A Root Canal From 2009 That Never Stopped Aching

Quick answer: A root-treated tooth that has never felt entirely right usually has a canal that was not found, not a tooth that needs extracting. Retreatment under magnification finds these, and success rates are good.

The call

Devora, 58, from Sheinfeld, described a tooth that had never fully settled since a root canal in 2009. Not agony — a dull awareness, an ache when she was tired, a tenderness when she pressed it with her tongue. Twice over the years it had flared properly and been calmed with antibiotics.

She had been told, more than once, that the tooth had "had its chance" and should come out.

What we found

The upper left first molar, root treated fifteen years earlier and crowned. On the x-ray, three canals had been filled, and the fillings looked adequate as far as they went.

Upper first molars very often have four canals, not three. The extra one — the second mesiobuccal, MB2 — sits a millimetre or two from its neighbour, is frequently hidden under a shelf of dentine, and is missed routinely without magnification. Studies looking at these teeth find that canal present in the large majority of them.

Two signs pointed straight at it. The x-ray showed a small, persistent dark area over one root tip, and when we took a second film from a different angle, an untreated canal space was faintly visible running alongside the filled one.

A missed canal is exactly what produces her symptom pattern: not a raging infection, because most of the tooth is sealed, but a small reservoir of bacteria that keeps a low-grade inflammation going for years and flares whenever her immune system is busy elsewhere.

What we did

Retreatment, in two visits, under the microscope.

We accessed through the existing crown, removed the old root filling material with solvent and rotary files, and then spent a serious amount of time — the better part of forty minutes — troughing carefully in the floor of the pulp chamber until the MB2 orifice appeared. It was there, calcified over at the entrance, and it opened up into a full-length canal.

All four canals were cleaned, disinfected with a long irrigation protocol, dressed with calcium hydroxide for three weeks, and then filled. The crown was sound, so it stayed, and the access was sealed.

The outcome

The tenderness went within a fortnight and has not come back. The dark area on the x-ray had substantially healed by the twelve-month review and was gone at two years.

She kept a tooth that two clinicians had written off. That is not a criticism of them — retreatment is time-consuming, needs magnification, and is not something every practice offers — but it is a reason to ask specifically before agreeing to an extraction.

What to do if this happens to you

1. Take "it has never felt right" seriously. It is not in your head, and it is not normal.
2. Ask whether all the canals were found, and ask to see the x-ray.
3. Ask for a second-angle x-ray or a CBCT scan. Missed canals often hide directly behind a filled one on a standard film.
4. Ask specifically about retreatment before agreeing to extraction. They are different skills.
5. Do not accept repeated antibiotics for the same tooth over years.
6. Ask what the alternative costs. Retreatment is usually considerably cheaper than extraction plus an implant.

A root canal that never settled? Ramat Beit Shemesh Urgent Dental Care assesses retreatment before recommending extraction. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh.

Based on real cases treated at the clinic. Names have been changed.