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Tuesday, September 2, 2014
Root canal redo
Dear Dr.: I had a root canal on my front top tooth (I believe it`s called #9) about 15 years ago as a teenager. Aside from being discolored, it has not bothered me since. I recently began seeing a new dentist who wishes to refer me to an endodontist for a redo of the root canal. Her reasoning is that my x-ray shows a small gap at the tip of the canal (i.e., the canal was not completely filled) and that this might be at risk for eventual infection. (She has not compared my x-ray to any old ones.) In someone who is asymptomatic, how does one know if a redo is really necessary?
If you are currently asymptomatic and there is no plan to do anything with the tooth, such as put on a crown, and there has been no pathologic changes in the bone around the tooth in question, you are probably safe not to have the tooth retreated. It is hard to argue with success even if the root canal filling is a little short of the end of the tooth.
I certainly understand your dentist's concern. She is looking out for you and a root canal filling that is short may be prone to re-infection. However, as long as the tooth remains sealed and your filling is intact, you are probably at low risk. Of course I say this assuming that everything else is healed and there is no decay on the tooth - which I do not know since I haven't examined you.
It probably wouldn't be a bad idea to at least have an endodontist look at your tooth and evaluate it. I would recommend that you do bring in some older radiographs of this tooth so he/she can compare them with the current x-ray. The biggest indication for the need of a retreatment would be breakdown of the bone around the tooth, symptoms such as chewing/biting pain or a draining abscess, or exposure of the root canal filling to the oral environment (i.e. saliva).
John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University