I had a root canal treatment done along with a dental crown a few months ago. It started hurting again. I went to see my dentist. When he x-rayed the tooth he didn’t see anything. Because of the pain, he referred me to an endodontist who placed me on an antibiotic. That helped for a bit. I revisited and she said it would only get better from there. It seemed to and then it flared up something vicious. Now she’s prescribed me some steroids but they don’t seem to be helping. Where do I go from here?

Corinne

Dear Corinne,

I’ve got several problems with how your treatment has been handled. I’ll work back to front regarding what she has done wrong here.

Steriods as a Treatment with Root Canals

Steroids are an anti-inflammatory treatment.  This means it will control swelling and inflammation. Sometimes that is useful. Other times it is counter-productive. How do you know when it is a good idea and when it does more harm than good? The swelling that comes when there is an infection serves an important purpose of bringing in white blood cells in order to help battle that infection. If you use an anti-inflammatory when you are dealing with an infection, you are essentially shooting yourself in the foot.

That leads me to my second issue here. Endodontists are supposed to be experts in root canal treatments. As such, she should know that they often need a secondary treatment. Some of those canals are hidden or hard to reach. It is not uncommon for a tooth to need a second treatment. As an endodontist, this should have been obvious when the tooth flared back up that it was possible you’d need more than just an antibiotic. Then, when it flared back up after the antibiotic, to me, that was a no brainer. Steroids were the wrong treatment and you needed a root canal re-treatment.

A third issue I have is that they put a dental crown on the tooth before being certain it was a successful treatment. This makes it much harder to re-treat because you have to drill a hole through the crown. There is limited visibility this way.

My first piece of advice to you is to get a new endodontist. After that, you have three options:

• 1. Root canal re-treatment
• 2. Root canal surgery
• 3. Extraction of the tooth.

If you do end up having to extract your tooth, it will be important to replace it. The best replacement is a dental implant. However, it does require someone with real expertise. Make sure you go to a dentist who knows what they’re doing. The best implant dentists are fellows with the International Congress of Oral Implantologists.

This blog is brought to you by Sugarland Dentist Dr. Siny Thomas.