Dr. Hall,
I have been trying to find information about calcification/mineralization of a tooth. (I was told by my dentist that, on x-ray, he does not see any remaining canal in one of my molars. It is one that already has a crown. After a round with antibiotics, if I still have discomfort in the tooth he says it may need to be pulled. Without a tooth canal present, he said he cannot do a root canal. I would rather keep all my teeth. Is there an on-line site with information about this subject so that I can read and be educated?) Thank you.
– Mikala from Wisconsin

Mikala,
I’m not comfortable with what you say your dentist is telling you.

First of all, this idea that if you’re not comfortable after the round of antibiotics you need to have this tooth pulled. Antibiotics alone in treating a toothache doesn’t solve anything. Sometimes antibiotics are used as a diagnostic tool – if the antibiotics solves the tooth pain, then we know your pain is caused by a tooth infection. That would be an indication that the tooth needs a root canal treatment or an extraction. But once you stop taking the antibiotics, if the pain has indeed gone away, it will return sooner or later, because you haven’t addressed the source of the infection.

But if the antibiotics don’t solve your tooth pain, then that would be an indication that the pain is NOT caused by a tooth infection, and the dentist should be looking for some other explanation for the pain. It could be from nerve irritation or who knows what. In that situation, he doesn’t have a diagnosis, so proceeding with treatment would NOT be the next step. It’s like he has this backwards.

And I have a problem with the notion that because the dentist can’t see a canal in the tooth, it doesn’t have one. Especially in an upper molar tooth where there is a lot of bone around it, it can make the root canal hard to see.

If you want to try to save this, I would get a second opinion. Look up endodontists in your area. Those are root canal specialists. Or just tell your dentist that you want a referral to an endodontist. If it were me, I would look up an endodontist on my own for fear that the dentist would send me to a buddy who would simply parrot what the dentist has said.

And to explain calcification, here’s what happens. As we get older, the canals in our teeth tend to shrink. This is a natural process that can be aggravated if there is irritation in the tooth, the tooth builds up more dentin on the inside of the pulp chamber and the canals of the tooth, making them narrower and possibly harder to find. It can make root canal treatment more difficult and sometimes, in extreme cases, can block the canal. But root canal specialists should have special tools to navigate through these calcified canals.

Good luck. If you want to save this tooth, go for it.

– Dr. hall