pain after root canal - trying to reach Laurence Stein, DDS

[apnea_1977]

hello everyone,

my issue today: i had a root canal done a few weeks back tooth # 3 witch now has a permanent crown on it.

currently im in the canary islands doing some apnea training and went for a dive a few days ago when i hit 10-15 meters i received an incredible pain above tooth # 3
after surfacing and attempting again; equalizing every meter or so the pain returned and persisted. i had to terminate any further diving attempts and headed back to land where the pain subsided but left me pretty shook. especially since in do to travel the next weeks with ample air travel etc.

today i went to a local [non diving] dentist witch explained the air pocket theory as well as hairline fracture possibility. both witch she cant do anything about. she gave me a shot of cortisone explaining it would expand and eliminate gas, haha thats sounds funny. fun aside has any one heard of this? 10/10 pain seems to be gone will it come back if unprovoked?

q's:

can i fly/travel?
what are my further steps?
endodontist? dentist?
im based out of florida but will be in germany next week [berlin]
any dive doc's there?

i read the articles by many members esp. doctor stein.
can anyone put me in touch with doctor stein? i tried both his aim/miami phone nr both didnt work.

i appreciate your help!

best,

AP

 

[Laurence Stein DDS]

apnea,

I don't know what is actually wrong. My first guess is that it is either a problem with your sinus or the root canal is not healing as expected.

You indicate that the pain is "above" tooth #3... the upper right first molar. So the pain may not be coming directly from the tooth.

It is now know that upper first molars have additional canals approximately one third of the time. The extra canal is often very hard to find and may require an endodontic operating microscope. If there is an additional canal, the root canal treatment may not succeed.

Yes, it is possible for the root canal to be completed apparently successfully only to go on to become a problem again... days, months or even years later. The extra canal is almost never seen on x-ray.

As to the use of an injectable steroid... It's not used in the US and I doubt its long term effectiveness. In addition, risks from parental (systemically injected) steroids is probably greater than any potential benefits... especially for treatment of a suspected root canal problem. Topical steroids placed into the canals during treatment may be used.

Can you fly? I don't know... I will say that the pressure change in an aircraft is a fraction of one atmosphere and you indicate that you problem occurred somewhere between 30-45 fsw... 1—1.5 ATM. If you're lucky you might not have any symptoms.

If your symptoms persist, then seeing a root canal specialist (endodontist) and/or and ENT may be necessary.

BTW, if your tooth is fractured then it is possible that no treatment except extraction will succeed. Fractures in roots are nearly impossible to detect. The diagnosis is often one of exclusion of all other possibilities.

Good luck.

 

[Doubler]

Doc Stein,
Your signature quote from "The Marathon Man" haunts me each and every time I go to the dentist. I felt it every time he flicked that nerve. OUCH

 

[apnea_1977]

thank you for the prompt replay.

this is correct, presently there is a slight sensation on the inside on the tooth area, not pain but more of a consciousness

You indicate that the pain is "above" tooth #3... the upper right first molar. So the pain may not be coming directly from the tooth.



my endodontist was using an microscope

It is now know that upper first molars have additional canals approximately one third of the time. The extra canal is often very hard to find and may require an endodontic operating microscope. If there is an additional canal, the root canal treatment may not succeed.



precise, x-ray shows nothing

Yes, it is possible for the root canal to be completed apparently successfully only to go on to become a problem again... days, months or even years later. The extra canal is almost never seen on x-ray.


besides feeling like the side effects of getting shot up with antibiotics there is no noticeable change.

As to the use of an injectable steroid... It's not used in the US and I doubt its long term effectiveness. In addition, risks from parental (systemically injected) steroids is probably greater than any potential benefits... especially for treatment of a suspected root canal problem. Topical steroids placed into the canals during treatment may be used.



ok

Can you fly? I don't know... I will say that the pressure change in an aircraft is a fraction of one atmosphere and you indicate that you problem occurred somewhere between 30-45 fsw... 1—1.5 ATM. If you're lucky you might not have any symptoms.


is there a way a endodontist can go in and and re examine the roots [hard to find canal]? see if there is indeed a fracture?

