Question:
My tooth doesn't hurt but my dentist says that I need root
canal treatment. Do I need it?
Answer:
Quite possibly yes. An x-ray might reveal a chronic
periapical (around the apex of the root) lesion which may
increase in size, or even lead to an acute abscess which can
cause pain and swelling.
This will never go away by itself.
This is one of the reasons why dentists will want to x-ray
your teeth before proceeding with dental care. If there's an
abscess (periapical lesion) it needs to be resolved before
you have that crown, bridge or filling.
Symptoms of a tooth requiring root canal therapy:
1. Periapical abscess.
2. Sensitive to percussion ("Doc, I can't put any pressure on
this tooth!")
3. Dull ache which is relieved by applying cold. Patient
comes to the office with McDonald's supersize drink with
lots of ice.
4. Sensitive to heat. Coffee makes it worse, cold relieves
it.
5. Swelling - sometimes quite extensive.
Many times, however, a tooth can be restored without root
canal therapy. Of course, this decision should be left up to
your dentist.
Conservative treatment:
Several years ago, a young lady agreed to a treatment plan to
replace several missing teeth with a permanent, fixed bridge.
This required preparation of several teeth for abutment
crowns which would hold the pontics (missing teeth
replacements). The bridge would be cemented onto those
abutment teeth.
The patient had pain in one of the abutment teeth for over 2
years. There was a very large filling in it, which was
leaking around the margins and was putting pressure on the
nerve upon chewing. I suggested the following to the
patient:
1. Prepare that abutment for a well-fitting temporary crown.
2. Cement that temporary crown and see if symptoms subside.
3. If successful, (no root canal) proceed with bridge.
4. If not successful, proceed with root canal therapy, before
bridge.
This type of approach avoids the necessity for root canal
therapy, unless definitely required.
I believe that a tooth with its own natural blood supply and
nerve is more desirable than a tooth that has undergone root
canal therapy (the nerve and blood supply having been
removed).
My reasoning:
a. A root canal tooth may be more brittle and may tend to
split more easily than a vital tooth (tooth with the nerve
intact). This concept is still questionable and unproven,
but there's anecdotal evidence. That is, it seems to be
so in many cases.
b. Many endodontists and general dentists excessively widen
out the coronal (crown) portion of the root canal chamber
in order to gain proper access to the narrow canals. This
may weaken what's left of the tooth and lead to root
fracture.
c. With root canal therapy, there's always risk of a
perforation, broken instrument, or canal which cannot be
properly negotiated.
d. A root canal tooth will many times require a post for
restoration.
e. A root canal tooth will many times require a crown for
restoration.
f. A compromised root canal tooth, post, and crown may need
to be splinted to adjacent teeth for support. This is one
sure way of avoiding problems. One problem tooth leads to
2, 3, 4 and more crowns, all linked together.
To reiterate, if a tooth needs root canal therapy, it needs
it. If there's a choice, a more conservative approach may be
more desirable.
The other side:
I have a colleague/friend who practices in an ultra-modern 12
chair office. He considers himself a big producer (his
words). He told me the bits and pieces of his treatment
rationale on several different occasions:
1. To the Doctor's chagrin, his (salaried) associate
refuses to follow through with many of the Doctor's
treatment plans. The associate alters treatment rendered.
2. If a tooth needs a crown, the Doctor always does root
canal therapy first. His thinking is that the tooth
probably will need root canal therapy at some point in the
future. He prefers to do the root canal therapy
beforehand.
3. If a tooth needs 3 or more restorative surfaces, he will
recommend a crown (and root canal therapy). His thinking
is that those large, unsightly fillings lead to more
breakage and will eventually need a crown, anyway.
As you can imagine, almost everyone leaves the office with
one or more teeth with crown, root canal and post.
The my most egregious example was a patient who had exactly
one tooth in his mouth (an upper wisdom tooth). He had a root
canal, post, and a beautiful crown on a perfectly useless
tooth! The patient called me for upper and lower dentures.
Normally, if there's one upper tooth, its desirable to rip it
out first, so that the upper denture will settle on the gums
properly.
In this case, I didn't have the nerve to tell that to the
patient, so I worked around this one lonesome tooth!
