Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

March 8, 2017

Delayed pain after a root canal treatment


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Dr. Hall,
I think your response to Patty from Kansas about increased post-root canal pain a few days following the procedure was somewhat misleading. It’s my understanding (and several resources suggest) that it is not uncommon to experience peak inflammation/pain 48-72 following a root canal, yet you advised: ‘The tooth being fine right after the second time doing the root canal but then the pain coming back a few days later, that is a particularly bad sign. This isn’t ordinary post-operative pain but a failed root canal.’
– Nan Anne from Chicago

Nan Anne,
I didn’t write what I wrote from reading research about it, but from actual extensive clinical experience and an understanding of the physiology involved. And I’m not sure that your reading is disagreeing with me. You didn’t say who these “several resources” were, but you did say they are suggesting that peak inflammation occurs 48-72 hours following the root canal. I think that may be true, if the pain is not treated by reducing the occlusion. The tooth hurts right after the novocain wears off but then, untreated, it feels worse the second day, maybe a little worse the third day, and then starts getting better. So the pain has peaked on the third day. That sounds about right. When there is postoperative pain after a root canal treatment that comes from simple inflammation, it will hurt right away and then get worse, and then get better.

But that is different from what Patty from Kansas reported to me. She said her tooth felt fine for 2-3 days after the procedure and then started to hurt again after that. That’s a typical pattern for post-operative infection. And then, to add further weight to this being an infection, she indicated that the pain continued after that and the root area is still tender.

Prodded by your comment, I did revise the blog post to make it more clear that when I said she had a failed root canal, I was talking about her particular case, and I don’t mean to imply that whenever a root canal tooth begins hurting a few days later it is a failed root canal. This was her second time around, so the root canal had already failed once. I’m confident that her renewed pain was not just a simple inflammatory reaction to the instrumentation of her tooth.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 20, 2017

Tooth with a crown is sensitive to heat


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Dr. Hall,
I have several crowns, some on natural teeth some on implants. I have two crowns next to each other on top and front. The crowns are maybe 20 or 25 years old. 1 week ago I saw my dentist for a cleaning and today I woke with constant strong pain but much worse when sipping coffee warmer than room temperature. My dentist isn’t in for a few days and the pain seems to be growing to include the crown on the tooth next to it. Any ideas?
– Randy from Illinois

Randy,
I’m sorry to have to be the one to give you the bad news, but the pulp of your tooth is dying and it is going to need a root canal.

You have two of the classic symptoms of a dying tooth. Teeth can be sensitive to a number of things, and that sensitivity can sometimes come and go and may not indicate a dying tooth. But if you have strong pain that isn’t provoked, that’s an indication of a dying tooth. Adding to it, your pain is aggravated by heat–a doubly bad sign.

What happens is that an infected pulp will draw in body defenses including white blood cells. The tissue wants to swell, but being in a confined space, it chokes itself and then dies. As it dies, it can sometimes give off gasses. Any warming up of the tooth increases the pressure of those gasses and increases the pain. Cold will cause the gasses to contract and will generally provide relief in this situation.

So what do you do when you have a crown on the tooth that needs a root canal? It isn’t difficult to make an opening in the crown and do the treatment through the crown. However, if I were your dentist, I would want to remove that crown and find out what is going on under it. I would also want to replace the 20-year-old crown on the adjacent tooth, because something similar may be happening to that tooth.

Why is this happening? There are several possibilities. One is that decay has gotten in under the crown. This can happen through a leaky margin that your dentist didn’t catch or maybe did see but didn’t attach enough significance to it. Another could be that the tooth has become irritated through exposed root surface.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 12, 2016

Root canal re-treatment isn’t working


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Dr. Hall,
I had a root canal re-treatment on my front tooth 3 weeks ago, by an endodontist specialist. I had the tooth checked just over a week ago and although I was still having pain around the tooth, he said that there was no swelling and it would all settle down. However, it is still very sore and sometimes the gum throbs, particularly if I am active, which surely tells me there is inflammation still. I am unable to take ibuprofen or aspirin and take paracetamol when needed.

I had gum swelling around the tooth before the root canal re-treatment, which was treated by erythromycin and this was finished about a week before the treatment was completed.

My question is what should I do next? It does not seem to be settling and I am worried if the bone around the tooth is infected and if it could spread. Should I wait more time to see if settles or see if the dentist will prescribe more antibiotics?
– Diane from Ashfield, UK

.

