Dr. Hall,
My 18-year-old daughter had her lower permanent retainer taken off 3 weeks ago. She had been wearing it for almost 3 years after having braces for 18 months. During the removal, tooth #25 was injured and it is now receded and slightly grey. It is painful for her to bite anything with it and hurts when she wears her removable retainer when water gets under the retainer. Her dentist took an x-ray—which looks fine to me, but based on doing a cold test he thinks her tooth is dead or dying and recommends a root canal. The endodontist he recommended does not use the GentleWave technology. She is leaving for college in 2 weeks and wants to follow the dentist’s recommendation but I am hoping the tooth is just bruised and inflammed and can recover. Would you wait on doing a root canal or is there an alternative to heal the tooth?
Thank you!
Caprice from South Carolina
I found your website searching for tooth root x-ray.
(See Dr. Hall’s answer below.)
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Caprice,
I have a direct answer to your question first, but then I have a couple other concerns that I’ll get to.
First, for the direct answer: no, if a tooth is dying or dead there is no other way to heal it other than a root canal. The problem is that since the inside of the tooth is a very confined area with no space for the living tissue to swell or to bring in antibodies to fight an infection, once it becomes diseased the only solution is to remove that tissue, which is what a root canal treatment is.
But I have a couple of other concerns about your daughter’s case, and an additional point.
My first other concern: I’m really curious about how this tooth was injured in the process of removing the retainer. I’m guessing that this must have been a fixed retainer that was bonded to the teeth but still, removing it should be a fairly routine procedure. Your dentist, of course, would be liable for the damage to the tooth and should be paying for the root canal treatment.
Next, I’m concerned about the diagnostic skills displayed here. You are saying the dentist thinks the tooth needs a root canal. If you’re meaning that the dentist is unsure of the diagnosis, that leaves me wondering. The tooth suffered some trauma after which it has begun right away to turn gray and is sensitive to biting and sensitive to cold. That’s enough right there for a definitive diagnosis of a dying tooth. And then the x-ray will show definite signs of a diseased pulp, if the dentist has sufficient diagnostic skills to properly read the x-ray. So I’m hoping you’re just using soft language and not telling me that the dentist is hedging on this diagnosis. If your dentist is unsure, I’d get a second opinion, maybe from an endodontist.
I’m not getting strong feelings of competence about this dentist of your daughter’s. I’m hoping there is more to the story here to explain these possible lapses.
Finally, you have no requirement to go to the endodontist your dentist recommends. Even if he is paying for it, you can find an endodontist on your own. This new GentleWave technology is attractive and is getting good reviews in the dental literature. If you want to find an endodontist who uses this technology, you’re within your rights to go looking.
I’m sorry for what happened to your daughter’s tooth, and wish her well.
– Dr. Hall
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.
Dr. Hall, As I read your comments to the above situation I was surprised to your fast judgement as to whether the dentist seemed competent. First of a, we as dentists are all taught that orthodontics over the long term can be a causative agent for the loss of vitality to a tooth or teeth from just the physical forced applied over the tenure of treatment. This could be the case as the tooth certainly did not turn “gray” in a matter of a couple weeks due to removing a fixed retainer. As a matter of fact what kind of “damage’ could have taken place as you noted with this fairly “routine ‘ procedure to cause the tooth to turn. It is by no means invasive in any way. It almost sounds like the gingival tissue was damaged and now root exposure is observed-which might account for the gray shade. As we all know the root does not look like enamel and thus possibly the root is now showing. A definitive diagnosis is needed I agree. Nothing needs to be done until that happens. By the way teeth requiring endo do NOT always display apical radiographic pathology. For you to ridicule him for his lack of knowledge in this area is ridiculous.
Dr. Joel Sardzinski
Hiawatha, Iowa
Response by Dr. Hall,
Dr. Sardzinski, I had a little trouble figuring out what you were talking about, because you commented on the photo that was actually attached to a different post, rather than on this post. But I found the post, moved your comment to the post so it will be visible, and now would like to clarify a few things.
If you read my comments carefully, you will see that I made no definitive statements about the dentist or his competence. The strongest thing I said was “I’m not getting strong feelings of competence about this dentist.” To amplify on that, I am saying that the information I have so far doesn’t convince me that he has a lot of competence, but I am open to further information. Right after that comment, in fact, I said that I hoped there was more information that would explain the situation.
I’m not sure I understand why you are bringing up the rare possibility that the tooth could have been damaged to the point of becoming non-vital by properly conducted orthodontic treatment. In my dental school education, I never remember being told that. Maybe I missed that, but I also never saw a case of that in my years of practice. But let’s say that this is possible. Caprice, the patient’s mother, states that the tooth was injured by removing the retainer and then it started turning gray. I’m not going to contradict the mother here by telling her that she didn’t see what she thought she saw.
I realize that there are dentists who believe that our professional duty is to stick together and defend each other against complaining patients. I understand that sense of obligation that many dentists have to the profession, and respect that, but I disagree. Anyway, I’m wondering if that is your goal. (Notice I didn’t say that this is your goal—I’m wondering.) But why else bring up some rare possibility that doesn’t seem to agree with the stated facts to try to absolve the dentist of any responsibility here. If we take the mother at her word that the dentist damaged the tooth in removing the retainer, it seems pretty clear to me that the dentist is liable for that damage.
And about reading the x-ray, my background is that I worked part-time and during summers as a radiology instructor at the University of Minnesota while I was going to dental school, so I am maybe tuned more into this than most dentists. There are subtle signs on the x-ray that will show up almost always whenever a tooth is dying or dead. You said that a tooth requiring endodontic treatment will not always display periapical pathology. I agree with that. But we’re talking about a tooth that is dying or dead and has become painful to biting—there’s a slight difference between what you are talking about and what I am talking about. If this tooth has become painful to biting, which, associated with the other symptoms, would indicate periapical inflammation, that is almost certainly going to show on the x-ray. I did not condemn the dentist for apparently not knowing this because my experience is that most dentists don’t read x-rays with that degree of detail, so I suggested she ask the specialist to do this. Those signs on the x-ray would confirm what seems to be a reasonably certain conclusion, based on the history and the symptoms. My goodness, the tooth is painful when water gets to it. That’s pretty bad. Happening right after a traumatic event, with the tooth now starting to turn gray, should make it pretty clear to us what is going on inside the tooth.
I do thank you for your thoughtful post, which gave me the opportunity to clarify these things.
-Dr. David Hall