Will deep cavity in wisdom tooth cause pain if I don’t get it extracted immediately?

[Class325Guy]

Hello, I have a wisdom tooth with a large cavity that needs to be extracted. I am currently working with a dentist who will be able to perform the procedure once they get authorization from the insurance. Most likely, the appt will be in exactly one month to have it removed, as that is the next time the surgeon will be in. In the meantime, I am worried about the tooth getting worse before then and being in pain. From what the dentists said, the cavity is already at the nerve, but for the most part it isn't too bad expect little twinges of mild/moderate pain or soreness and sensitivity here and there throughout the day. I called the dentist again today to check that they got my X-rays from the previous dentist so they could proceed with scheduling the surgery. While I was on the phone, though, I was able to speak to the dentist, and he said that I shouldn't be concerned about it getting worse before the appt but I just want to be sure. So do you think I can take the dentist's word on this, or are they just trying to make me feel better? I figure since it's already at the nerve and I am not in severe constant pain, it won't get any worse, but I want to be sure and someone else said that even though the cavity is already at the nerve and you're not in pain doesn't mean you won't be in the future if the nerve starts to die.

So when it comes to assessing a cavity that has already reached the nerve, how would you be able to determine whether a patient would likely be in severe constant pain before you had a chance to do the procedure?

Thanks

 

[Gordon]

There's absolutely no way to know for certain what is going to happen regarding future pain from this tooth.

Given that your dentist has had the chance to examine you and seen the situation for themselves, then their opinion that it's likely to be OK is the best you're going to get

 

[Class325Guy]

@Gordon Hi Gordon, thanks for the reply. I understand that you cannot make a specific diagnosis without seeing things for yourself. I was just wondering if it's actually possible for the dentist to tell whether the tooth will likely be ok for another month without pain when it's already reached the nerve when looking at x-rays and examining things for yourself. Like, is there specific things you can see on the X-rays or when examining it visually to determine this?

Thanks

 

[Gordon]

The best clue is (somewhat ironically) the size of the cavity. If it's a small hole into the nerve chamber, then there's a bigger chance that it'll get blocked up with food debris (rice is really good for this!) and then, instead of draining out into the mouth, you get a build up of pressure inside the tooth which is where the pain mostly comes from.

What you can't really tell is the chances of the pulp debris getting colonised by a particularly aggressive and fast growing bacteria, which would cause a rapid change for the worse.

 

[Class325Guy]

@Gordon, hello again, thanks for the help. From what I understand, the cavity is big and not just a small hole. In this case, the most likely cause for the pain to get worse would be an infection in the tooth; is that correct?

 

[Gordon]

Not really. The pulp (nerve) in the tooth is dead, due to toxins from the bacteria in the cavity. It's already infected if it's open to the oral cavity. Bacteria from the dead pulp are able to exit through the apex of the canals and into the small space around the tip of the tooth. Your body is throwing white blood cells and antibodies into the area to keep them in check.

However, it's not painful because
1: The nerve is already dead in the tooth
2: The dead bacteria, excess white cells and assorted debris is able to drain out through the cavity fairly easily so the pressure in the tiny space round the root tip isn't too bad.

It'll get painful if the bacteria are faster growing or harder to kill (not likely) than what's in there already, or if the cavity gets bunged up and the debris can't escape.

It's pressure in the area of the root tip that causes most pain, hence why biting on an abscessed tooth hurts and hot things make it worse.