Do I Really Need a Root Canal?

[wallies]

I have a large cavity in tooth #20, lower bicuspid. The X-ray doesn't look like it's impacting the root, although it's close. I believe there's a sliver of tooth left there. I have no pain, swelling or sensitivity. I passed the pulp vitality test. The only reason I know it's there is from X-rays.

I'm otherwise in good physical and dental health.

My dentist refuses to drill it.

The endodontist says if I don't get a root canal I'll lose my tooth. She gave me a prescription for antibiotics when I went for the consultation and I nearly laughed. The thing has been in my mouth for YEARS and hasn't changed a bit.

I have TMJ that will be greatly aggravated by this procedure, not to mention my dental fear of needles and anesthetic. They'll need to give me a mandibular nerve block injection. I'm extremely anxious about this. I can't be sedated since I have to drive home.

It's hard for me to go through with this because if something goes wrong I'll feel like I injured my mouth for no reason. There's a chance the tooth may never get any worse. And there's a chance it could "explode" as my dentist says. What to do?

 

[Gordon]

Wait and see would appear to be your only option given the circumstances you describe, or else try a different general dentist.

 

[wallies]

Thanks, I appreciate the response. I just need to write out a few things to clarify my thinking. Feel free to respond or not. At this point, I'm not looking for answers so much as a forum to try to logically think this through. I'm agonizing over this and I need to come to some sort of resolution. I need to either cancel my appointment and wait and see if obvious problems arise or totally convince myself this is the thing to do right now. If you want to check my thinking please do so.

In order to get this root canal, I need to be on board with it fully. I consider this procedure pretty invasive. In order to get through it properly I need to give it my all. I need to believe that this is really necessary and that it will save even more pain, infection and tooth loss down the road. That's the only way I can be fully cooperative with the endodontist, which is vital to making this procedure successful. I can't go into it having doubts the way I do right now. So I must reconcile these doubts within the next two weeks (my appt is Jan 22) or I should cancel.

It's either necessary, or it's not. Period.

The tooth seems 100% healthy to me. There's a large cavity threatening the tooth. This cavity has been there for many years (exact number unknown) and hasn't caused any pain or problems. I wish I could know the chances this cavity will get bigger. I wish I could know for certain that it will stay in "stasis" for the rest of my life. If I could know it wouldn't get bigger, I wouldn't have this done. I'm definitely of the opinion - "If it ain't broke don't fix it." But I can't know for certain. There's NO WAY to predict the future. There's certainly by anyone's measure a great deal of potential for problems there.

I'm 41, I expect to live to about 90. 49 years is a long time for either a) the cavity to stay in stasis b) deal with possible side effects of having this root canal - specifically, persistent pain and/or numbness. I wish I knew the success rates of root canals 50 years later. I do know the success rate of root canals is better when there's no obvious symptoms (as in my case). If I wait until there's symptoms, the overall prognosis is worse.

Each year that goes by won't make it easier to do this if I need to later. My overall health is good right now; that may not be the case in the future. My dental insurance is currently some of the best that is offered, anywhere, and I have access to good doctors. I don't believe I'll have this insurance for very long. Right now, I'm financially in position to do this.

 

[MountainMama]

Not a dentist but I would urge you to get the work done if you have the means to do it. I put off getting a crown done on a tooth with a possible crack, because the tooth wasn’t really hurting and I also have TMJ issues. I ended up losing the tooth. It never did have the typical cracked tooth symptoms until it was too late to save it.
From my understanding, cavities open up the tooth to further damage as the protective enamel is removed in that area. Cavities can be pretty sneaky, too. I had decay under a crown on a molar that never hurt. The decay was discovered when the dentist recommended redoing the crown as it had not been done right previously. She found the decay when she removed the crown. The decay had reached the nerve and I started having a lot of pain and had to get a root canal and then extraction when that didn’t work.

 

[wallies]

Here are my scans of the bottom left premolar. I have no pain or sensitivity. Hard to do this when I'm not experiencing any symptoms.

 

[Gordon]

That looks eminently fill-able. I don't understand your dentist's reluctance to fix it.

 

[wallies]

I would like to get a second opinion, however every dentist wants to take their own X-rays. I've had 2 X-rays and the CBCT scan since November. Do you think that is too much radiation? The American Dental Association suggests that an adult with good oral health and low risk of dental problems should have x-rays taken at intervals of every 24 to 36 months. I hate letting the cavity go for another 2-3 years, but I feel like I also have to weigh the risks of too much radiation exposure.

 

[Gordon]

One small x-ray for that area is going to be a very minimal dose of radiation, but having said that, if you turned up with a fairly recent radiograph like that one, I think it would be bordering on malpractice to take another one...

 

[wallies]

I found a dentist yesterday that said he would drill this tooth and use local anesthetic. Do you know of local anesthetic techniques for tooth #20? I forgot what he called the injection. I thought they always did IANB or mandibular block for this area. If I can get numb using less invasive method I'm all for it.

 

[Gordon]

There are three or four ways to numb the tooth without using a block. Depends what your dentist is comfortable with.

 

[wallies]

I got this cavity fixed yesterday with a new dentist and I'm feeling fine. The numbness wore off and I have no tooth pain or sensitivity. I'm so glad I didn't get an unnecessary root canal. Thanks to Gordon and everyone for your support and advice!

 

[Gordon]

You're welcome, thank you for updating us.