Question:
I have some fillings in the molars that are becoming quite large. My
dentist has suggested that crowns are required soon. I agree with this.
However, he has suggested that we should do a root canal on these teeth
before the crowns. I do not have any pains or any other problems with the
teeth in question. The dentist did say that it is optional to have the root
canals. The x ray looked fine to the dentist as well.
My wifes dentist said that about half the dentists suggest root canals
before crowns, and the other half don't.
I would prefer not to have a root canal if I don't need one. Is a tooth not
in better shape before a root canal than after. I had one root canal about
15 years ago and this tooth has discolored, and looks somewhat "dead".
Answer:
To generalize and suggest that wholly all teeth getting crowns need
root canal treatment is wrong IMHO. Each tooth should be considered
individually. If there are some symptoms, then you may want to
consider having the RCT proactively. If there are no symptoms
whatsoever and the tooth is vital (undamaged pulp, or nerve tissue
inside), then I would not suggest having RCT electively.
Remember though, evey person and tooth is highly variable. When you
have any dental work, your tooth is subjected to a high speed
handpiece at 200,000-500,000 rpm! This creates heat! This is why we
use all that water spray, to try to keep the tooth from burning. The
tooth may then be subjected to a myriad of dental medicaments ranging
from hemostatic agents, varnishes, primers, bonding agents, placement
of cord(string) tucked under the gumline, temporary cements, setting
of acrylic on the exposed underlying tooth structure, drying out of
the tooth........ All of which may irritate at the least.
And then we all expect everything to be OK.
Usually it is OK. I'd say 95% of the time everything works just like
it is supposed to, you get the crown put on and then TADA thats it.
Then there are the cases that need RCT one week after placement of the
crown. Or the cases that need RCT 8 years after the crown.
Sorry, I know I'm rambling.
Ultimately, you and your dentist get to decide together. Ask him if
any of them are really close to needing RCT. Consider elective RCT on
those. On the others just get the crown. But don't be totally shocked
if one day you need RCT on one of the teeth that seemed fine. The
human body is a wonderful puzzle!!
I agree . I would not recommend doing endo on a molar or
premolar (And very rarely on an anterior tooth. Esthetics can sometimes
be a problem and require it.) without clinical symptoms or radiographic
evidence. It is fairly unusual for me to have to do endo after a
regular crown on a healthy tooth.
Even with cracked teeth, I usually get the temporary crown on to see if
the biting sensitivity subsides before doing the endo.
Even so there are some large studies showing that some
15 -20 % need RTC within a year after preparation. Maybe
the temporaries were a contributing factor.
