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Root Canals

Do I still need a root canal?

06/29/2007

Question:

Two months ago, my upper left molar (the last tooth) became painful. I saw my dentist right away. After tapping on the tooth and x-ray, he said I needed a root canal. He prescribed some antibiotics which I took for about 3 days and stopped because the pain completely went away. A few days a ago, I finally saw the endodonist just because my insurance had pre-approved the root canal. The specialist also took x-rays and used a cold-tip instrument that tested each tooth`s sensitivity to cold. While, the doctor did not point to any cracks or problems on the x-ray, he concluded that I DO need the root canal because the suspect tooth did not react to cold which meant the pulp/nerve was dead. I asked him if the nerve is already dead and I have no pain, why do I still need the procedure. His answer was not clear and confusing. It seemed to me that my body sort of took care of the problem. Can you please tell me what may happen if I did nothing? Can the dead nerve still get infected and cause problems and if so why couldn`t I do a root canal then? I really appreciate your insight.

Answer:

When the tissue inside a tooth dies, the dead cells break down and release a number of toxins that cause your body's immune system to react. If bacteria are also involved, the reaction can be somewhat more severe. Using antibiotics helps the immune system fight the infection caused by the bacteria, but they do not resolve the problem, which is dead tissue and bacteria inside the tooth.

Although your symptoms went away, they will probably return in a few weeks when the bacteria again escape from inside the tooth and/or cause an immune reaction. This process will continually repeat itself until either the tooth is taken out or the root canal is done. A draining abscess may also develop.

By not having the tooth treated you run the risk of bacteria gaining access to your bloodstream and causing other problems as well as destruction of the bone that supports the infected tooth and the neighboring areas. Waiting until there is pain or swelling does not mean the tooth cannot be treated, it just means you are going to be in pain for a while until the infection/inflammation subsides. The root canal treatment will not alleviate those problems immediately.

The test that the endodontist did was to see if he could stimulate the vital (alive) pulp. The fact that there was no response from the tooth is generally a good indication that the nerve of the tooth has died.

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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