If your symptoms persist, then seeing a root canal specialist (endodontist) and/or and ENT may be necessary.



FANX!

 

[Laurence Stein DDS]

apnea,

Immediately following root canal therapy, some patients experience discomfort. It may be slight to severe. The vast majority experience no pain. Typically, this pain is associated with residual inflammation of the Periodontal Ligament, the membrane which surrounds the root of the tooth. When inflammed, this membrane thickens and any pressure on the tooth may cause pain. Sometimes there is enough inflammation to literally push the tooth slightly farther into the mouth and into an extra heavy bite.

The more you bite on this already sore tooth, the more inflammation occurs... and so on. and so on. The dentist usually has to "adjust" the bite to relieve the excess pressure.

Another source of pressure in you situation might be the use of the snorkel during your dives. I not sure you did but if so, it is a source of excess pressure on the tooth.

Your question about re-examining the tooth to look for an additional canal would entail either the removal of the new crown (rather difficult to impossible) or making a hole through you new crown, cleaning out any core material within the nerve chamber and then trying to look around all the orifices of the roots of the tooth. If there is a post in any canal, it is unlikely that it can be removed without destroying the tooth.

The most likely place for an extra canal is the Mesio—Buccal II canal. If your dentist already identified and filled the extra canal, it is very unlikely that another exists.

My first suggestion would to try a little "tincture of time" Give the tooth a little time to heal... anywhere from a week or so to a month or more. As your consciousness of the tooth diminishes, you may find that your pain during diving goes away. This is probably better than the potential complications of re-entering the tooth on a reconnaissance mission which could turn into search and destroy.

Remember, it could still be you sinus.

One final question... is everyone sure that your pain is actually coming from this one tooth or could an adjacent tooth also be a culprit? If another tooth WITH a nerve has a fracture, it would be more likely to cause dental pain than a fracture in a tooth with root canal therapy.... Just a thought.

 

[apnea_1977]

first off - thank you so much for taking your time. its a soothing feeling to able to get such thoughtful advice, [as well as the humor it helps a lot thanks..]

check

My first suggestion would to try a little "tincture of time" Give the tooth a little time to heal... anywhere from a week or so to a month or more. As your consciousness of the tooth diminishes, you may find that your pain during diving goes away. This is probably better than the potential complications of re-entering the tooth on a reconnaissance mission which could turn into search and destroy.


after two days passing its seems more and more like the pressure seems to be coming from the sinus area. i did some reading and it was mentioned that the sinus floor might have been ruptured? any thoughts? experience with the proceeder possibilities?

im a little anxiety ridden do to a rather long flight tmr, with multiple stops in [foreign countries where they love to pull stuff]
on a side note, i attempted a little high altitude test yesterday where elevated roughly 1000 meters above sea level from 0-3 meters, the good news was no new news. nothing changed.

Remember, it could still be you sinus.


we x-rayed my mouth up-down-around a few times with 4-5 different docs having a look, if it is another toof i [we] nobody knows.

One final question... is everyone sure that your pain is actually coming from this one tooth or could an adjacent tooth also be a culprit? If another tooth WITH a nerve has a fracture, it would be more likely to cause dental pain than a fracture in a tooth with root canal therapy.... Just a thought.

 

[Laurence Stein DDS]

Oooo! Ruptured sinus sounds so... Explosive! I doubt that you can do that free diving. You can rupture some blood vessels and occasionally compress a nerve that supplies feeling to the lips and teeth. The symptoms are quite different.

Personally, I would stay out of the water for a reasonable period and take lots of chewing gum on the airplane... almost any flavor will do. Perhaps a little Afrin about an hour before the flight just to keep the sinus open.

 

[apnea_1977]

made it to berlin in one piece. thanks for everything, i will keep you posted.