A missed nerve can cause problems after root canal
. One other important thing to look for is the possibility that a nerve canal was not treated or “missed” during the original procedure.
A patient recently came to my seattle dentist office with pain and swelling on the gum of a tooth that was treated with root canal twenty-five years ago. For twenty-three of those years, the only problem that he had was that the tooth had discolored. To improve its color, his previous dentist needed to drill into the tooth and whiten it from the inside out. This process, called internal bleaching, was successful, but unfortunately he soon began to have pain in the tooth, and a hard swelling appeared on his gum. He was then referred to an oral surgeon who removed the infected cyst, but failed to treat the underlying cause of the problem. Not surprisingly, the swelling eventually returned. Subsequently, he came to my office for a second opinion.
When I evaluated the patient, an x-ray revealed that the root canal performed twenty-five years ago was apparently well done, but the characteristic “black circle” of and abscess was clearly visible at the tip of his root. I suggested that we re-treat his root canal to see if the infection can be cured. If that did not work, the root tip would need to be surgically removed (an apicoectomy). To re-treat a root canal, the old rubbery filling inside the root is removed; the root is reshaped, disinfected, and then refilled. One other important thing to look for is the possibility that a nerve canal was not treated or “missed” during the original procedure. This problem is usually not picked on the x-ray because an x-ray is a two-dimensional representation of a three-dimensional object and can sometimes obscure a seattle dentist’s findings. If there is a missed nerve canal in a tooth treated with root canal, this is usually the primary reason why the tooth becomes re-infected.
During my re-treatment of his root canal, I did, in fact, find a missed nerve canal. I completed the procedure, and his infection cleared up. Even though root canal therapy is about ninety percent successful when properly performed, problems can occur. If a root canal becomes re-infected, a missed nerve canal should be explored as a possible cause.
