Root Canal Treatment: Common Concerns and Questions

Q: Root Canal Treatment: Common Concerns and Questions

Hello： For calcified root canals in the maxillary posterior teeth, if it is a difficult case and the clinic's dentist has indicated that they are unable to proceed, it is recommended that you visit a medical center in the area for treatment, as it would be more reassuring. <br>Th

Root canal treatment

I had a root canal treatment on my second to last tooth in the upper right on May 15.
I had the second treatment on May 16, and the dentist filled the cavity on May 23.
However, on May 24, that tooth was unable to bite anything, including tofu, and it was very painful.
I could still bite soft foods before.
I returned for a follow-up on May 25, and the dentist reopened the cavity and cleaned it again.
He said to come back on May 30.
(The last two teeth in the upper right have cavities, which have been filled, but they still feel uncomfortable.
I have seen many dentists, and they all said it looks fine, but the enamel is worn down, causing sensitivity.
They suggested monitoring it, but if it remains uncomfortable, I may need a root canal since the second to last tooth has a larger cavity, which is why the dentist treated that tooth.)
I have a few questions:
1.
The dentist mentioned that the tooth has three root canals, one of which is open, another is calcified, and the last one cannot be located, possibly completely calcified (????).
He said he can only clean and medicate it as much as possible, and if it remains uncomfortable, I would need to be referred to a medical center for special equipment to perform the root canal.
The dentist said he cannot see if it is clean and can only rely on my feelings.
I find this strange—why can't the dentist see it?
2.
If I feel better in the next few days, does that mean I don't need to be referred to a medical center? I heard that using special equipment like a microscope for root canals is out-of-pocket.
If I feel better, would I need a crown? If the treatment is done without a microscope and the dentist performs a blind procedure, could it be that it is not cleaned properly and the issue recurs soon?
3.
How much does the out-of-pocket cost for the microscope treatment typically run?

candy, 40~49 year old female. Ask Date: 2020/05/28

Dr. Lin Jiayong reply Dentistry

Hello: For calcified root canals in the maxillary posterior teeth, if it is a difficult case and the clinic's dentist has indicated that they are unable to proceed, it is recommended that you visit a medical center in the area for treatment, as it would be more reassuring.
The costs for out-of-pocket expenses are regulated by the local health bureau and dental association, so there is no need to worry.
Thank you!

Reply Date: 2020/05/28

More Info

Understanding root canal treatment can be quite complex, especially when complications arise. Based on your description, it seems you are experiencing significant discomfort after undergoing root canal therapy on your upper right second molar. This situation raises several important points regarding root canal treatment, its potential complications, and the options available for further management.

1. Complexity of Root Canal Anatomy: The human tooth can have multiple root canals, and in some cases, these canals can be quite complex. It is not uncommon for a tooth to have three canals, as you mentioned. If one of the canals is calcified or difficult to locate, it can lead to incomplete treatment. This is why your dentist may have suggested that they can only rely on your feedback regarding the pain and discomfort you are experiencing. Unfortunately, traditional X-rays may not always reveal the full anatomy of the root canal system, which is why some practitioners use advanced imaging techniques or even 3D imaging to get a better view.

2. Need for Referral: If you notice improvement in your symptoms over the next few days, it may not be necessary to transfer to a specialized center immediately. However, if the pain persists or worsens, a referral to an endodontist (a specialist in root canal treatment) would be advisable. Endodontists often use advanced techniques, including operating microscopes, to locate and treat difficult canals effectively. While it may involve out-of-pocket expenses, the precision offered by these tools can significantly improve the chances of successful treatment.

3. Concerns About Incomplete Treatment: You raised a valid concern about whether a "blind" approach to root canal treatment could lead to incomplete cleaning of the canals, resulting in recurrent issues. Indeed, if all canals are not adequately treated, there is a risk of persistent infection or pain. This is why thorough cleaning and disinfection of all canals are crucial for the long-term success of the treatment. If your dentist is unable to locate all the canals, it may be wise to seek a second opinion from an endodontist who can utilize specialized equipment.

4. Cost of Advanced Treatments: The cost of using a microscope for root canal treatment can vary widely depending on the location and the specific dental practice. Generally, the additional cost for advanced imaging and treatment techniques can range from a few hundred to over a thousand dollars. It is best to consult with the dental office directly for an accurate estimate.

5. Post-Treatment Care: After root canal treatment, it is essential to follow up with your dentist regarding the placement of a crown or other restorative work. This is crucial not only for the function of the tooth but also to protect it from future fractures or decay.

In summary, your situation highlights the importance of thorough diagnosis and treatment in root canal therapy. If you continue to experience pain, seeking a referral to an endodontist may provide you with the specialized care needed to address the complexities of your tooth's anatomy. Remember, effective communication with your dental care provider about your symptoms and concerns is key to achieving the best possible outcome.

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