Root canal or wait?

[Toothfairy8]

Thank you for your help. Im terrified of dental work and this is all ive been able to think about. I really hope I can avoid a RCT so any advice or example of success is appreciated. Just thinking of the drill is making me shake.
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About a month ago I bit into a VERY hot sandwich which lead to sharp pain in #11. I decided to wait and see — avoiding hot drinks, food and hard items. The tooth was sensitive to tapping at first but that improved, and no pain when biting or upon release, so in my head things were improving.

Two weeks ago a sip of warm tea led to throbbing pain (not sharp) so I called my dentist. He referred me to an endodontist who performed a cold test (I failed). His recommendation is a RC but knowing my teeth have been extremely “hot” in the past to fillings and bonding (for abfractions) I am now trying to decide —

1) do I go for a RCT or wait?
2) If I wait how long do I give it?
3)What is the risk if i wait longer? I don’t want to lose the tooth or damage the tooth since as of now there is no abscess and I wont need a crown.
4) is a cold test at home with ice the best indicator?

A few more details:
- Tooth still not overly sensitive to cold but it feels like it is healing? Maybe that is just wishful thinking.
- I can wear my retainers at night just fine. No pain in the morning.
- no longer hurts to tap
- I can chew on it (but have not been doing so)
- xrays (attached) showed nerve is a bit inflamed compared to other side but no clear damage
- no trauma to the tooth
- no cracks (I had two dentists check)

Other: i had about 3 months of invisalign and very little movement for my teeth (4 trays, slight adjustments). This was done by an orthodontist and very slowly.

I worry that this changed my bite and the new bite is off.

5) If i ask the dentist to adjust my bite would this be the best first step and aee if my tooth heals? He did a bite test last time in the office and said things were fine. The endodontist also said with that short invisalign period this likely wasnt what has lead to the RCT.

 

[Toothfairy8]

Left image: right side (normal)
Right image: left side (tooth third from right is #11)

 

[Gordon]

1) do I go for a RCT or wait?

Wait. Doesn't seem any real indication to proceed

2) If I wait how long do I give it?

Until it gets worse? Hard to answer really, sorry!

3)What is the risk if i wait longer? I don’t want to lose the tooth or damage the tooth since as of now there is no abscess and I wont need a crown.

None really. It's not like there's decay to progress.

4) is a cold test at home with ice the best indicator?

No. Cold test in general is pretty poor. An electronic pulp test (EPT) is better but not 100% reliable.

No 5: I don't see the symptoms pointing towards the bite being off, sorry.

 

[Toothfairy8]

@GordonThank you for your reply!

What would be the “until it gets worse stage”? Constant pain and throbbing without a trigger? One of the biggest worries I have is Im hoping to get pregnant in January (IVF) so I do not want to go through an operation a be medicated when that is the case. Meaning December would likely be the latest to make a decision.

I’m now extremely worried I have a lack of feeling to ice on #9 and another tooth at the bottom. The more I think about it I don't remember the ortho taking x-rays before invisalign, but again the dentist and endo didnt see problems on the xray alone so maybe it was so minor or my teeth being overly sensitive.

 

[Toothfairy8]

@Gordon ive stopped wearing my retainers (in case those were causing me to clench). Anything else I can do to potentially help the problem?

 

[Toothfairy8]

@Gordon is there anything that is 100%? From what Ive read it just seems people wait until there is too much pain to bear. Unless there is an abscess of infection then generally the tooth structure isnt at risk.

 

[Toothfairy8]

Sorry for all of the messages. I have been up all night worrying and thinking about this. I appreciate the answers and education.

 

[Gordon]

What would be the “until it gets worse stage”? Constant pain and throbbing without a trigger?

You're kind of looking for absolute answers in a case where there aren't any, sorry!
Sure, those would be a lot worse and would drive most folks into doing something
Reading your original post, you've had 2 incidents in a few months which haven't lead to anything more severe, is that right? I'd probably not jump into doing RCT at this stage... given the symptoms and other evidence.

One of the biggest worries I have is Im hoping to get pregnant in January (IVF) so I do not want to go through an operation a be medicated when that is the case. Meaning December would likely be the latest to make a decision.

Good luck with that. I hope it goes well for you.

I’m now extremely worried I have a lack of feeling to ice on #9 and another tooth at the bottom. The more I think about it I don't remember the ortho taking x-rays before invisalign, but again the dentist and endo didnt see problems on the xray alone so maybe it was so minor or my teeth being overly sensitive.

Ice tests are pretty inaccurate. I really wouldn't worry about them.

The most accurate tests we have are EPT, but even they aren't 100% reliable.

 

[Toothfairy8]

@Gordon one final question (heading into the city to speak to the endo and make the call).

How long would you give PDL to heal? I looked at an old pair of retainers and I had cracked them under the tooth in question, leading me to believe clenching may be the culprit to this soreness. My understanding is PDL can mimic some symptoms (like sensitivity to heat) but it can also lead to needing a RC.

 

[Gordon]

Depends a bit, how long the trauma lasted, how good the gingival health is, whether the trauma is fully eliminated, could be a few days to a few weeks.