root canal Archives - Atlanta Dental Implants

Do I Have a Cyst in My Gums Above My Incisor?

Posted on June 24, 2025 by AllSmiles.

I have a tender, swollen lump above my left incisor that my dentist has been watching since late 2023. After talking to my dentist again, I’m concerned that it may be a cyst. During my 6-month exam and cleaning last week, my dentist said the lump is probably an abscess, but it could be a cyst. My dentist mentioned a cyst for the first time last week. I am concerned about my dentist’s uncertainty. She mentioned that if it’s not a cyst, she can do a root canal on the tooth or refer me to a specialist for a procedure called an apicoectomy to remove the lump. Would either procedure work? I am afraid of losing a tooth unnecessarily. Thanks. Lydia from Tampa, FL

Lydia,

While dental school thoroughly covers oral cysts and their potential issues, it’s important to distinguish between a cyst (a fluid-filled sac) and an abscess (a pus-filled sac). Although there’s a slight possibility that your condition is a cyst, it’s more likely to be an abscess. A January 2025 article in Today’s RDH explains how dental professionals can use an X-ray to distinguish between a cyst and an abscess.

What Is the Treatment for a Tooth Infection?

An apicoectomy accesses a tooth from the root tip instead of its crown, as with root canal treatment.

A root canal treatment is recommended to eliminate a tooth infection. This procedure is usually effective. We advise against the gum procedure, known as an apicoectomy, because it is likely unnecessary.

What Are the Effects of a Prolonged Tooth Infection?

A prolonged infection can allow bacteria to enter your bloodstream, affecting your overall health and energy. It’s concerning that your dentist has monitored the swelling for three years without intervention. Resolving this infection through a root canal treatment should help alleviate your symptoms.

Generally, root canals have a success rate of at least 85%. The percentage is often higher when a root canal specialist (endodontist) performs the procedure. If root canal therapy does not fully resolve the issue, an endodontist may recommend an apicoectomy. Your description of the issues doesn’t seem to indicate that you will experience tooth loss and require tooth replacement. You may choose to schedule a second opinion appointment with a periodontist (gum specialist).

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Do I Need a Crown or a Filling for a Root Canal Tooth?

Posted on March 31, 2024 by AllSmiles.

I recently switched dentists because my former dentist retired. After an exam and cleaning, I talked to the dentist about teeth whitening. She said that she is concerned about a molar root canal tooth before she would do the whitening. The root canal tooth has a loose filling. The dentist wants to do a crown with posts instead of another filling. She says that I must complete it before I get teeth whitening. Is this necessary, or can I get another filling? Since this is a new dentist, I am not sure if I trust her recommendation. Thank you. Lance from Reno

Lance,

We understand your concern, especially because you are a new patient for this dentist.

Does a Root Canal Tooth Need a Crown?

Not every root canal tooth needs a crown. But that is particularly true of front teeth because crown preparation can weaken the tooth against lateral stress.

Molar teeth

Without a crown, a molar root canal tooth is susceptible to breaking for several reasons:

Root canal treatment can weaken and tooth and make it brittle
Molar teeth receive a lot of chewing pressure because they are the farthest back in your mouth
Cusps on molar teeth are likely to separate with the stress of chewing. And the pressure increases the risk of the tooth cracking in half. If that happens, you may lose the tooth and need a dental implant to replace it.

If the filling in your molar tooth is loose, it is understandable that your new dentist wants to protect the tooth with a crown. We wonder why your former dentist chose a filling instead of a crown.

We suggest that you get the crown as your dentist advises. But if you want your teeth whitened, it should be completed before you get the crown to ensure the crown matches your brighter teeth. Unless your dentist has a good reason for doing the crown before whitening, usually dentists complete whitening first to ensure the crown matches your whitened teeth.

Could a Cavity Develop Beneath My Dental Crown?

Posted on December 11, 2023 by AllSmiles.

I got three upper crowns in early 2020. One of the three crowns has a cavity beneath it. The tooth has been hurting, but I was very surprised when my dentist told me that I had a cavity beneath the crown. I thought the crown was going to protect my teeth from future decay. How could this happen? Will I need a root canal? Will insurance pay for this if I need a new crown, although it is relatively new? – Tristen from Macon, GA

Tristen,

It is unusual to have a cavity beneath a crown after almost four years. A dentist would need to examine your crown and tooth to determine why you have a cavity. But we can provide some basic information about a cavity beneath a crown.

How Can You Have a Cavity Beneath a Crown?

A dental implant with components labeled - crown, abutment, implant screw

Get prompt treatment for a cavity beneath a crown to prevent the need for a root canal or a dental implant if you lose the tooth.

Having a cavity beneath a crown is unusual, but it can occur. What are some possible causes?

Tooth infection not removed – If a dentist covers a tooth with a crown without removing decay thoroughly, you might develop a cavity.
Gap at the margin – Your dentist must ensure the margin where your tooth and crown meet is closed and smooth. Even a small gap allows bacteria to creep in. Plaque can build up and promote decay.

