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Why You Need Another Root Canal: Endodontic Retreatment Explained

Endodontic procedures, such as root canals, are done to treat certain types of tooth problems and prevent additional decay or damage. In some cases, the original treatment that’s done leads to improper healing or results in new tooth problems. When this happens, your endodontist might recommend endodontic retreatment. Knowing more about this type of treatment can help you understand why it might be needed and what to expect from this procedure.

Reasons for Endodontic Retreatment

Endodontic procedures are meant to help eliminate tooth decay and treat damage in order to reduce the risk of infection or other problems. While these procedures are generally successful, some end up being unsuccessful for different reasons. This can lead to improper healing or ongoing pain and discomfort that lasts for several months or even years. When a treated tooth does not heal properly, this might be due to any of the following:

  • Complex canal problems that were not found when the original treatment was done
  • Narrow canal or curved canal that was not included in the original treatment
  • Contamination from saliva that entered the treated tooth
  • Dental restoration or crown was not done soon enough after the original endodontic treatment

In some cases, a new problem might occur that affects the original endodontic treatment. For example, new decay might develop in the treated tooth and lead to an infection. This can happen if the filling material in the root canal is exposed, allowing bacteria to enter. Crowns and fillings that become loose or cracked might also result in infection since these leave the inner part of the tooth exposed.

 

What to Expect from Endodontic Retreatment

When you need to have endodontic retreatment done, the process is somewhat similar to your original root canal or endodontic procedure. This starts with your endodontist reopening the treated tooth in order to get to the root canal filling. Your endodontist will then take the filling material out of this tooth and closely check it for signs of damage, decay, or other canals that need to be treated.

If the treated tooth has an infection, your endodontist will take the infected tissue out. Doing this helps prevent the infection from becoming worse. In serious cases, these infections can spread to other areas and require emergency care when they’re left untreated. After removing the infected tissue, your endodontist will then thoroughly clean the affected canal or canals and shape them. Once this is done, your endodontist will put new filling material in the canals. After the filling material is placed in the affected canals, your endodontist will cover the opening with a temporary filling.

If your endodontist has difficulty with this procedure, such as if you have very narrow canals or a blockage, endodontic surgery might be recommended. This procedure makes it possible for your endodontist to fully treat and seal the ends of the affected root.

 

After Endodontic Retreatment

As soon as the treated tooth heals, you’ll have a dental crown or another type of dental restoration put on it. This helps protect the treated tooth from bacteria, decay, and damage. Keep in mind that you’ll need to see your endodontist promptly once the tooth heals to have the dental restoration or crown placed on it. Waiting too long can lead to unsuccessful retreatment. When you have a crown or restoration placed, this helps restore the treated tooth’s function, so that you can chew and speak clearly.

After having this procedure done, it’s important to follow all of your endodontist’s instructions on how to care for the treated area. This helps prevent infections or other complications from occurring. For example, you might be told to avoid eating certain foods until your tooth heals. You might have slight discomfort after endodontic retreatment, but this should go away within a week or two.

If you need help with a tooth problem, please contact us to schedule an appointment with our endodontist, Dr. Ernest Rillman. Our office provides endodontic retreatment, root canals, and other services for patients in and around the Largo, FL area.

 

Regarding Covid-19 

March 28, 2020

Updates regarding Covid-19 is continuously changing and we are being sure to stay up-to-date with news released from the CDC (Center for Disease Control), ADA (American Dental Association), and AAE (American Association of Endodontists) for recommendations posted for dentists and dental specialists in regards to the Novel Coronavirus (COVID-19). As an endodontic practice, we at Largo Endodontics, Ernest Rillman DMD, your root canal specialist is primarily an emergency based practice. As such we are taking all appropriate and indicated precautions screening patients, and continuing to provide support to our dental colleagues and patients in the community. If you need us we are here.

