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Lower Right First Molar - Trying to Avoid Extraction



Junior member
Aug 2, 2017
Short story:
My lower right molar is scheduled for extraction in a month's time. I'm not convinced this is the best / only option and I'm terrified of losing the tooth unnecessarily. I'm looking for support (please)!

Long story:
About six months ago, my lower right first molar top a whack from a cold Curly Wurly chocolate bar. Tooth “LR6” I believe.

I knew it wasn’t good news as that whole side of my jaw was painful, and the tooth super sensitive to cold over the weekend. I went to the dentist on Monday who checked it out and took an Xray but couldn’t find much amiss. By now, the pain had pretty much gone, except when I pushed the tooth from the inside. She prescribed some fluouride toothpaste for two weeks!

It gradually got even better until, a week or so later, one quarter of the crown’s cusp came off. It has obviously been cracked since the original incident. I returned to the dentist who – to my surprise – was pretty non-plussed and proceeded to fill in the missing cusp with glass ionomer cement. This lasted for a week until a little bit chipped off, but I returned and she fixed it again.

The tooth itself has been fine since but, after a few weeks, the outside lower gum area around that tooth started to feel a little swollen and tender. After a couple more weeks I returned to the dentist (someone different this time) who took an Xray, said there might be some infection, and prescribed antibiotics. These didn’t make any real difference, but things did not get any worse. That was in early September.

At the beginning of November, the swelling seemed to disappear, but I also noticed a gum boil below the tooth. I believe these are technically called “sinus tracts” or “fistulas”. I was sure that whatever was causing the swelling had broken free through the fistula. Still no pain at all though – and everything felt fine. The tooth had been a little loose but now felt tight again. I returned to the dentist again (someone different once again) who took another Xray, noted some “periapical radioluceny” around one root and suggested I bring my next check up forward to see how things moved forwards.

I returned for this check up two weeks ago, he Xrayed the tooth once more and noted no change. He did a cold sensitivity test and said the tooth was "non vital". He noted that one of the tooth's root looked different (I think it is slightly "calcified").

I was offered four options:

1. Do nothing
2. A referral me for endodontic treatment on the NHS (as I’m registered as an NHS patient)
3. A referral for private endodontic treatment
4. A referral for extraction.

Options 2 and 3 were caveated with the phrases "If you're determined to try and save the tooth" and "I can't be sure that a root canal will resolve the problem. He also said he was certain the NHS referral would be refused, as the tooth in question is a back molar. I have since found the local referral guidelines and his point does look reasonable.

In the heat of the moment and, because I was fed up with going to the dentist, I opted for the extraction. This is currently scheduled for 16 January.

After reflecting on this for a few days, it’s fair to say I’ve been having second thoughts. I'm terrified of losing the tooth. I realise that someone is clearly wrong and it needs some form of treatment, but I’d much rather at least try and save it than be faced with losing my first tooth (and a big molar at that).

Feeling very anxious, I called the dentist early last week and described the situation. I said that it wasn’t a money thing, and asked for the referral for private endodontic treatment. They called back and repeated the line that "he's not sure endodontics will save the tooth" abut said they would send my notes to the endodontist for a view before booking me in. That was a week ago. I called today and asked if there was any progress but they said they hadn't had a response yet.

This is all a bit frustrating now and I obviously wish I'd said I wanted to try and save the tooth at my last appointment. I’m in no pain whatsoever, never feel any bitter taste or anything like that and, if I didn't know the fistula thing was there with a little bit of fluid / pus squeezing out occasionally, I'd be none the wiser. If I don't get any joy with my dentist and a referral this week I'm minded to try and get a second opinion elsewhere at the beginning of Jan, before the extraction on 16th. I really want to at least try and save this bad boy from being pulled.

I'd welcome and thoughts, comments, ideas and encouragement. Thank you.
The treatment options for a non-vital tooth is usually a root canal or an extraction.

That said, there are instances where a root canal may not work. These are usually because of fractures, and not enough good tooth structure left before and or after the root canal treatment. The prognosis for such teeth is not good.

Perhaps you could cancel or postpone the appointment for the extraction until you have gotten the endodontist's opinion.
Thank you assertives - that's really helpful. I definitely want to explore the root canal option before going ahead with the extraction, my challenge is getting the dentist to actually refer me (or at least say why they won't / can't). I think, if necessary, I'll go elsewhere at the beginning of January for a second opinion. The extraction isn't until 16th Jan. Thank you again.
I would go for root canal first and then if that didn’t work, consider the extraction.
Thank you for the encouragement Jennteeth. That's exactly what I'm hoping for. I found out yesterday that the specialist endodontics is away until the new year, so I'm hoping for good news from him then.
Hello. I thought I'd post an update, just in case anyone reads this post in the future ...

I saw the specialist endodontist last week and he was non-plussed with the tooth, characterising it as a definite candidate for root canal treatment followed by a crown. He said the infection below the root of one of the tips reduced the success rate predication to around 80%, but RCT is the right thing (I supposed he *would* say that of course!). But I was immediately reassured by him, his competence and his approach. I cancelled the extraction I had booked and have the RCT scheduled for the beginning of Feb.

I'll update again afterwards. Best wishes to you all.
Good luck! I hope it works and speedy recovery to you.
I just thought I'd update this for anyone interested now or in the future ...

I have the root canal treatment done with the endodontist on Saturday 10 February. Not painful at all, other than a couple of little pricking sensations when he chiselled a teeny tad to far in one of the canals. I wasn't really expecting it to be bad or painful, but it was actually rather interesting. The oddest bits were the terrible stink that came from the infected tooth and the smell of bleach afterwards.

He told me to expect some swelling and pain afterwards but there was hardly anything. I took ibuprofen for the next day and then stopped. The top of the temporary filling cracked a little on the Sunday so I went back to my regular dentist on Monday who checked it out and shaved it down a little. Since then I've had a medicinal taste in my mouth a few times (The endodontist told me to expect this - either from the filling or the root sealer being absorbed I think?. This sinus / fistula on my gum has stopped oozing pus and appears to have healed over, which feels great. I've had a couple of momentary sensations where the tooth has felt different, but no pain at all.

All quite encouraging. I'm back to the dentist on Monday afternoon next for a review. Fingers crossed!
Hmm... perhaps I spoke to soon. Yesterday, the gum down below the root canalled tooth feels a little swollen and sore, as if there is something hard beneath the fleshy wobbly gum. The endodontist did say I should expect some swelling after the treatment, but I assumed that would be straight away rather than two weeks later. There's no pus and previous fistula hasn't opened up again (yet!)

I have a review on Monday with the dentist. Any thoughts on whether this swelling should be expected? I'm starting to think I need to prepare myself for the worst :(
Again, just for anyone who reads now or in the future ... by Monday the soreness had almost completely gone and I felt a lot more positive. My dentist had read all the notes from the endodontist who did the root canal. He checked my tooth and gum and said healing was well underway, and it's fine to start organising the crown. I was rather surprised! I'm booked in for the prep on Friday 09 March. The only pain is, once again, in my wallet.
... and just to update (5+ years later!), the crown went in without incident and has been problem free (and very nice) ever since. If I needed to in future for any other tooth, and it was possible, I'd definitely go for root canal treatment then a crown rather than extraction.

Is an update after 5+ years a forum record I wonder!!!???
It may well be!! Thanks so much for the update, great to hear that everything worked out well!