Diane,

It doesn’t look good for your front tooth. Your instincts are correct – after three weeks it should be feeling better. Am I correct in assuming there is no improvement in the tooth? Residual tenderness in a tooth after any root canal work isn’t that unusual, but there should at least be some gradual improvement which you should be able to notice after three weeks.

I would not do any more antibiotics. Antibiotics won’t get at the source of the infection in a tooth – they only assist your body in fighting off the infection. Yes, the tooth would feel better for a while but then when you quit taking the antibiotics, since you haven’t eliminated the source, the pain will come back and now you will have an antibiotic-resistant infection.

There is no significant risk of the infection spreading at this point. You aren’t having an increase in pain, from what you are saying, and there isn’t any serious swelling.

Something is still wrong with the tooth that wasn’t fixed with the root canal re-treatment. Re-treatments don’t always work and it appears that yours isn’t. After initial root canal failure, which you experienced, the chances for success for re-treatment are somewhere in the range of 50-80%, depending on the nature of the problem that led to the failure.

The way antibiotics were used in your case seems strange to me. You said you had erythromycin before the treatment, and this was finished a week before doing the re-treatment. That would just give the infection a chance to come back before starting the re-treatment. If antibiotics were needed, I would have started them, done the re-treatment after they had taken effect, and then continued the antibiotics for a couple of days afterward. I just mention that because it’s strange – that’s not why your tooth isn’t getting any better.

Your options at this point are limited. You could have root canal surgery, but I’m skeptical about the chances for success of that treatment in your case, since, based on what you’re telling me, your endodontist isn’t inspiring me with a lot of confidence. You could maybe try that if you get outside your UK National Health Service. Your other option would be to have the tooth extracted and then replaced with whatever options they give you in the UK.

Dr. Hall

Question and answer go here.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 29, 2016

Removing a metal post in a tooth


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Dr. Hall,
I just found out my dentist inserted a stainless steel post into my root canal tooth–my upper molar. A temporary crown is placed over it now and a permanent crown will be placed in a week. My question is can the post be removed and a zirconia or carbon post (I don’t think he does those) be put in instead? I don’t want steel in my mouth even though he said it’s encased. My ears have been pulsating since. Please tell me it’s removable!
– Linda from Brooklyn

Linda,
Yes, a stainless steel post probably can be removed, though there may be some risk involved.

Let me give a little background on this to frame my answer.

stainless steel dental post

A metal post in a lower molar

When a tooth is “bombed out,” needing a root canal treatment and with little tooth structure left, a dental post is often placed in the tooth. This post can serve a couple of purposes. For front teeth and premolars, it can strengthen the tooth against horizontal fracture. For molars and any other teeth, it can also provide additional retention for the crown. If there is little of the original natural crown of the tooth left, the post, anchored in the root of the tooth, will help retain a buildup in the tooth, and the buildup retains the crown.

There is a history to the material out of which the post is made. In the 1970s and earlier, stainless steel was the material of choice for prefabricated dental posts. However, in the 1980s it was discovered that even though a post is cemented inside the tooth and doesn’t come into contact with the bloodstream at all, metal ions were found to leach through the tooth and into the bloodstream. Stainless steel contains nickel, which causes sensitivity reactions in many people (see some of our blog posts on metal allergies). To guard against potential reactions as you seem to be experiencing, many dental practices, including mine, switched to titanium, which is not only very strong but the most biocompatible metal available. In the 1990s, other materials were introduced for posts, including carbon fiber and fiberglass. More recently, zirconia has been used for posts. Zirconia is a ceramic that has high flexural strength and is also very biocompatible.

So yes, you have a legitimate concern about this stainless steel post. Your dentist should get with current technology. From what you are telling me, he isn’t into any of these newer post materials, most of which have been around for twenty years or more.

Now, as to removing the post that is in there, that could be tricky and, depending on the situation, you may not want to trust your dentist to do this but may want to see a root canal specialist or another dentist who feels comfortable doing this. It depends on how deeply the post goes into the root of your tooth and how well it is cemented. It may be possible to dislodge it with an ultrasonic tip. I remember one patient I had who was adamant about removing several metal posts in his teeth. I don’t remember why his posts were so difficult to remove, but I ended up telling him that I had to drill out all of these posts and I had him sign a paper acknowledging that I had told him there were serious risks in doing this, that I could perforate the roots of any or all of these teeth, leading to the loss of the teeth. He was willing to accept those risks. The good news is that I got out all of the posts without any accidents, but I remember it was very stressful for me.