We have always gone above and beyond in our sanitization and cleanliness but we are taking extra precautionary measures as recommended by the CDC and ADA. We are also having each patient who comes in wash their hands in our facility using our guidelines and are taking each patient’s temperature before we see them. We ask if you are feeling sick in any way to please postpone your appointment.

We are in this together and our patients and employees health and safety is our number one concern. Our office is open Monday through Thursday 9am to 5pm and Friday 9am to 2pm. We are here to answer any questions you may have. Please call us at (727) 399 – 2969.

For more information regarding the Coronavirus, please click HERE.

Thank you,
Ernest Rillman DMD

Five Signs You Might Need A Root Canal 

With today’s technology, root canals are not nearly as painful and invasive as they were back in the day but people still hesitate on asking if they need one. So what are the top five signs that you may need a root canal?

  • #1 – Tooth Pain
  • #2 – Swollen or Inflamed Gums
  • #3 – Tooth Sensitivity
  • #4 – Painful Tooth Appears Darker
  • #5 – Tiny Bump on Gums

#1—Tooth Pain

The number one symptom of a potential root canal is tooth pain. This pain is not a once in a while occurrence. This is chronic, ongoing tooth pain that is difficult to ignore.

If you experience pain when you chew or when you put any sort of pressure on a certain area of your tooth, that is a good sign that the infected tooth may need a root canal.


#2—Swollen or Inflamed Gums

Are the gums near the source of the pain swollen, red, or showing raised bumps? An infected tooth will usually cause some sort of discomfort in the gum tissue surrounding it. If all the gums are inflamed, that may be the sign of a different issue, like gingivitis.


#3 – Tooth Sensitivity

Do hot or very cold drinks make the area extremely sensitive? That may be a sign that the temperature is affecting the pulp right through micro-fractures in the tooth itself, through the gum or anywhere where tooth decay has compromised the strength of the tooth. Or are you having a significant amount of pain in your tooth without any referable cause? It is likely that your tooth is decayed and your nerves are exposed. You should contact a Dentist or Endodontist near you. 


#4 – Darker Tooth

If you notice a discoloration or darkening of the painful tooth, this could be a sign of infection and/or nerve damage. Usually the affected tooth will start taking on a grey cast. That would mean it’s time to get examined by an Endodontist to know for sure.


#5 – Tiny Bump on Gums

Do you see a tiny bump on your gums that almost looks like a pimple? This is not a normal and this pus-filled ‘boil’ could mean a tooth infection. If this is near where you are experiencing pain, it could mean you need a root canal.

If you are experiencing any or all of these signs, it would be wise to consider booking an appointment to see if a root canal could be the solution. Until then, use ice to sooth the irritated area in the mouth and rinse with salt water to keep the area clean, especially after eating and drinking.

Root Canal Safety

Doctor addressing the patientThe relationship of our teeth and mouth to overall good health is indisputable. Endodontics plays a critical role in maintaining good oral health by eliminating infection and pain, and preserving our natural dentition.

A key responsibility of any dentist is to reassure patients who are concerned about the safety of endodontic treatment that their overall well-being is a top priority. The American Association of Endodontists website (www.aae.org) is the best place for anxious patients to obtain comprehensive information on the safety and efficacy of endodontics and root canal treatment.

While plenty of good information is available online from the AAE and other reliable resources, patients sometimes arrive in the dental office with misinformation. This has occurred with the long-dispelled “focal infection theory” in endodontics, introduced in the early 1900s. In the 1920s, Dr. Weston A. Price presented research suggesting that bacteria trapped in dentinal tubules during root canal treatment could “leak” and cause almost any type of generative systemic disease (e.g., arthritis; diseases of the kidney, heart, nervous, gastroinestinal, endocrine and other systems). This was before medicine understood the causes of such disease.

