washing out the area thoroughly. Your dentist or oral surgeon calls this procedure aspiration, incision and drainage. More serious periodontal abscesses often can be cleared up by the same method. However, the periodontal disease that caused the infection will require more intensive treatment to prevent another infection.
Your dentist may give you a prescription for antibiotics to help the abscess heal and prevent the spread of the infection to other parts of your body.


On a side note. You friend isn't a dentist. There are quite a few instances with root canal treatments that it looks standard on a dental xray (which is only 2 dimensional with a 3 dimensional object) and once you "open" it up it's anomalie wonder. Also when one has an abscess most rct are not routine because there's an abscess involved. Just make sure you stay proactive and keep getting the unresolved abscess taken care of. Good luck!!!