If you feel that you are experiencing a sensitivity reaction to the post, I would put a halt to the crown procedure until you can have the post removed. Cementing a crown on the tooth will only make it more difficult, as your dentist would have to start by drilling through the crown, possibly ruining the crown.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 30, 2016

My tooth was fine until my dentist worked on it


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Dr. Hall,
I went to my dentist recently and he filled a front tooth. While in the chair he stated that he saw a small crack on the rear molar on the left side, and he said it needed to be repaired. He drilled the tooth out, banded it, and filled it with composite. I called him the next day because the tooth was extremely painful. Two days after he did the procedure I was back in his office, and after a cold test he said that I needed a crown and a root canal. I had him pull the tooth. Should I pay him for the extraction when there was no issue with the tooth, before he removed half of it, other than a small crack?
– Mark from Georgia

Mark,

Nothing you told me indicates to me that your dentist did anything wrong. Yes, it’s possible, because I don’t know the whole story. But I’ve seen this sort of thing many times, and it sounds to me like your dentist did the right thing.

When you say that there was nothing wrong with this molar but a small crack, that’s not the complete story. A crack is almost always a symptom of a major underlying problem with the tooth. A tooth that is otherwise healthy will not have a small crack in it. From subsequent events, it seems clear to me that this tooth was already infected. Yes, working on it irritated it a little more and placing a well-sealed filling over the infected pulp of the tooth caused an immediate painful reaction. Had your tooth been healthy before your dentist worked on it and had merely had some accident during the procedure, your tooth would have started to get diseased and it would have taken some time for it to flare up. The fact that it was immediately painful indicates that this disease process was probably already pretty advanced.

The reason your dentist was concerned when he saw this “small crack” was that the tooth probably had a large filling in it. You didn’t say what type of filling, but almost all teeth with cracks have large fillings in them, usually amalgam fillings. The crack would probably indicate that there is some leakage around the filling, meaning that decay will be able to leak through and get under the filling.

Not being able to see the x-ray, and not having looked over the shoulder of your dentist while he was working on your tooth, I can’t say with certainty what happened, but let me tell you what probably happened, based on my experience with many of these situations. Your dentist removed the old, leaky filling, likely with some decay underneath it. The dentin that was left between the bottom of your cavity and the pulp of the tooth was thin but intact. However, dentin is porous, and because of how the tooth reacted it appears to be clear that bacteria from the decay had been able to penetrate that porous dentin to infect the pulp of the tooth, causing it to be slightly inflamed. Working on the tooth irritated it somewhat, as it always does. Your dentist then replaced the old leaky filling with a new composite resin filling, bonded to the tooth and tightly sealed. The well-sealed filling now caused the internal pressure of the inflamed pulp to increase, which is what caused your immediate painful reaction.

I’m sorry for your sake that you had the tooth pulled when it could have been saved, but that is water under the bridge now. If it was the tooth furthest back in your arch, that shouldn’t have a serious impact on your bite, but you might eventually end up also losing the opposing tooth because it now may have no tooth to chew against and will hyper-erupt.

My recommendation to you would be to have your dentist look at your entire mouth and all your old dental work with a new set of eyes, and replace any old, suspicious fillings with new, well-sealed composite fillings, to help prevent this from happening again.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 20, 2016

The use of steroids to treat root canal pain


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Dr. Hall,
I had a root canal in May in a front tooth and serious pain following it, I was treated with antibiotics and steroids. This did not help so the dentist redid the root canal. I felt OK for 2-3 days then the pain came back. I feel a lot of pressure on this front tooth and the gum is inflamed and the root area is tender.
– Patty from Kansas

Patty,
There are some experts in root canal treatment who recently have been advocating treating postoperative root canal pain with steroids, but I disagree with that. Yes, if there is simple inflammation, steroids are an effective treatment. But the problem is that you have some dentists who don’t understand pharmacology well enough or aren’t good enough at diagnosis, and you have the treatment being misapplied, as I believe it was in your case.

Steroids block inflammation. That’s why some of these dental school professors recommend it for post-operative pain. There is irritation of the tissue around the end of the root of the tooth because the instruments used to clean out the teeth irritated it. When that happens, that tissue tends to swell, raising the tooth and causing traumatic occlusion, which only irritates that tissue more. It’s a nasty vicious cycle and Decadron, a steroid, is an effective treatment.

But the problem is that steroids also block the body’s response to infection. So when you have a post-operative infection, as you apparently did, steroids do more harm than good. And then the dentists feel that, to cover the possibility that there is infection involved, they need to prescribe antibiotics. This leads to an overuse of antibiotics and contributes to the serious public health problem of cultivating antibiotic-resistant bacteria in the population.