Dr. Price advocated tooth extraction—the most traumatic dental procedure—over endodontic treatment. This theory resulted in a frightening era of tooth extraction both for treatment of systemic disease and as a prophylactic measure against future illness. Dr. Price’s research techniques were criticized at the time they were published, and by the early 1930s, a number of well-designed studies using more modern research techniques discredited his findings.

Decades of research have contradicted Dr. Price’s findings since then. In 1951, the Journal of the American Dental Association published a special edition reviewing the scientific literature and shifted the standard of practice back to endodontic treatment for teeth with non-vital pulp in instances where the tooth could be saved. The JADA reviewed Dr. Price’s research techniques from the 1920s and noted that they lacked many aspects of modern scientific research, including absence of proper control groups and induction of excessive doses of bacteria.

More recent research continues to support the safety of dental treatment as it relates to overall systemic health. In 2007, the American Heart Association updated its guidelines on the prevention of infective endocarditis, drastically curbing the indications for premedication for dental procedures and excluding endodontic treatment from dental procedures requiring premedication. In April 2012, the AHA found no scientific evidence linking periodontal disease and heart disease, concluding that heart disease and periodontal disease often coincidentally occur in the same person due to common risk factors of smoking, age and diabetes mellitus.

Decades of research contradict the beliefs of “focal infection” proponents; there is no valid, scientific evidence linking endodontically treated teeth and systemic disease. Yet some patients still hear about this long-dispelled theory.

 

Dentists are asked to use the following guidelines to address patients who inquire about a connection between root canal treatment and illness:

  • Acknowledge the patient’s concerns; stress that optimum health is the goal for every dental patient.
  • Provide the patient with written information about endodontic treatment, and discuss it. The AAE has a variety of patient education brochures available for purchase (www.aae.org/onlinestore).
  • Provide the patient with information from the AAE website about common root canal myths:
    www.aae.org/patients/treatments-and-procedures/root-canals/myths-about-root-canals-and-root-canal-pain.aspx#2.
  • Indicate that the patient is in control of his/her own decision to move forward with any dental procedure, and reiterate a commitment to the highest quality dental care.

References

Myths About Root Canals and Root Canal Pain

There are many misconceptions surrounding root canal (endodontic) treatment and whether patients experience root canal pain. The American Association of Endodontists wants you to have accurate information. As always, when considering any medical procedure, you should get as much information as you can about all of your options. Your dentist or endodontist can answer many of your questions, and if you still have concerns, it is often wise to seek a second opinion.

  • Myth #1—Root canal treatment is painful.
  • Myth #2—Root canal treatment causes illness.
  • Myth #3—A good alternative to root canal treatment is extraction (pulling the tooth).

Myth #1—Root canal treatment is painful.

Truth—Root canal treatment doesn’t cause pain, it relieves it.

The perception of root canals being painful began decades ago but with modern technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as “painless” than patients who have not had root canal treatment.

Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.


Myth #2—Root canal treatment causes illness.

Truth — Root canals treat illness and remove infection.

The myth: Patients searching the Internet for information on root canals may find sites claiming that teeth receiving root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This false claim is based on long-debunked and poorly designed research performed nearly a century ago by Dr. Weston A. Price, at a time before medicine understood the causes of many diseases.

In the 1920s, Dr. Price advocated tooth extraction—the most traumatic dental procedure—over endodontic treatment. This resulted in a frightening era of tooth extraction both for treatment of systemic disease and as a prophylactic measure against future illness.

The truth: There is no valid, scientific evidence linking root canal-treated teeth and disease elsewhere in the body. A root canal is a safe and effective procedure. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.

  • The presence of bacteria in teeth and the mouth has been an accepted fact for many years. But the presence of bacteria does not constitute “infection” and is not necessarily a threat to a person’s health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma. Research shows that the healthy immune system takes care of bacteria in a matter of minutes.
  • Tooth extraction is a traumatic procedure and is known to cause a significantly higher incidence of bacteria entering the bloodstream; endodontic treatment confined to the root canal system produces much less trauma and a much lower incidence and magnitude of bacteria entering the blood stream.
  • There is no adequate replacement for the natural tooth – it should be saved whenever possible. Root canal treatment, along with appropriate restoration, is a cost effective way to treat infected teeth because it is usually less expensive than extraction and placement of an implant. In most cases, endodontic treatment allows patients to keep their natural teeth for a lifetime.

