3D X-ray to help diagnose problem root canal tooth?

29 Posts

Hi, I’ve posted a few weeks ago about resurgence of toothache from what I suspect is from a previously root canal treated upper first molar.
Apologies for the long post but I’m trying to include as much detail as possible to get some answers.
So about a year ago I had an infection in my upper first molar tooth, which I had root canal treated from an Endodontist. Though expensive (£700) it seemed to be successful and I had no issues for the next 12 months. However 3 weeks ago out of the blue I started having a dull pain/ache coming from the area near the RCT molar, this pain can vary throughout the day, sometimes it’s very painful and at nighttime it tends to settle down a little. I went to my NHS dentist and they did a standard 2d X-ray and they said all looked fine, no infection, the root canal tooth looked good (3 good root fillings all the way down to the base of the roots). Then dentist said it could be sinusitis (which I disagreed with since I had no symptoms) and gave me a course of amoxicillin and sent me on my way.
A few days after that I went for a second opinion to another NHS dentist at a different practice and again they gave me another X-ray and again said the they could not see any infection with that that or any other surrounding teeth and the RCT tooth looked well done. But said they could remove the tooth if I wanted which I refused, not wanting to remove teeth with no certainty it is the source of the problem.
Days after that I went back to my Endodontist and they also X-rayed the tooth (which I’m a little concerned I’m going to get radiation poisoning at this point) and repeated what the other dentists said, the X-ray doesn’t show a problem. But he said my gums looked a bit red around the tooth and said to wait and see if the amoxicillin helps calm things down (which was the last day on a 7 day course).
A few days after that I went for a second opinion to another NHS dentist at a different practice and again they gave me another X-ray and again said the they could not see any infection with that that or any other surrounding teeth and the RCT tooth looked well done. But said they could remove the tooth if I wanted which I refused, not wanting to remove teeth with no certainty it is the source of the problem.
Days after that I went back to my Endodontist and they also X-rayed the tooth (which I’m a little concerned I’m going to get radiation poisoning at this point) and repeated what the other dentists said, the X-ray doesn’t show a problem. But he said my gums looked a bit red around the tooth and said to wait and see if the amoxicillin helps calm things down (which was the last day on a 7 day course).
A week after that (this week) still suffering with tooth pain I went back to my Endodontist and he said my gums still look a little red around the edges and said I needed a deep cleaning. He went ahead used ultrasonic scaler around the tooth and also drilled down the composite filling slightly to make sure the tooth wasn’t riding high and causing pressure when I bite down. He also prescribed me another course of different antibiotics (which I’m hesitant about taking since the first course did nothing), he was pretty sure that would solve the tooth ache.
3 days later (and a total of 3 weeks suffering) the toothache is still no better!
I’m now thinking there may be a possibility I have a hidden tooth infection in the root canal treated Molar that standard 2D X-rays aren’t picking up on (especially any hidden infection around the jaw bone). The only way to diagnose the issue is to get myself a 3D X-ray (CBCT scan) which is vastly more detailed but is expensive (£200, which I’m hesitant about wasting any more money on this tooth). It requires me to search for 3D X-ray providers, but so far the nearest location requires me to travel 20 miles to the nearest city. Then if any infection is spotted I will at least feel assured I’m making the right choice about getting the extraction. But then again I’m also concerned having a cone beam X-ray along with 3 other dental X-rays in one month is too much, all that radiation can’t be good for me.
The cheaper and far more convenient option is to simply have the RCT molar extracted by an NHS dentist and pray it solves this incessant pain I’ve been dealing with for weeks now! But I run the small risk of having the molar extracted and it turns out it wasn’t the source of the pain, but I am fairly certain that is what is causing the pain.
I believe Toothsmith mentioned from my previous thread about teeth clenching possibility having said I was given a night guard by another dentist last year (no other dentist mentioned it) , but I really couldn’t use the night/mouth guard as I was up into 4am trying to fall asleep which I failed to do until I removed the damn thing! Lol, but I really don’t think I even have been grinding my teeth because I have no other symptoms, it’s only one tooth that is causing the pain.
Any help/opinions from Dentists on this board would be highly appreciated! Thank you.
3 days later (and a total of 3 weeks suffering) the toothache is still no better!