If you feel pain or discomfort in the tooth, without treatment, you may need a root canal treatment to remove an infection. Without a root canal, the infection will progress, causing tooth loss and more costly treatment for tooth replacement, such as a dental implant.

Check with your insurance company regarding coverage toward replacing the crown. Many insurance plans expect the crown to last at least five years. If replacement is needed sooner than that, the insurance company will ask for documentation from your dentist to determine if they will provide benefits.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

Is My Root Canal Tooth Infected Again?

Posted on January 17, 2023 by AllSmiles.

I am afraid that I will lose my root canal tooth and need a dental implant. My dentist completed a repeat root canal on my upper left first premolar in October 2022, but I think the tooth is infected again. Is that possible? The left side of my face is puffy beneath my eye and around my cheek. It’s not painful yet, but it is uncomfortable. Will I need an extraction and dental implant? Thank you. Kamal from Honolulu

Kamal,

Thank you for contacting Pumphrey Periodontics of Atlanta. We understand your concerns about your tooth and whether a dentist can save it.

Is Your Root Canal Tooth Infected Again?

Your root canal tooth may be infected again if it hurts and you have swelling in your gums or face. You may also feel discomfort when you put pressure on the tooth or use it for biting or chewing.

Can a Dentist Save a Repeat Root Canal Tooth?

Whether or not a dentist can save a repeat root canal tooth depends on the tooth’s condition and the extent of the infection. Your dentist may refer you to a root canal specialist if the tooth’s canals are curved and challenging to reach.

Why Would You Need Another Root Canal?

You might need another root canal if your dentist missed a canal while removing the infection or if the canals are challenging to reach. After root canal treatment, your dentist or specialist will prescribe an antibiotic to help your body get rid of the infection.

What If Your Root Canal Tooth Is Not Savable?

Dental implant

If a root canal tooth is not savable, your dentist may refer you to a periodontist for tooth removal and a dental implant. If your jawbone around the tooth is healthy, you may get a tooth extraction and an implant on the same day. The advantages of same-day implant placement include:

Preserves the jawbone
Prevents the need for bone grafting later
Reduces overall treatment time

A June 2022 Journal of Periodontology article published results from a two-year study of immediate placement for 63 first premolars in patients. Forty-one of the implants that dentists restored were still functional after two years. The long-term survival rate for first premolars requires further studies.

Consult with a Periodontist

If you require tooth removal and a dental implant for your first premolar, we recommend scheduling a consultation with a periodontist (a specialist in teeth, gums, and the jawbone). After an exam and 3-D x-ray, the specialist will explain your treatment options for a dental implant. Each patient’s case is unique.

Dr. David Pumphrey, an Atlanta periodontist, sponsors this post.

My worst nightmare is coming true…I have a loose tooth!

Posted on July 1, 2017 by AllSmiles.

One of my worst nightmares is to dream that one or more of my teeth are loose. I’ve noticed over the past couple of months that my back molar on the bottom left is getting loose. I take pretty good care of my teeth, and my dentists have always said I have good teeth, so I usually go to get cleanings every other year or so. Now I’m afraid to go to the dentist because maybe I’ll need a root canal. Can you help me?

Thanks,
Ray in Florida

Hi there Ray,

There are several reasons your tooth could be loose. You haven’t mentioned whether you are experiencing other symptoms or if you have pain, but your dental routine gives a hint about the possible cause here. It is possible to have “good teeth” as you put it and to take “pretty” good care of them and still experience gum disease.

In fact, one of the most important reasons a dentist recommends a dental hygiene routine that include twice-yearly visits to the dentist is to monitor the health of your teeth and to make sure that gum disease doesn’t go unnoticed and untreated.

There are some situations in which a loose tooth doesn’t point to gum disease. Our teeth are connected to our jawbones with a layer of ligaments, which allow for some movement in the sockets. And if your tooth became loose suddenly or if you experienced an injury, that could also explain the looseness you are experiencing.

More often, though, loose teeth point to gum or periodontal disease. Other symptoms that accompany periodontal disease can include bleeding gums, tender or swollen gums, gums that have pulled away from the teeth, pus between the teeth and gums, persistent bad breath, and changes in the way your teeth fit together. As you can see from the image to the left, periodontal disease breaks down the supporting structures of the tooth.

Whether or not you’ve experienced any of these other symptoms, it’s important to overcome your fear and call a dentist or periodontist at this point. Although you say you fear a root canal, it’s probably more likely that you’ll need non-surgical gum treatment.

Take a look at Pumphrey Periodontal’s Technology page — just scroll down to the bottom to the information on the Perioscope. You mentioned how fearful you are, and the information on this one new piece of technology should help you overcome your fear. The perioscope can help make both diagnosis and treatment much easier than it has ever been before. And please remember that sedation dentistry has come a long way since you were a child.

Best of luck for your continued dental health.

This Blog is brought to you by Dr. David Pumphrey at Pumphrey Periodontics in Atlanta.