When all goes well, a tooth extraction – simple or surgical – is a routine process with a routine healing time. In most cases, the build-up to the procedure is more stressful than the procedure itself. However, for some patients, not everything goes as planned. Here’s what you need to know about root tip issues: what they are, how to recognize them, and what to do if they happen to you.
What are root tips?
Every tooth has the same basic anatomy. The crown is the part of the tooth that is visible, and the roots reach into the gums and attach to the tooth socket. The root tips are the very end of the root, the part most deeply embedded in the gum.
During extraction, the root tips may accidentally fracture or break, leaving root tips after extraction still embedded in the gum or tooth socket. It’s hard to know exactly how often this occurs. The closest guess is that somewhere between 11 and 37% of people end up with a retained root tip after extraction.
What are common root tip issues?
When they are attached to the tooth, root tips (also referred to as the apex of the tooth) cause no problems whatsoever. In the front of the mouth, most teeth have one root tip, with more per tooth as your move back to the molars. This could be why most of the root tip issues that occur do happen in the molars.
Some common issues include:
- Infection: A root tip that is left behind after root canal may not be clear from the infection that prompted the root canal in the first place. A retained root tip may continue to generate infection that can lead to more serious oral health issues.
- Longer healing times: Retained root tips can lead to longer healing times after root canal. The presence of a root tip also means that the surgical site heals differently, which may or may not impact dental restorations later.
- Surgical removal needed for implant: Some patients decide against a dental implant after root canal, so they don’t worry about a retained root tip. However, if they change their mind down the road, leaving root tips after extraction means surgical removal is necessary before the implant can be placed.
How do I know if I have root tip issues?
Some patients have no idea that they have a retained root tip after extraction. Their extraction site may heal perfectly, and they may go on to receive a dental restoration that does not uncover that small bit of bone left behind.
Other patients may not be so fortunate. The following symptoms may indicate a retained root tip after extraction:
- Pain, redness, and swelling in the extraction site
- Dull, nagging, and frequent jaw pain
- Bitter taste in the mouth
- Foul breath
- Signs of infection, such as slight fever or drainage at the extraction site
- Slow healing
- Swelling on the side of the gums
The root tip may also begin to migrate to the extraction wound. This can be unsettling (to say the least!). You may feel a small piece of bone underneath the stitches. It is rare to see the retained root tip through the gum, but this movement is your body’s way of removing the retained root tip for you.
Because the root tip may have migrated, the only way to diagnose a retained root tip is with an X-ray.
What treatments help with root tip issues?
There are conflicting views on treatment for root tip issues. On one hand, if the retained root tip is causing no problems for the patient, adding an additional oral surgery seems unnecessary, especially if the patient does not elect to have a dental implant.
On the other hand, even if the retained root tip is not causing issues presently, this does not mean that will be the case in the future. And if a dental implant is the dental restoration of choice, the root tip will have to be removed in order to set the implant.
A root tip extraction procedure is similar to a surgical extraction and follows these four steps.
1. Locate the root tip
Using an X-ray, your dentist will confirm where the root tip is located.
2. Prepare the root tip extraction site
The surgical area is numbed, and if you are at all anxious about the procedure, your dentist can also prescribe a mild sedative to help calm you.
They may also use nitrous oxide during the procedure.
3. Extract the root tip
There are two ways to remove a root tip. If the root tip is not in contact with the bone and has migrated towards the surface of the gum, your dentist may be able to make a small incision to locate and remove the root tip.
If your root tip is still connected to the jawbone, the procedure is more complicated. Your dentist will open a flap of gum tissue in the side of the gum (as opposed to straight from the top). This gives them better access to the jawbone.
Using an X-ray to guide them, the dentist will then remove a bit of bone surrounding the root tip to help loosen it from the jawbone. They may use a drill to remove the bone surrounding the root tip before extracting it. Even if you undergo this treatment, your dentist will monitor you closely to manage any pain during the procedure.
4. Close the wound
Your dentist will carefully clean the surgical site and stitch up the wound.
A root tip extraction procedure is sometimes confused with an apicoectomy. An apicoectomy (also called a root-end resection) is different in that it surgically removes the root tip through the gum, also removing inflammation and infection. The root end of the tooth receives a filing to seal the rest of the tooth against infection.
If you are experiencing root tip issues after extraction, as a result of a failed root canal, or for any other reason, AZ Dentist can help. Get in touch today!