I’m now thinking there may be a possibility I have a hidden tooth infection in the root canal treated Molar that standard 2D X-rays aren’t picking up on (especially any hidden infection around the jaw bone). The only way to diagnose the issue is to get myself a 3D X-ray (CBCT scan) which is vastly more detailed but is expensive (£200, which I’m hesitant about wasting any more money on this tooth). It requires me to search for 3D X-ray providers, but so far the nearest location requires me to travel 20 miles to the nearest city. Then if any infection is spotted I will at least feel assured I’m making the right choice about getting the extraction. But then again I’m also concerned having a cone beam X-ray along with 3 other dental X-rays in one month is too much, all that radiation can’t be good for me.
The cheaper and far more convenient option is to simply have the RCT molar extracted by an NHS dentist and pray it solves this incessant pain I’ve been dealing with for weeks now! But I run the small risk of having the molar extracted and it turns out it wasn’t the source of the pain, but I am fairly certain that is what is causing the pain.
I believe Toothsmith mentioned from my previous thread about teeth clenching possibility having said I was given a night guard by another dentist last year (no other dentist mentioned it) , but I really couldn’t use the night/mouth guard as I was up into 4am trying to fall asleep which I failed to do until I removed the damn thing! Lol, but I really don’t think I even have been grinding my teeth because I have no other symptoms, it’s only one tooth that is causing the pain.
Any help/opinions from Dentists on this board would be highly appreciated! Thank you.
0
Latest MSE News and Guides
Replies
if you imagine that down on the ground, the x-rays from the sun are filtered out by all the atmosphere the light goes through, then you will understand that whilst up in an aeroplane, you are being exposed to more x-rays than when on the ground. A small dental x-ray is the equivalent of a couple of hours in an aeroplane. The cone-beam scan is a bit higher, but none are as big as something like a barium meal - which is equivalent to a couple of decades in an aeroplane!
It's still true that they can cause changes in the body, so you should only have exposures when necessary. If 3 different dentists have taken x-rays and said it's ok, I would say chances are, it's ok. As they are positioned by hand, each one would have a slightly different angle, so if something was wrong, it would probably have shown up on at least one of them. I can't guarantee that, but it's hard to justify more radiation at this time.
Going back to the bite guard, did you try wearing it during the evening before bed? Just because you're having problems tolerate a bite guard doesn't mean your problem isn't tooth grinding related. In fact, I sometimes find that tolerance problems are higher amongst those that really need the things!
If wearing it just the evening doesn't overcome the tolerance issue, then try wearing it for more time during the day. It doesn't have to be a continuous run all the way to bedtime. Just have it around, and any time you can pop it in your mouth for a while, then take it. The more you wear it, the more natural it will become, so the easier you will get to sleep with it in.
Finally, sticking to one dentist can often be a better way to sort out tooth problems when a direct cause isn't obvious. There can often be several things that have to be looked at as a possibility, and different treatments tried, and given some time to see if they get to the bottom of it. By swapping about, one dentist won't know what a different one has tried, and so you may find one trying something another one has already tried. It can often be a bit of a detective job to pin down a particular problem, but the very last thing any dentist would want to do, or you as a patient would want, would be to have a tooth out that wasn't responsible for the pain.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.
It is interesting about the different levels of radiation put into context, I shall not worry too much from now on, but the same time try not to have any more unnecessary X-rays. The only reason I mentioned the possibility of getting a 3D X-ray is because I came across an article online through google titled “infected root canals and what to do about them - integrative dentistry, San Diego” (sorry I can’t post a link) and it showed a perfectly fine root canal tooth on a standard 2D X-ray with no signs of infection, however once a 3D X-ray was used they spotted rather large infected granulated tissue going up into the sinus cavity! I’m concerned any possible infection may not be obvious using the 2D X-rays? My Endodonist show me my previous X-ray before I had the root canal (when it was infected and I was in extreme pain) and I couldn’t believe how subtle and small the dark shadow was on the base of the root looked on the X-ray! So I wonder any smaller infection may be virtually invisible to further X-rays?
Regarding the mouth guard I found it highly uncomfortable, I have mildly crooked lower teeth and I found the customised mouth guard felt like it was putting horrible pressure on the teeth, it felt like I was wearing braces! Also the depth of the mouth guard went all the way down to the base of my lower jaw and felt like it was cutting into the skin, Finally once I was wearing the guard I felt like I had no room for my tongue which had to rest above the guard.
As an experiment I should simply pull an all nighter (ie try to sleep with the mouth guard) and not get any sleep to see if my toothache improves the next day, but it is hard and frustrating not getting any sleep all night, but at least I shall know if any clenching is responsible for this toothache or not.
Thanks again.
"A little learning is a dangerous thing. Drink deep or taste not the Pierian Spring; There shallow draughts intoxicate the brain, and drinking largely sobers us again"
Like your fear of illness from the x-rays was calmed when put in a bit of context, the problems a single week of amoxicillin can cause really don't add up to what you've concluded from Google.
On the other hand, your rather specific diagnosis of a 'mild non-allergic rash' from head to toe and 'feeling terrible' would be something I'd be a little more concerned to investigate, and certainly wouldn't put it down to serotonin and dopamine level fluctuations caused by destruction of gut bacteria. That does sound to me more like an allergic reaction. But obviously, I can't see you. But I would mention it to your dentist (although you might have done, if he gave you a different type of antibiotic this time)
Tooth/jaw problems can come in many and varied forms. One thing about jaw problems though is that they are linked to stress. So something that has not caused you a problem before could be doing now as at the moment everyone is more stressed due to this bug that's going around! I'm seeing a big increase in tooth grinding symptoms and people breaking cusps off teeth!
My advice would be to choose the dentist you want to help you sort this out, stick with them, and let them investigate it properly and work through the processes they need to to come to the correct diagnosis, and leave Google alone for a while whilst this process works through.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.
Thanks again and Merry Christmas to you!
In all honesty, from what you say you've done to it, I'm not sure your bite guard would be much use now. I would ask your dentist what his opinion on you trying a new one would be, and get one made. Taking in your old one to let him see it and as an aid to you describing what you found uncomfortable with it would be useful.
Just prior to lockdown, the brake disc on my pedal bike wore out. Bike shop couldn't fit it in to do it ( and bike shops had to close right at the start) I looked on you tube, and found a video on how to change them. I'm the son of a mechanic, and have always been pretty handy at fixing stuff, so I got the part online, and I fixed it.
It took 18 months and 4 operations, ( including 2 replacements) to get right! I was on a broad spectrum antibiotic at a huge dose for 3 months between replacement one coming out, and replacement 2 going in. I didn't Google anything! (At the same time, I was getting divorced! I didn't Google anything about that either!
So yes, Google can be useful for some things, but many times it can be a rabbit hole you can disappear down and end up way more dispirited or confused than you otherwise would be. It needs great care.
1. Get recommendations from friends/family/neighbours/etc.
2. Once you have a short-list, VISIT the practices - dont just phone. Go on the pretext of getting a Practice Leaflet.
3. Assess the helpfulness of the staff and the level of the facilities.
4. Only book initial appointment when you find a place you are happy with.