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Monday, May 20, 2013
Filling a root canal
I recently had a root canal performed on a rear molar (3 weeks) Since then the tooth has been a little sensitive to the touch and bite. It does not ache or throb though. My dentist who was going to do the crown and who took xrays says the fillings in the roots extend beyond the root into the bone and that is the cause of the sensitivity. When I asked my specialist about the issue he said that that had nothing to do with what I was feeling. Who is right in this case. Should I have the specialist redo the root canal? I don`t know what to do.
Actually, both of your providers could be right. When a root canal is filled, occasionally some of the filling material may be extruded or extended beyond the root of the tooth. In fact, some practitioners actually advocate this. Others don't condone it.
There are 2 components to most root canal fillings. The sealer and the core. There are a number of different types of sealers. They are put into the canal in a paste or creamy consistency, and they fill the voids between the root wall and the solid core material. They eventually set or harden. These materials can cause an irritation of the tissues at the end of the root, but this should eventually go away. Your immune system's cells will gobble this material up and transport it away. If you look at an x-ray, that material would not be visible in about 6 months. The core material is a solid and in a great majority of cases is composed of gutta percha (and other chemicals). A new material has come on the market in the last 3 years that is composed of nylon. These core materials are considered biologically inert. That is, they do not cause an immune response nor damage the tissues. However, they will also not disappear like the sealer may.
In your case I, obviously, cannot say which of these things is out of the tooth. Either of these two could be causing your sensitivity, but there could also be other causes. Some patients have what is called a 'flare-up" after a root canal, and that is when the immune system responds to the remnants of an infection in the attempt to heal an area. This is a possibility. There could be issues with your bite or the temporary filling. Periodontal disease could be a cause, or trauma to the ligament surrounding the tooth.
Was one of the root canals missed? I cannot say. Continuing to monitor the problem for healing is probably the best bet before you have the crown placed. Evaluation of potential crown cracks is also recommended. Keep your dentist and endodontist informed as to any changes in symptoms and have further evaluations as needed.
John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University