Question:
I'd like some advice from a Dentist please. I went to the dentist lately for
a general check-up - no current problems/pain/sensitivity, and to my shock,
after a bite wing radiograph, he discovered extensive decay on my upper left
premolar. Decay had come in from the side of the tooth, not affecting the
base, and was about 0.5mm from the pulp. He told me that root canal maybe an
option, but has a 20% failure rate, would could result in extraction (which I
am trying to avoid). He did a vitality test on the tooth, which came out
fine, and the tooth is symptomless. Kindly enough, he then gave me the
option of having first, a temporary filling done with Kalzinol, assess the
situation, and then if pain arises, to have root canal OR if no pain, to have
an amalgam filling. He said in the latter situation I could need root canal
in 5-10 years. All the advice was great, except one thing concerns me. I've
now had the temporary filling done, the tooth is still symptomless, but he
had to leave some of the decay in, since it was so close to the pulp, and he
didn't want to expose the pulp, which apparently would mean he would have to
do the root canal. Is this safe? What is the probability of the infection
still progressing to the other root (or one root may already be affected?)?
Or perhaps to the bone? I want to definitely avoid this situation, yet also
avoid the root canal too, but play it extremely safe? What is your advice in
this situation?
Answer:
It would be useful to know if the pulp is vital right now. The
vitality cannot be determined simply by judging the depth of decay.
It is still a common practice to leave a small bit of decay on the
floor of the cavity if it is thought that removing the last bit of decay
will expose the pulp. Certain materials such as calcium hydroxide can
encourage the pulp to wall off the decay from the pulp. Furthermore,
the small bit of decay under a filling will NOT progress IF the
surrounding tooth structure is sound and the margins of the filling are
clean. I don't know what Kalzinol is, but from the name I wouldn't be
surprised if in fact is is some kind of calcium hydroxide preparation.
If this is the case your dentist is following what is still considered
standard practice.
I have myself seen many teeth like yours remain vital indefinitely. A
more permanent filling should be placed in the tooth, leaving a base of
the medicated preparation over the remaining decay. The tooth should be
checked periodically for signs that the pulp is breaking down, and you
should understand that root canal treatment may be necessary in the
future if it turns out there was prior damage to the pulp.
A 20% failure rate for root canals is way high--unless there are
particular circumstances with this tooth that give your dentist pause.
That's really reinforcing to me since I've had the hot & cold stimulus
vitality test done and my tooth did respond. I am aware the tooth has two
roots though, and the Dentist has rightly made me aware that one root may
possibly already be affected (but he doubts this), and the other could
possibly be reacting to the stimulus test, so he's going to monitor.
