Hello,
I had a root canal on the second to the last bottom left tooth back in April of 2008. I started having pretty bad pain over the past weekend and went to the dentist yesterday to have it X-rayed. The dentist and the endodontist who performed the root canal in April both agreed it was a perforation and said that the only way to fix it (and eliminate the worsening pain) is to extract the tooth. That would mean a bridge or implant and since I don't really want to have an implant, the bridge would mean destroying two fairly new crowns on either side of the blank space that will be left by the extracted tooth.

Is the perforation a result of a mistake on the part of the endodontist? If the roots are supposedly gone on the tooth, why am I feeling pain?

Any advice you can provide would be greatly appreciated as I dread having another tooth pulled. Thank you very much.

Sincerely,
Alexis Twiford

There are many things that can cause a root canal problem. A root canal perforation is when a dental instrument accidentally rips an unnatural hole through the tooth into the surrounding gums or bone. Root canals are supposed to be restricted to the inside of a tooth. During the initial penetration into the tooth, a high speed bur could go through the bottom of the chamber into the bone. Additionally, a root canal file can bore through a root and make its own exit, especially in highly curved roots.

Part of a root canal file can break and remain stuck inside a canal. Unfortunately, this accident is common and often not preventable. However, every patient who has a file break inside a tooth should be informed of this root canal problem since it decreases the chances of success.

The tooth or a root could split during a root canal procedure. Dead teeth get very brittle and many of the teeth that root canals are performed on were dead a long time before their root canal procedures were started. With their premature death, they became brittle and a potential root canal problem is that they can crack during the root canal filing process.

Sodium hypochlorite (bleach) is used to clean and sterilize canals during root canal therapy. Some of the bleach could squirt out into the surrounding bone. Several hours later a patient can be in excruciating pain from this accident but fortunately, this root canal problem usually goes away within a day or two.

In years past, many holistic dentists were concerned about root canal problems that resulted from unfilled canals. However, technology and materials have advanced to where this is no longer as valid a root canal problem complaint. Ultrasonic cleaners along with antibiotic lubricants usually thoroughly clean and sterilize canals before being filled with hypo-allergenic filling materials.

Another root canal problem is the failure of a lesion at the root tip to heal after a completed root canal. There are many reasons that this can occur. Sometimes this root canal problem can create problems in the sinuses in the upper jaw bone.

I can understand your reluctance to have a tooth extracted. From my research into this I understand there is a treatment for the perforation but endodontists are reluctant to suggest it because of the extreme cost; this is called mineral trioxide aggregate: a modified matrix concept.

I also understand why you don't want to destroy two crowns to initiate a new bridge, but you are left with a tough decision. Implant or just have the tooth pulled. But I would say that having that hole filled up would be a better choice rather then having the teeth on either side move around over time.

This is not a diagnosis, just suggestions. Good luck.

Very well said tickle!

I just want to add one thing. Rarely a root can decay from the inside out particularly from trauma. This happened to me.

Forget bridges. Implants don't really hurt. There is a lot of waiting involved. Just make sure the prostadontist checks the clearance of the teeth. If you feel resistance with the dental floss - complain.

"perfs" happen... you can try to get it fixed with MTA, or get a root amputation (cut off the perforated root) but that's trying to perform heroics generally, and they would have probably offered it to you if it was possible... just get it yanked, and if the space doesn't bother you leave it... not EVERY tooth needs to be replaced... I've broken an instrument off in a root and perf'd... it happens

Hi -

My dentist attempted a root canal on one of my molars. After the 2nd visit she said she needed to refer me to a psecialist because she couldn't find the third canal. The endodotist she sent me to found that not only did the dentist leave a portion of the tool in my tooth but she also perforated the tooth. I wasn't told this during the procedure - only after being charged $1295 for the procedure. Although they say I should get it crowned and then monitor it to see if the RC fails, I am leaning toward having the tooth pulled as saving the tooth does not seem likely to me and I don't have the money to waste. Any thoughts?

Also, I feel like I should have been informed of the imbedded tool and the perforation BEFORE the root canal was done by the specialist. I would not have agreed to it. I think the dentist should cover the cost, but am not sure if I'm over reacting.

Cathy, you are piggybacking on an old thread from 2008. Your concern is worth starting over again with your own post so you get informed answers. You won't here because the only ones who will see your post are the ones who answered this one.

Tick