An Endodontic Treated tooth with Post operative Apical Periodontitis often is a result of improper BMP, missed canals, fracture of tooth, loose restoration etc. during Root Canal Treatment. There are many causes of failure of Root Canal treatment which are mentioned in this post – Link
Only a small number of species of micro organisms have been found in the root canals of properly endodontically treated teeth which in follow up revealed a persisting Asymptomatic periapical radiolucency’s.
So in case of a failed Endodontic therapy it is easy to identify the micro organisms based on Culture methods as the number of species to suspect are very few in comparison to an Actively infected tooth. Below are the list of micro organisms which have been isolated from a Re-infected tooth after a failed Root canal treatment with the help of Culture.
The Micro organisms Genera found in Periapical regions of a Failed Endodontic treated tooth are:
- Actinomyces
- Enterococcus Fecalis
- Propioni bacterium (previously called as Arachnia)
- Yeasts
- Candida Albicans – Most commonly isolated Fungus
Enterococcus Fecalis – Most common pathogen found in periapical region of failed Root Canal or Endodontic Treated tooth.
Among the enterococcus Species the most commonly found is Enterococcus Fecalis which is given particular interest because it is “Rarely found in Untreated and Infected Root Canals”. This means that Enterococcus Fecalis is found alone in the Root canal and can live without help from other Micro organisms.
Enterococcus Fecalis can grow as a mono infection in treated canals in the absence of Synergistic support from other bacteria.
Therefore E. Fecalis is held to be a Recalcitrant (Stubborn) Microbe among the potential etiologic agents of post treatment apical periodontitis. This needs special treatment protocol to clear the peri apical region of the micro organisms. One such method is the use of TAP or Triple Antibiotic Paste.
How you know E. facalis is the major cause ? It can also be as a commensal bacteria .
Many studies have been conducted with samples from failed RCT treated tooth being collected and checked for the bacteria in the peri apical region. Will be sharing the links to these studies in the next comment.
About 3 years ago I a peace of a large filling in my molar had broken off ..The dentist insisted I needed a root canal ” because I need something to anker the filling to” ! Reluctantly I had the procedure done. After the procedure,I felt a very light pain, especially,if I was chewing on that molar, and a slight sensitivity and swelling of the gums around the tooth.I thought it would eventually get back to normal, but it did not. I never really felt well again after the procedure and the symptoms described persisted, to 3 years later- no better – no worse! But now I have developed serious healthproblems, and wonder if the dental problem is “at the root “? Of this, and I will have to have it all extracted ? How do I know what to do ?….
Hi Frederika,
May your health improve soon, as for the tooth infection the slight pain persisting and gum swelling might suggest to a Gum problem or the Root Canal not being done completely. If you want to find out if it was the Root Canal a periapical Xray would be the best option to see whether there is any infection in the bone. After an Xray is taken the Dentist will decide if the tooth needs to be extracted or left alone. From the Xray even the Gum problem can be diagnosed.
hello docter varun i want to share something about root canal treatment , a pt. came to me and told me that his tooth was treated by root canal but after the treatment the tooth is still very much sensitive , he even can’t touch it with his own tounge .
Did you take an Xray ?
There can be many reasons for this – Missed Canal, Over extension of the GP point beyond the apex, Periapical pathology still present or even something as simple as a High point from the Post Endo Restoration.
Check one by one to eliminate the cause and treat it accordingly.
Can a dark shadow under a root canal be soothing otber th a an infection of the tooth has never bothered you and z root csnal eas performed 25 years ago?
Thank you doctor for your article! I had my RCT done 3 yrs ago but now i had a bump come out on the gums, the xray shows as doc explained that root canal wasn’t treated to the end and infection has started. why would my previous doctor didn’t treat it to the end? i have to redo all my bridge now again?!!
Not sure about why your previous Dentist has not completely filled the canal, but as you have re-infection you have to get Re-RCT or a procedure called Apicectomy done to save the tooth. If there is a possibility the Re-RCT can be done through the Bridge which can help in saving the bridge.
If there are no symptoms there is nothing to worry about, our immunity can take care of any mild infections present periapically. Only of there are symptoms you will have to attend to it.
Hello Varun . Could a root canal that has broken be causing my headache that I’ve had for a month ? A piece of it broke off . I’m thinking I might have gotten bacteria in there ? Is that possible . Thank you
Depends on whether you are having toothache along with the headache or just the headache. In case of a Re-infected Root Canal there will be pain in the tooth and certainly there can be pain in the side of the head. It is always best to get a Crown placed on a Root Canal treated tooth as it helps in preserving the tooth which in a sense is dead and has become brittle.
So visiting your Dentist is the best option as they can take an IOPA and get to a conclusion whether it is because of the tooth or anything else.
Hello sir I had RCT one year ago but in X Rey there is a black shadow under the teeth. But there is no pain in the teeth for the last one year, is there anything to worry about?
Until it is asymptomatic or without pain there is nothing to worry about. What did your Dentist say about the black shadow near the root tips ??
There are many radiographic faults which can make it look like a shadow which is not actually infection.
If a dentist cannot get all the infection out of the canals because he said my own body had sealed it off , but then the gums keep inflaming then going back down again with jaw pain and crackling noises from time to time in my sinus on that side of the face , would that be classed as a failed root canal?
There was no real pain in the tooth itself but the gum did get painful and bouts of antibiotics helped but it would keep flaring . He didn’t crown it for two years while this was going on , as he didn’t know if there was any point .
I’ve since had it extracted and have dry socket which is so painful , I’m hoping to get an implant if I’ve enough bone .
Can you have radiating jaw pain but no exact tooth pain from a failed root canal ?
My tooth had broken off to below the gum line when first treated .
Was Apicoectomy not advised in that particular tooth which was having repeated infections?
Hi Dr Varun, I have root canal done on 2 teeth and both of them was down 6 years back.6 month back the crown broke but I haven’t replaced the crown.I had pain in jaw a year back but now I do not have any jaw pain.one of the near by tooth has a large cavity but has no pain.The xray of root can shows filling was done only till half length.But I do not have any pain.Do I need to extract this tooth or is it fine if I can place a crown on this tooth along with fill and crown for the nearby tooth ad well.Would like to get some insights from you.
Sometimes even with half a filling it’s the body which takes care of the healing. As for leaving it Just as it is and going for a crown or going for a Re-RCT depends on the periapical region or tip of the root. If there is any periapical radiolucency it is best to go for a Re- RCT and then a Crown.
Hello Dr. Varun,
I have a root canal done before 10 years and have small dark shadow at the bottom of the nerve on 31st tooth. Shadow has decreased a lot after doing the treatment but now it still has small shadow for 2 years and has not gone completely. My Doctor suggested me to remove that tooth and said me there is leakage from the seal, but I have no pain due to it. So, what would you suggest me to do?
There is an option for treating such PeriApical Lesions which are recurring known as Apicoectomy. You can try that if you feel the tooth can be saved.