trying to decide if I need a root canal or not. Dentist advice please!

[river]

I don't have dental anxiety but I do definitely have endodontist anxiety. I have recently (2 months ago) had to extract a previously root canaled tooth after a root canal caused nerve pain through my face for a year. Recently my other existing RCT has been causing irritation but no one can see anything on xray so I am not sure what to do about that one. I have no decay or gum issues, every dentist I have seen says my teeth and gums look great. I just have extremely bad dental luck it seems.

On top of all that...

I have a front lateral tooth which very recently became sensitive to heat (sharp pain sometimes but not always with hot foods/drinks.). It also developed a constant dull pain.

I saw my dentist who said it physically looks fine, it's a virgin tooth. He did a CBCT scan and there was no abnormality found other than it and all my front teeth having very short roots. He referred me to an endodontist for another opinion.

The endo took a PA and said it was a tooth with extremely blunted roots from aggressive childhood braces, which I knew. No sign of infection. He said that the root space looks very calcified. He did a cold test with endo ice and I could only barely feel the cold on that tooth. Other teeth responded normally. He flushed a syringe of hot water on it and I got the same sharp pain as I had felt at home sometimes but it went away back to the dull baseline pain. It has absolutely no issues with pressure, chewing or tapping with his instrument. He recommended root canal but...he's an endodontist! I would imagine that is pretty much the default. I would prefer not to pull it as its a front tooth. But I would also prefer not to get a root canal because I have had issues with prior root canals and I simply don't trust the procedure, I feel like it traps anaerobic bacteria in the tubules which can't ever fully be sterilized and eventually all RCTs will become chronically infected. I have had bad luck with my 2 prior root canals over the years. He said its up to me to decide. He did not know why the tooth would start calcifying and cause pulpitis without decay or trauma unless the trauma was from my braces, but those were 25 years ago.

Does this seem like a tooth that could recover? Or if I was willing to live with low grade discomfort, could it stay in my mouth the way it is now? I am trying to decide between having the RCT or leaving it and seeing if it would get better by itself.

Unless I drink or eat hot things, the pain itself is dull and pretty liveable. Heat sometimes but not always causes it to get worse for a short period of time. The endo said that it's not an emergency situation, there is no sign of infection but it's up to me, He was confused why I would not want a root canal to get out of pain, but he said there is no danger in delaying it if I wanted to wait and see what it does on it's own. He diagnosed it as an "irritated nerve."

So my main questions are: Do you think this tooth needs an RCT or could it get over its nerve irritation over time if I wait it out? What are the real dangers (if any) of waiting it out? If I choose to wait, how long should I give myself to see if it gets better? If I do agree to RCT, what are the chances it would be successful with a calcified tooth? My other existing RCT was on a similarly calcified tooth (I don't know why my teeth calcify) and in the middle of the RCT he had to switch to an apicoectomy because he couldn't pass through the canal. I never want to be in that situation again. That was awful.

If anyone could respond soon, I would appreciate it as I would like to make a decision soon. I just need guidance.

 

[gentledental]

Hello, I'm a dentist and based on your symptoms it sounds like you're going to need a root canal if you want the pain to stop. I mean you don't have to have root canal if you don't want to but these are the main risks if you choose to ignore:
1) pain will get worse
2) you may develop an abscess
3) you may get further root resorption, which will make the tooth mobile
4) the canal may further calcify and then when it becomes blocked you have no chance of having root canal treatment in future if problems develop

An endodontist specialises on the root canal system therefore personally I would trust him more on the diagnosis and treatment rather than a general dentist. I mean if you had a tumour in your brain you would rather trust a neurosurgeon than your run-of-the mill general doctor wouldn't you??

Good luck

 

[carole]

Hi to the forum.

Based on what the endodontist said if you are worried about having a rct then I would give it 6 months and see what happens to the tooth.

It is your choice to make and you must feel confident with your decision. Your dentist can always refer you back to see him again.

After saying all that I would go with the advice that he gave you and have the rct in order to prevent further pain and the risk of an infection developing. I have had good and bad experiences through the years but if you can build up a trust with the dentist and the endodontist it might help you feel less anxious about the treatment.

All the best to you, let us know how you get on please

 

[river]

Thank you both for your responses.

