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Medical Forum / General / Dentistry / October 2005Root Canal Treatment
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? > 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, [quoted text clipped - 16 lines] > avoid the root canal too, but play it extremely safe? What is your advice in > this situation? 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. BTW, a 20% failure rate for root canals is way high--unless there are particular circumstances with this tooth that give your dentist pause. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thank you for your advice Steve. May I ask, what are the methods of determining if the pulp is vital? > Thank you for your advice Steve. May I ask, what are the methods of > determining if the pulp is vital? There are electrical pulp tests, where a small current is applied to the tooth. A live pulp will respond; a dead one will not. An acutely inflamed pulp will give an exaggerated response. It is also sometimes done to drill carefully into the tooth without anesthetic. It is not necessary to drill to the point of significant pain, but a vital pulp will respond. Sometimes, a source of heat or cold (say, ice or ethyl chloride spray) can determine vitality. Having said this, it is sometimes difficult to determine vitality unequivocally. Furthermore (and esp. in a multi-rooted tooth) you can have a pulp which is partially dead, and partially still alive. So this isn't always easy to determine. But usually applying one (or several) of these tests you can get a pretty good idea of what is going on. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 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. Thanks for all your advice Steve. Steve, Kalzinol is resin-modified ZOE cement. Shan, I would go for the amalgam filling straightaway. If the dentist can clear the decay from the walls and margins as Steve suggested without exposing the pulp, he could place a filling (better a bonded amalgam) to cut off the "food supply" of the decay. RCT may be unavoidable in the long term however. Best of luck, George > Steve, Kalzinol is resin-modified ZOE cement. > Shan, I would go for the amalgam filling straightaway. If the dentist [quoted text clipped - 5 lines] > Best of luck, > George Thanks for the info, George. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >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 [quoted text clipped - 3 lines] > >Thanks for all your advice Steve. This sounds like a smart dentist ....... > BTW, a 20% failure rate for root canals is way high--unless there are >particular circumstances with this tooth that give your dentist pause. > >Steve I would say failure rate for RCT is between 3 - 5 % Given good treatment and a good coronal seal. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >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, [quoted text clipped - 12 lines] >didn't want to expose the pulp, which apparently would mean he would have to >do the root canal. Is this safe? He soulds like a very decent dentist to me. Joel M. Eichen DDS >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? Zero. No blood supply and no oxygen for aerobic bacteria in there. > 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? |
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