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Root Canals

How can you tell if a root canal is needed?

01/16/2007

Question:

I recently had 2fillings replaced in two molars and a temporary crown placed on a third tooth all next to each other. I had some sensitivity prior to the dental work in one of the teeth, not sure which tooth it was, but the tooth that is temporarily crowned had many cracks in it and had a leaking filling. I now have some discomfort to the side where the teeth have been worked on and sometimes have an ache to the lower jaw below . I can contol the pain with advil for 8 to 12 hours but need to take something to contol the pain it rarely wakes me at night. I am also dealing with a sinus cold and had been on an antibiotic for 7 days for a upper resp. infection. I will still have a 3 week waiting period before my new tooth will be ready, I am concerned I may need a root canal. How can they tell if it will be needed? Will an xray show an infection? or how can they detect which tooth is giving me the problem? I have never had so many teeth worked on at one time and they are all next to each other. I had large fillings in the teeth that were refilled, one of them ,my previous dentist wanted to crown, but my new dentist felt it could just be refilled. My last two crowns had required root canals, the teeth that were worked on were symptom free but within days of being temporarily crowned they caused me severe pain and I need advil around the clock every four hours, this is a bit more suttle but similair in discomfort. Can the endotontist do a test to be sure the correct tooth is being worked on? Will I do any harm by allowing the discomfort to go on for 3 weeks?

Answer:

Determining the need for a root canal following the amount of work you have had done in one area of your mouth can be tricky. Sometimes it is hard to determine if the pain/sensitivity is due to a pulp with irreversible damage, or due to the trauma of having fillings placed and a tooth prepared for a crown. When you add the potential of cracks in a tooth, the picture becomes even cloudier.

Your symptoms should be a guide. If you continue to need pain medication to relieve a toothache, then there is a good indication that one of the pulps is in trouble. The next step is to determine which tooth is the source. That needs to be done in the office by either your dentist or an endodontist. An x-ray will help tell if there is an infected tooth, but may not help determine if a tooth is cracked.

Having these diagnostic tests done before the permanent crown is cemented would be beneficial since crowns can distort or nullify the tests on that tooth. Waiting to have this problem looked at shouldn't lead to more damage (in most cases), but could lead to more pain as you wait. The sooner an evaluation is done the sooner you can get relief.

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Response by:

John M Nusstein, DDS John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University