Replace filling or Root Canal

[Grant3791]

Hi all,

First post for me but have been lurking for a while.

10 days ago my lower left 1st molar suddenly started to have some pain / pressure. But only mild. I should add the tooth already has a very large old silver amalgam filling, probably 10 years old.

I have a massive fear of the dentist and suffer from anxiety and panic attacks, to the point I have passed out in dentists twice before. So with the toothache starting I knew I needed to get an appointment as I haven’t been for over 7 years. I have spent the last week losing sleep, not eating very well and just being complete stressed out mess.

I found a dentist I liked the sound of and my first appointment was today and I managed to force myself to do, the dentist was lovely and the appointment went well, much to my relief and am proud of myself for doing so.

Back to my lower left first molar, I didn’t feel an increase in pain from the air, or on a percussion test. I could feel the cold test but it was delayed a few seconds compared to my other teeth. The x-ray showed no infection in the root yet but did show decay under the filling.

I have been given two options of root canal and crown or remove old large filling, remove decay and place new composite filling and see how it goes. My dentist felt it was right on the borderline of reversible / irreversible pulpititis and couldn’t be 100% sure how the nerve would settle with the new filling as it was so close.

I initially wanted iv-sedation for any work done but would have to accept it could be a few week wait and would be £300 an hour as they would have to get someone in to the clinic to administer the sedation. So will greatly add to the cost.

The root canal treatment and crown would have to be over 3 appointments and the endodontist isn’t a huge fan of doing rct on molars under sedation.

The fillings (also need one on the premolar next to it) would be one appointment and I’m wondering if I may be able to push myself to do the two fillings without sedation.

So my main two questions;

Based on what I’ve tried to describe do you think it’s worth going for a filling replacement instead of RCT and crown or is re-filling the tooth likely a lost cause?

Could it really just be the decay under the current filling causing my toothache currently?

Thanks for your help.

Grant

 

[Gordon]

Really sorry but it's not possible to answer your questions. It's really not an exact science when teeth get like this, sometimes they'll settle back down and other times they won't, but unfortunately there is no way to predict which way it'll go

 

[Grant3791]

Hi Gordon, thanks very much for your reply. I guess with that I mind, I don’t have much to lose by trying the filling first. The main toss up would be wether I can push myself to do the two fillings without sedation as the sedation costs more than the fillings. Where as if I was paying for the sedation for rct it would be more justifiable, although a much more expensive procedure.

I was surprised by how well I managed to keep myself calm in the consultation so am now hoping I may be able to push on with the two fillings with just LA. My two biggest fears at this stage are panic attacks in the chair and worrying about managing to keep my jaw open all that time.

My dentist mentioned about possibly putting something on the nerve when doing the filling to try and calm it down but not sure what that would be?

Nothing in life is ever cut and dry!

 

[Gordon]

It's worth a shot. Remember to agree beforehand with your dentist on stop signals and ask if you can get a break every now and again. A "prop" can be helpful to make it easier to keep your mouth open, basically just a rubber wedge that you can bite against to support the jaw.
The stuff would be a sedative dressing, not normally placed right on the nerve but just above it. It can be helpful.