What I did for post-operative root canal pain in my practice, that was very effective, was that I would give a strong dose of ibuprofen at the beginning of the root canal appointment, so that it was fully absorbed by the time I was done with the appointment. This would help head off that inflammatory response. (Ibuprofen is a non-steroidal anti-inflammatory drug.) Then I would reduce the occlusion of the root canal tooth so that it didn’t touch the opposing tooth when the patient clenched together. Since the tooth would later need a crown anyway, it wouldn’t hurt to reduce it a little. That pretty much took care of any post-operative pain.

So what do you do now? The tooth being fine right after the second time doing the root canal but then the pain coming back a few days later, that is a particularly bad sign. This isn’t ordinary post-operative pain but in your case appears to be a failed root canal. In your case, this would be the second failure on this tooth. It seems that the infection here has never completely gone away, and thus the tenderness around the root comes from that persistent infection. If this wasn’t done by a root canal specialist, I would ask for referral to a specialist. The specialist may feel that he or she could solve the problem by re-doing the treatment one more time. Or, root canal surgery is fairly simple on an upper front tooth, if that’s what tooth we’re talking about. That may be required. Or you could end up losing the tooth.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 10, 2016

Is this a salivary gland stone or a toothache?


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Dr. Hall,
I had a mercury filling replaced in my bottom back tooth closest to the ear. Now pain develops and radiates into my ear. Before the filling I was experiencing the same discomfort with some earache. My ear is good. The doctor suggested I have a salivary gland stone. I tend to believe it’s a dental problem.
– Bruce from Nova Scotia

Bruce,
A salivary gland stone? That seems like a stretch for your situation.
You can get calicifications in your salivary gland ducts, but the pain would not radiate to your ear. It would be in the soft tissue, in one of your salivary gland ducts, if you had pain. A couple of those ducts are under the tongue, and one is in the middle of each cheek. A salivary gland stone will cause swelling in that duct when you eat and maybe pain, and it would show up on an x-ray.
No, pain radiating to your ear sounds very much like a toothache. And if you have had a recent filling in a lower molar on that side, that would be the first tooth to check.
I would get a second opinion.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 11, 2016

I have an awful toothache, and my dentist is trying to tell me the tooth is fine!


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Dr. Hall,
Over a month ago, I had a toothache and ended up needing a root canal treatment on a lower molar. After that was done, the tooth felt somewhat better, but has never completely settled down. Now this last weekend the pain really flared up. It actually felt like it was the tooth next to this one. It started hurting so bad it scared me. So I went back to the endodontist who did the root canal. He took x-rays of all the bottom teeth on that side. He says that nothing is wrong and I could have all the teeth on that side pulled, including the new root canal and the pain would still be there. He told me to go to a neurologist.
Do you have any advice?
– Kendra from Oklahoma

Dear Kendra,
It’s tough for me to tell what is going on without a personal examination. But I think I can be helpful.

I can tell you that it isn’t uncommon at all for pain to feel like it is coming from a tooth and that tooth is fine. There are several possibilities for pain like this:

  • One is referred pain. I have seen where an upper tooth is infected and the pain feels like it is coming from a lower tooth. Or the pain can feel like it is coming from a tooth next to it. You don’t see referred pain crossing from one side of your mouth to the other, but you do see it from upper to lower, and you do see it from teeth that are in the same quadrant.
  • A second is some type of neuralgia. Yes, this happens, and it isn’t all that rare—a nerve problem that feels like a toothache. So yes, it is possible that your endodontist is right.
  • A third possibility is some other type of pain. A sinus infection, for example, can feel like a toothache. The maxillary sinus often is very close to the roots of upper teeth and infection there can press on those roots and feel for all the world like a toothache. Or that pain could be referred and feel like it is a lower tooth. Other health problems can feel like toothaches sometimes.

I can also tell you that it is possible, from a careful reading of x-rays, to determine that a tooth and its root are healthy. If a root canal isn’t healing properly, there will be x-ray evidence of that.

So I don’t know how to tell, from here, what the problem is. My advice would be to listen to the endodontist.

