Tooth Pain: Insights on Wisdom Teeth and Root Canal Issues

The first molar next to the lower left wisdom tooth?

Hello Doctor: The first molar next to the lower left wisdom tooth underwent root canal treatment a long time ago, but now there is intense pain when pressing on the gums with my finger, and the molar is also loose (the tooth structure is still intact).
There has been severe pain while eating and during normal occlusion for the past two weeks.
I have been taking antibiotics and painkillers for a week due to a cold, but the pain persists.
I visited a nearby dental clinic where the dentist took X-rays, and there was a dark shadow in the gum area beneath the wisdom tooth.
The dentist explained that there might be a crack in the tooth, which could be the reason for the pain in the previously treated tooth.
The treatment plan suggested by the dentist is to extract the upper left wisdom tooth, the lower left wisdom tooth, and the currently painful and loose lower molar, followed by dental implantation for the lower molar.
The dentist mentioned that redoing the root canal treatment on the previously treated tooth would be ineffective if there is a crack.
Additionally, there is no dentist available to perform apicoectomy on the molar, and if there is a crack, the apicoectomy would also be ineffective.
Therefore, the recommendation is to extract the molar and proceed with implantation.
I asked the dentist how they could determine from the X-ray that there is a crack in the tooth, and the dentist only said it was because the tooth is loose.
Since each treatment option starts at a significant cost, I would like to ask the following three questions, thank you: 1.
Is there no dentist available to perform apicoectomy on the first molar next to the lower left wisdom tooth? 2.
Will the severe pain subside after the extraction of the molar, with subsequent implantation? 3.
Is it necessary to remove the crown and undergo microscopic root canal treatment (which is out-of-pocket), or is standard root canal treatment sufficient?

Liu Xiansheng, 40~49 year old female. Ask Date: 2023/12/08

Dr. Zeng Guanghui reply Dentistry

Dear Mr.
Liu,
1.
The roots of the lower left molar are shorter than those of the anterior teeth.
If root canal treatment fails, an apicoectomy may be necessary.
After the surgery, removing a portion of the root tip can further shorten the already short roots of the molar, which may affect its support.
2.
If the molar has a crack that leads to an infection in the jawbone, extracting the molar will naturally improve the symptoms.
3.
If the initial root canal treatment was inadequately filled and the canal cannot be completely filled, a microscopic root canal treatment may be considered.
However, if there is a crack present, extraction of the tooth is recommended.
Sincerely,
Director Tseng Guang-Hui
Dental Department, Nantou Hospital

Reply Date: 2023/12/08

More Info

Tooth pain, especially in the context of wisdom teeth and root canal issues, can be quite complex and distressing. Based on your description, it seems you are experiencing significant discomfort in your lower left molar, which has a history of root canal treatment. Additionally, the presence of a dark shadow on the X-ray suggests possible complications, such as a crack in the tooth or an infection.

1. Is there no option for apicoectomy (root-end surgery) for the first molar next to the wisdom tooth?
Generally, apicoectomy is a procedure performed when a tooth has persistent infection or pain after root canal treatment, and it involves removing the tip of the tooth root along with any infected tissue. However, the feasibility of this procedure depends on several factors, including the tooth's anatomy, the extent of the damage, and the dentist's expertise. If your dentist has indicated that this procedure is not an option, it may be due to the complexity of the case or the condition of the tooth. In such cases, extraction may be the recommended course of action.

2. Will extracting the painful molar alleviate the pain, and is it advisable to proceed with dental implants afterward?
If the molar is indeed the source of your pain and is also loose, extraction may provide immediate relief. The pain you are experiencing could be due to various factors, including infection, inflammation, or structural issues like a crack. Once the tooth is removed, the area can heal, and you can then consider dental implants as a replacement option. Dental implants are a reliable long-term solution for missing teeth, provided that there is sufficient bone structure to support the implant.

3. Is retreating the tooth with microscopic root canal treatment necessary, or is standard root canal treatment sufficient?
Microscopic root canal treatment can provide a more thorough cleaning and sealing of the root canals, especially in complex cases where standard treatment may not have addressed all issues. If your dentist suspects that there are additional canals or complexities that were not treated adequately during the initial procedure, then microscopic treatment may be warranted. However, if the tooth has a significant crack, even the best root canal treatment may not save it, as the structural integrity of the tooth is compromised.
In summary, your situation requires careful consideration and possibly a second opinion from an endodontist (a specialist in root canal treatment) to evaluate the condition of your tooth and the best course of action. It’s crucial to address the pain and underlying issues promptly to prevent further complications. Always discuss the potential risks and benefits of each treatment option with your dentist to make an informed decision that aligns with your health needs and financial considerations.

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