Q: I had a crown come off a lower back molar with part of the tooth stuck in the crown. I saw a new, very young dentist. He told me since the tooth has an old root canal, which shows nothing wrong on the X-ray, I should get the root canal done over again before I get a new crown. He also told me I need to start on an antibiotic immediately because bacteria might have infected the old root canal. What do you say?
A: Well the dentist is totally wrong, in my opinion. It has nothing to do with him being young. When I took over a practice in Palm Beach nearly 29 years ago, I was 28 years old.
Patients would call the outgoing retiring dentist at home and ask him if they could trust me, as I looked about 16 years old. I still can’t grow a decent beard. One patient asked the woman at the front desk if I took a skateboard to work.
To combat this pre-judging thing, I slicked my hair back with some gel that looked like it came from a Jiffy Lube and bought wire framed Benjamin Franklin glasses to look older. One older female patient said I looked like Rudy Valentino, another Andy Garcia.
As long as the root canal is not showing any signs of infection in the bone adjacent to the tips of the roots on X-ray, and no fistula (puss-draining pimple) is present or any signs or symptoms of a fracture, there is no reason to perform re-treatment of a root canal. I have never in 33 years seen a good-looking root canal go bad after making a new crown on the tooth.
I also say boo on the antibiotic. No infection was diagnosed in your case. Why take the risk of a GI infection from killing off the good bacteria and allowing the bad bacteria to overtake your GI tract?
The treatment is to build up the tooth stump with pins, posts, and composites for a strong foundation, and make new porcelain or gold crown.