My question for the "gentaldental" dentist is: If my tooth is already calcified, how will they be able to do the root canal even at this time? When I read your #4 it made me think---they already pointed out that it was "very" calcified at this point. I don't know how I could ask the endo that question again before the procedure.

I really trust my general dentist. I have a hard time trusting endodontists. This particular one seemed like a very very nice guy. I just have had bad endo experiences before and have had years of pain as a result of poor endodontic treatment or even endodontic treatment where "nothing" looked wrong but yet pain existed. So I am just SO hesitant to get future root canals. If this was a back tooth I would most likely be asking for an extraction. But I am only in my 30s. I do not want to have missing visible front teeth.

I understand the 4 risks you mention. But I still have the question: Would the pain ever get better in any cases like this if I choose to wait? Like, could the nerve un-irritate itself and calm down? Since the irritation is not from decay, and we don't know why it is irritated, could that happen?

 

[gentledental]

Yes the pain will go away eventually. From the sounds of things, the nerve inside the root canal is dying and the nerves that respond to heat are still sensitive. Eventually this will die off as well and then you will have no symptoms.
If the dentist can see the root canal in the radiograph then it is treatable. If they cannot then the root canal might be too calcified to treat. There is no predictable way to say whether it is treatable or not until they start looking for it.
With the correct magnification and lighting, an experienced dentist should be able to find this root canal. A good endodontist should have a telescope and be able to work comfortably with a magnification of x10 or x15. A good craftsman will have the right tools and maybe these are things you should ask to find out.

I have written a little article on root canal treatment and you can possibly ask whether your endodontist has any of those equipment for starters. I'm a general dentist but my equipment in my clinic is close to specialist level.

 

[river]

Thank you. What I am not clear about from your reply is that if the pain goes away from the nerves dying, is this a feasable outcome? How long can a tooth be retained in this fashion vs a root canaled tooth?

I can attach the photo of the tooth here. I just had it emailed to me. I asked the endodontist and he said that he would be able to access the canal because even with the calcification he had a solution that can dissolve it if there were problems but he didn't expect any.

I am still 50/50 on if I should do this or not.

 

[gentledental]

Hi, I think with the amount of root resorption you've had, if you leave it, then I am worried it will become wobbly and eventually you will lose it if you decide to leave it alone. Can you see the tooth in question is much shorter than the rest?

I can see the root canal but it is very deep meaning whoever is treating will need to drill deeper than usual before they will find the root canal. That is why a microscope is needed so they can drill a small entry hole and not weaken the tooth.

 

[river]

Thank you, you have been very helpful. Yes, all my 4 upper front teet have the same short roots, the two laterals are the shortest. I've been told it is the fault of too early and too aggressive braces.

Now...If I do the root canal will it stop the possibility that the tooth will come loose one day? Can that still happen even if it is root canaled or would that arrest the process?

if I do decide to leave it alone if the nerve does off and the pain stops (I think it's going that way--my pain is much less this morning) and not root canal it and just risk that it can become loose one day, is that the only downside? Can a tooth stay in the mouth with a calcified canal and a dead nerve? If do that, should I have frequent PA xrays to check for silent infection?

 

[gentledental]

Hello in medicine, there are no guarantees to anything. All I can say is that having rct will most likely stop the resorption and pain you are experiencing. Doing nothing is waiting for a timebomb.

Good luck

 

[carole]

Hi also I know gentledental has mentioned the fact that it will be prone to getting infected. If you leave it, it will be a matter of time before you get an infection. When it does it will further weaken the tooth and may end up with it having to be extracted.

I would while you are out of pain and it isn't an emergency get it sorted out now. Thus preventing potential problems down the line.

It is your choice to make and must be your choice, but I wouldn't chance leaving it for too long.

 

[Spike 1969]

Hello river

This is exactly the issue that I had earlier in the year, I had a tooth filled by my previous practice that started becoming sensitive, I had already flagged this to my new dentist and we were keeping it under surveillance; eventually it started giving me quite a bit of discomfort so we decided to treat it with an RCT before it could get worse.

The whole thing took 2 appointments, was totally painless and to date has removed the source of the pain.

My advice would be to get it sorted before it can cause any real trouble.

kind Regards