DENTAL CARE

Jeffrey Gross, DDS, FAGD

Q: Nobody Believes Me When I Say that My Tooth Still Hurts After a Root Canal! A: I believe you and I do see patients with this issue. They come to me from all over and wonder why this is so. I want to explore this topic for just a little bit. As usual, so that we are all on the same page, allow me to give you a little background. Whenever a tooth causes severe pain that doesn’t give up, there are two choices to make which will let the patient feel better. One option involves removing the offending tooth. The other choice consists of keeping it in the mouth. There are many factors to consider in deciding which approach is the most appropriate for the situation. No one right answer is applicable all the time for everyone. However, one theme will apply in many cases. If we can and want to keep the tooth in the mouth, then our goal is to eliminate the pain. Age of the patient, condition of the rest of the teeth, medications or illnesses will all have a bearing upon this decision. Once we decide to keep the tooth, it must be treated to eliminate the inflammation or infection that is pres- ent. This is the source of the pain. This treatment is called an endodontic procedure or better known as a root canal procedure. This course of treatment ensures that the pain will go away. We clean, disinfect and as best as possible create a bacteria-free environment inside the tooth. This clean tooth, if you will, will allow the body to heal itself and pain go away. There has been some new research that explores alternative ways to treat a painful tooth. Whenever we traditionally manage a tooth, we end up with a tooth that has nothing living inside of it. It is called a dead tooth. When a tooth is no longer alive, if something were to go wrong, there is no alarm system to let us know early enough. This lack of living tissue can result in the tooth fracturing and ultimately lost from the mouth. Remember, we tried to avoid this. Vivek Kumar, Ph.D. and Peter Nguyen, Ph.D. are researchers at the New Jersey Institute of Technology. They presented the results of a study last year. In the study, they looked for a chemical which would stimulate both new blood vessels and dental stem cells growth within the tooth. New research showed that new blood vessel growth occurs in a limb after outside stimulation. If so, then why not inside a tooth? They created a unique compound that they placed into the teeth of dogs that have undergone root canals. The goal was new blood vessels and possibly even new enamel formation. Depending upon the results, human clinical trials may be in the future. This research is fascinating. We could potentially bring a tooth back from the dead. This would revolutionize how we treat our patients. However, until that happens, we are dealing with a tooth that is not alive. So why does a tooth “still hurt”? Typical reasons are a slower healing time, a tooth nearby that is having issues. A minor root fracture will not allow the tooth to heal. Remnants of infection are hiding in out the way areas that root canal procedures cannot reach. There are others also. Suffice it to say that the complaint must be taken seriously and investigated. No one wants to remove a tooth that just had a root canal procedure. However, there are times when this is appropriate. Listening to the patient and performing appropriate diagnostic test will help create relief for a patient. What is important to remember is that every complaint must be analyzed carefully. At the same time avoid jumping to conclusions. These guidelines apply to both the dentist and the patient. If you are having an issue or would like a second opinion, please contact us so that we can help you. Call Megan at 440.951.7856 and set up a complimentary consultation. Hopefully, you and I can work together to make you feel better. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine. The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com