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Root Canals

Why would cotton be left after a root canal?

01/18/2008

Question:

I had a root canal over 10 years ago on tooth #30 and just moved from Cincinnati,OH to Durham, NC in November `07. The tooth bothered me off and on for some time but Dentist like for me to believe that I have sensitive teeth. Last week #30 began to hurt so bad that I called the emergency number for my dentist on Dec. 28 and was prescribed Vicoden and Penecillin. On December 29 I was able to get to a dentist and here in Durham and he referred me to an endodontist. On December 30 and January 1 the pain was so bad I ended up in the emergency room both times and had to get a shot of a stonger pain medication along with a prescription for oxycoden and ibuprofen. On January 2 the endodontist retreated the root canal and found cotton left behind by my previous dentist, which could have been the cause of the infection along with leakage. The infection was so bad that my face was swollen and I had bone loss starting. The endodontist couldn`t finish the procedure and sent me home to return in 30 days. He didn`t have time to fight with the fourth root canal and had difficulty getting to the end of it. The pain was again so bad that night that I was up all night and the next day found a dentist to extract the tooth. This was the most excruciating pain that I have ever experienced!

Why would a dentist send a patient home in this condition? Why would a dentist leave cotton in a tooth?

Answer:

The pain you were experiencing most likely was coming from a reinfection of the original root canal. The treatment for this situation is to have the root canal redone and the inside of the tooth disinfected. This is what the endodontist started.

Unfortunately starting this procedure does not immediately resolve the pain that goes along with the infection. This is because the infection and inflammation is in the bone around the tooth and that needs to heal itself. The endodontist merely cleaned out the source of the infection to prevent further irritation of the area and allow the body to begin healing. There was nothing the endodontist really could have done to alleviate the pain for you immediately.

Cotton pellets are placed in teeth to help in the quick removal of temporary fillings. It helps the dentist determine that the temporary filling has been removed and the bottom of the tooth is being approached. In most cases the pellet is removed prior to the placement of a permanent filling. There may be a reason to leave it behind, but I don't know what your original dentist was planning. The cotton pellet itself is not a source of infection since they are usually sterilized.

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Response by:

John M Nusstein, DDS John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University