However, I would allow for the possibility that this endodontist isn’t very sensitive to patients or a good listener. You get some of that in the dental profession. If you have the feeling that he doesn’t really care that much and is trying to get rid of you, it might be smart to get a second opinion, just to be sure you’re getting correct information. Find another endodontist. If there isn’t one in your town, so much the better. It would be worth a drive to go get a good second opinion. But in getting that second opinion, make sure it is a blind second opinion. DO NOT tell the second endodontist the whole story, and especially don’t give the name of the endodontist who treated you or even give any clue that you went to an endodontist. Don’t say anything about the diagnosis you’ve been told. Just say that you had this root canal a month ago and now you have pain flaring up and ask if he or she can figure out where it is coming from. If they press you for more of the story, just be frank with them—tell them you want a blind second opinion and you’re not going to say anything more. They’ve got eyes and training—they don’t need anything more than the basics of the story, their eyes, and x-rays, to come to a diagnosis. You don’t want to complicate the second opinion by having this new endodontist call your old one. They probably know each other and there will be a strong inclination of the one to want to protect the other.

I hope this is helpful.
Dr. Hall

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Read more here about failed root canal treatments.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 12, 2016

The tooth extraction site is sensitive to warm food

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.

Dr. Hall,
I had an oral surgeon remove a wisdom tooth. About 2 weeks later I shoveled snow in 20 degree temps for about 3 hours. The tooth site felt a bit achey. Now, a week later the site still seems achey and now seems very sensitive to warm-hot food. The extraction site appears very healthy. Is there anything I might need to attend to or check? Thank you so much for your time and attention.
– Tia from Michigan

Tia,
It’s normal for an extraction site to start to ache after physical exertion, if you’ve had a recent extraction, especially for a wisdom tooth. However, the sensitivity to heat is a different matter.

I get these reports of an tooth extraction site being sensitive to cold or air after an extraction and almost always it’s the adjacent tooth, and I suspect that’s what is happening in your case. Sometimes extractions will cause the root of an adjacent tooth to become exposed and that tooth with the exposed root will become sensitive. Sensitivity to cold wouldn’t be much concern especially if it’s mild, but sensitivity to heat could potentially be a serious problem in that tooth. I’d have it checked.

When a tooth becomes irritated, it will often become sensitive to cold. If that irritation persists without getting resolved, the tooth can become sensitive to heat. That happens when the pulp tissue inside the tooth begins to die. In the process of dying, it gives off gasses. Heat causes those gasses to want to expand, but since they’re confined inside the tooth, there is no where to expand and that causes pain.
– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 11, 2013

How to tell from the x-ray if a tooth needs a root canal treatment

Kathryn from New Jersey asked me if she could wait to have a root canal treatment. She had a tooth that was recently filled, then went to a new dentist who said that there was something on the x-ray that looked like decay under the filling, therefore she needed a root canal treatment. See the earlier post: “There are a lot of things that can look like decay on an x-ray.”

Here is the x-ray she sent, with the tooth in question marked:

does this tooth need a root canal treatment?
And here are my comments:

Kathryn,
Maybe there needs to be more training in dental school on radiographic diagnosis. This is by no means a case calling for plunging in and doing a root canal treatment.

Yes, I see the dark area under the filling, but I see three characteristics of this dark area that they are not telling you about:
1) While tooth decay will show up as a dark area, not all dark areas are decay. This could be a radiolucent base material under the filling, a gap in the filling, or decay – three different possibilities.
2) The dark area is on the surface of the tooth. If it is decay, the dentist should be able to poke that area with an explorer and it will be soft. You gave me no indication that they did this because you said, “There is what looks like some decay under the filling on x-rays.”
3) The dark area does not go anywhere near the pulp. Now there is an optical illusion that creates the impression that the dark area is directly under the filling and between the filling and the pulp. The way to deal with that is to cover up the filling, which is white, with your finger. Now look at the remaining tooth structure. When you do that, you can see the clearly defined margins of the dark area (decay would have fuzzy edges) and that they stop well short of the pulp. There are a good 2 to 3 millimeters of solid tooth structure between this radiolucent area and the pulp.

Now I can’t give a definitive diagnosis here without actually seeing your tooth and finding out more about what went on, but I can tell you that if they are just relying on the x-ray, there is no justification for doing a root canal treatment. There is no indication of inflammation near the root tip, which is the first indication of an infected tooth. And you are saying that the tooth feels fine.

Finally, there is some clear evidence on the x-ray that the root of the tooth is healthy.

If you look at a clearly healthy tooth – for example, the canine tooth next to this one. There is a thin white line that goes all the way around the root of the tooth. This is called the lamina dura. When a tooth gets infected, one of two things happens to this white line. It either becomes broken in the area around the root tip, or it pulls away from the tooth. When I look at the lamina dura of your lateral incisor, I can follow it all the way around the root tip. Because of the angle, the lamina dura appears more fuzzy than it does on the canine, but it is nonetheless there and intact. THAT is the key to the diagnosis of this tooth. The root is healthy.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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