Do I Need Root Canal Treatment for Tooth Pain and Abscess?

Q: Do I Need Root Canal Treatment for Tooth Pain and Abscess?

Hello Miss ETing： Based on what you described, I would like to point out some considerations since I haven't seen the X-ray. <br>In addition to inflammation of the root canal system and periodontal issues, excessive occlusal pressure can sometimes lead to root fractures. <br>Of c

Chewing pain with an abscess, is root canal treatment necessary?

Hello Doctor: I have a cavity in my right first molar, which I had root canal treatment done by Dentist A over a decade ago.
I haven't had any issues since then.
Recently, I received orthodontic treatment from Dentist B.
Earlier this year or late last year, I experienced pain in the back of my right jaw, and I noticed a lymph node under the right first molar.
However, Dentist B said it might be due to my wisdom teeth, and the pain subsided, with the lymph node decreasing in size.
A few months ago, I discovered a small white abscess below the first molar; it wasn't painful, and pressing on it didn't cause much discomfort.
After informing Dentist B, he said I needed a root canal treatment.
Later, I went back to Dentist A, who performed the initial root canal, and he said that a root canal treatment might not be necessary.
If the initial treatment wasn't thorough, the abscess would have developed below and not too close to the tooth.
He then cleaned the area around my tooth and gums, and a week or two later, I received a crown.
(During the preparation for the crown, I noticed that the right first molar had turned black...) After getting the crown, I found that biting into things caused pain, but only when biting! Tapping on it didn't hurt.
(I also had a crown on the left side, and that was fine!) Dentist A suggested it might be an occlusal issue and adjusted the crown again, but I noticed the abscess again.
This time, Dentist A cleaned the abscess thoroughly! After that, I was pain-free for a few weeks, possibly over a month.
Today, I suddenly noticed a slight pain when biting on the right side again, but I don't see any abscess...
I am worried that it might be due to the initial root canal not being done properly.
Do I need to undergo root canal treatment again? But I already have a crown...
Do I need to drill it open again?

ETing, 20~29 year old female. Ask Date: 2006/06/27

Dr. Lin Qingye reply Dentistry

Hello Miss ETing: Based on what you described, I would like to point out some considerations since I haven't seen the X-ray.
In addition to inflammation of the root canal system and periodontal issues, excessive occlusal pressure can sometimes lead to root fractures.
Of course, not every condition will present symptoms in the early stages, and pain is not the only indicator of a problem.
Even healthy teeth that have not undergone treatment should be carefully used for chewing to ensure their longevity.
As for whether significant treatment is necessary, my recommendation is to have the dentist who is making your dentures conduct a thorough examination.
I believe your issues and symptoms will improve.
Don’t worry, be happy! Dr.
LIN.
TEL: (06) 6351131-2208 2006/06/30

Reply Date: 2006/06/27

More Info

When it comes to tooth pain and the presence of an abscess, particularly in a tooth that has previously undergone root canal treatment, the situation can be complex. Based on your description, it seems that you have a history of dental work on your right first molar, including root canal therapy performed years ago. Recently, you have experienced pain and the development of a small white abscess, which raises concerns about the health of the tooth and the surrounding tissues.

Firstly, it is essential to understand that an abscess typically indicates an infection, often stemming from the pulp of the tooth or the surrounding bone. In your case, the fact that you have a history of root canal treatment suggests that there may be residual infection or complications from the initial procedure. If the root canal was not entirely successful—meaning that all the infected pulp tissue was not removed, or if there are additional canals that were not treated—this could lead to the formation of an abscess.

The presence of a lymph node swelling in the area, which you mentioned, can also be a sign of infection. While it may have reduced in size, the recurrence of pain and the appearance of the abscess indicate that there could still be an underlying issue that needs to be addressed.
Regarding your question about whether you need root canal treatment again, it is crucial to consult with a dental professional who can evaluate the current state of your tooth. If the abscess has returned or if you are experiencing pain when biting, it may suggest that the tooth is not healing properly. A repeat root canal treatment, sometimes referred to as retreatment, may be necessary to clean out any remaining infected tissue and to properly seal the tooth.

If you have already had a crown placed on the tooth, the dentist may need to remove it to access the tooth structure underneath for retreatment. This can be a concern for many patients, especially if they have already invested in restorative work. However, it is vital to address the infection to prevent further complications, such as the spread of infection to adjacent teeth or systemic issues.

In some cases, if the tooth is deemed non-restorable due to extensive damage or if the infection persists despite retreatment, extraction may be the only option. After extraction, options for replacement, such as dental implants or bridges, can be discussed.

In summary, based on your symptoms and the history of your tooth, it is advisable to seek a thorough evaluation from a dentist, preferably an endodontist who specializes in root canal treatments. They can take X-rays to assess the condition of the tooth and surrounding bone, determine if retreatment is necessary, and discuss the best course of action moving forward. It is important to address these issues promptly to avoid further complications and to ensure your overall dental health.

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