But what about Dr. Price? This is a good example of how the Internet can give new life to long-dispelled theories. Believe it or not, the misinformation about roots canals that is found on the Internet is still based on Dr. Price’s century-old, discredited research. Dr. Price’s research techniques were criticized at the time they were published, and by the early 1930s, a number of well-designed studies using more modern research techniques discredited his findings. In 1951, the Journal of the American Dental Association took the extraordinary step of publishing a special edition reviewing the scientific literature and shifted the standard of practice back to endodontic treatment for teeth with non-vital pulp in instances where the tooth could be saved. The JADA reviewed Dr. Price’s research techniques from the 1920s and noted that they lacked many aspects of modern scientific research, including absence of proper control groups and induction of excessive doses of bacteria.

As recently as 2013, research published in JAMA Otolaryngology—Head & Neck Surgery, found that patients with multiple endodontic treatments had a 45 percent reduced risk of cancer.

Reference


Myth #3—A good alternative to root canal treatment is extraction (pulling the tooth).

Truth—Saving your natural teeth, if possible, is the very best option.

Nothing can completely replace your natural tooth. An artificial tooth can sometimes cause you to avoid certain foods. Keeping your own teeth is important so that you can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in your diet. If your dentist recommends extraction, ask whether root canal treatment is an option.

Endodontic treatment, along with appropriate restoration, is a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and placement of a bridge or an implant.

Endodontic treatment also has a very high success rate. Many root canal-treated teeth last a lifetime.

Placement of a bridge or an implant will require significantly more time in treatment and may result in further procedures to adjacent teeth and supporting tissues.

Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment. Those healthy teeth are helping patients chew efficiently, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists and dentists worldwide enable patients to keep their natural teeth for a lifetime.

How to Make the Most of Your Dental Insurance

You finally make the leap and start paying for dental insurance this year, so it only makes sense to understand the best way to utilize your plan and take full advantage of everything it offers. We hope that our tips below will help you make the most of each monthly payment towards dental insurance to not only get the most out of it but also to make you smile bigger :D. 

 

 

Get to know your plan

Many people don’t end up getting the most out of their dental insurance simply because they don’t take the time to learn about all of its benefits. When you sign up, take the time to get to know your plan, doing the research to find out what exactly is covered under your plan. Also, don’t be hesitant to ask your Dental Provider what all your insurance will cover. Not only will you be able to receive more treatments, but you will also avoid any surprises down the line.

 

Go over the explanation of benefits

An explanation of benefits is issued to both you and your Dentist each time a claim has been paid (or denied). Be sure to reach over this notice so you are aware of the process and how to react if necessary.

Know your annual limits and use it

Many patients are unaware of the annual limit established by their insurance provider. Being aware of your annual limit comes in especially handy when you need a multi-part procedure such as a root canal. If possible, try scheduling a root canal treatment at the end of the year and then your crown at the beginning of January. This will prevent you from going over your annual limit and save some for the next year!

 

Schedule treatment when you are eligible for the most dental insurance coverage.

If you can, try to plan out your more complex dentistry. For example, if you are near the end of your plan’s year and you’ve already maxed our year dental coverage cap, ask your Dentist or Endodontists if you can schedule the non-urgent treatment after your cap resets. This can help you minimize out-of-pocket costs.

 

The more you know about your dental plan and available benefits, the better prepared you’ll be to get the dental care you want and need. And as we know, dental needs never come at a planned or convenient time. It’s always when you least expect it that you get a toothache or cracked tooth so be sure to plan ahead.