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Medical Forum / General / Dentistry / April 2006I'm always going to wait 3 weeks before getting a root canal!!!!
...That is, if an xray does NOT show a clear and obvious problem despite a severe toothache (which responds well to aspirin). But i really wonder, what was that (toothache) all about! An infection that took care of itself? About 3 weeks a rear molar became extremely sensitive to cold...very painful. Then a few days later spontaneious aching...very bad especially at night....but aspirin worked quite wel, usually. From the beginning, chewing caused only minor discomfort (unless chewing COLD). For the past few weeks, I've been rinsing my mouth with hot water (when brushing teeth and flossing) which seemed to make it feel better when aching. A few days after pain started, I saw a dentist, took an xray, didn't see any problem at first, but then said maybe she sees a lesion, and a ??ligament moved away from a spot which maybe looks infected???....she also suggested irreversible pulpitis....and said I need a root canal. But said it's not urgent, and can wait on that. And everything I read on dental care suggested I need a RCT, based on my symptoms. And most of what I read says toothaches don't go away unless treated (dentist said this also). Now, about 3 weeks later, the spontaneious pain is gone (though once in a while i feel a very mild sensation there), the cold sensitivity is reduced about 80%, and chewing (which only hurt a little), hurts even less than that. I'm just thinking what a huge mistake it would have been to get a root canal a week or 2 after that initial pain, but i was very close to doing that based on what I've read and what the dentist said. Was it an infection? Did the pulp die and now I do need RCT (that's VERY unlikely isn't it?)......I'll wait a few more days then probably see another dentist to ask what was going on. > I'm just thinking what a huge mistake it would have been to get a root > canal a week or 2 after that initial pain, but i was very close to [quoted text clipped - 3 lines] > VERY unlikely isn't it?)......I'll wait a few more days then probably > see another dentist to ask what was going on. Actually, this is the most likely thing. Whatever irritant caused the pulpitis has succeeded in killing the pulp (after all the pulp can only take so much beating) - no pulp no pain from the tooth. The bad news is that the pulp space will now become a shelter for bacteria and art any time you will get a lovely infection in your periapical tissues and the pain will start again. My professional opinion is that you should get a vitality test for your pulp ASAP. If the pulp is dead it should be treated by RCT as soon as possible. A root canal done at the pulpitis stage has a success rate of 85-90% or more. The ones done after the pulp dies and you get a periapical lesion have a decreased chance of success. So the huge mistake would be not to treat it now. Regards, George Thanks Steve and George. Steve suggests watching it...I assme that means xrays every few months (?)...I'm not sure (obviously) whether the cold-pain will remain at it's current varirly low level (at least compared to cold pain i've had in the past!!) or disappear. George suggested a PVT. I doubt the pulp is dead because (am I wrong here?) it still is sensitive to cold (actually about 60% as sensitive as last week, not 20or 30% as I wrote a few hours ago), though no spontaneous pain as last 2 weeks. But I got a "pvt" (or did I???) 2 weeks ago (and the spontaneous pain went away about 2 days ago). Here's three-quarters of a post I made 2 weeks ago here (was this the kind of pvt you mean?): **************************************** Yesterday I made an appointment to see a new (to me) dentist today (I asked for an "ASAP" appointment), and after a 30-minute visit (including one small xray of my upper rear teeth) the bill came to $130. I didn't read the bill until after I left, but it had 3 items: (1) x-ray: about $24 (2) "comprehensive exam" $55 (3) "pulp vitality test" $51 As far as i know, #3 was never done. Maybe you can enlighten me on this though. First of all, I saw her because for the past 4 days my upper rear molar has been very painfully sensitive to cold, with some spontaneoius dull aching about 30% of the day (thoughlow doeses of aspirin takes care of the pain so far). So, at the office today I told her i was only about 80% sure what tooth was causing the pain, she did a few tiests on all teeth in that general area (1) trapping/touching then (2) applying cold. After determining which tooth it is, she took an xray. At some point she also had me biting on a hard thing to get any evidence of cracks (which she didn't see in the xray). After a few minutes of studying the xray, she initially said i should try a temp crown and see if that helps...then permanent. Upon studying the xray more, she said she sees a probable lesion (though "hard to see"), with a "ligament" that seems to have moved away a little (from a spot of bacteria, perhaps) (?? maybe i'm garbling what she said, but she did say irreversible pulp damage or pulpitis).....and she now definitely thinks i should get get a root canal, and skip the temp crown. She said there was no urgency for treatment AT ALL (assumiing I can control the pain, and that waiting a month or more wouldn't be a problem). ******************************************************* > Thanks Steve and George. Steve suggests watching it...I assme that > means xrays every few months (?) I mean it should be checked. That may well mean pulp testing, thermal or electronic. I do not mean to imply you should wait for your face to swell up. For sure if that happens, it'll be New Year's eve, or right before that nice Valentine's day dinner... Steve ...I'm not sure (obviously) whether the > cold-pain will remain at it's current varirly low level (at least > compared to cold pain i've had in the past!!) or disappear. George [quoted text clipped - 42 lines] > wouldn't be a problem). > ******************************************************* > ...That is, if an xray does NOT show a clear and obvious problem > despite a severe toothache (which responds well to aspirin). [quoted text clipped - 29 lines] > VERY unlikely isn't it?)......I'll wait a few more days then probably > see another dentist to ask what was going on. These are all good questions--wish I had an answer as good. Truth is, we really don't know unless we go into the nerve. But your symptoms are strongly suggestive of a problem with the nerve. The course of pulpitis is very variable--sometimes it proceeds directly to obvious abscess, swollen face, etc. Sometimes the nerve continues to be sensitive for a long time. And sometimes the nerve will die, but the inflammation subsides and there may be no symptoms for a greater or lesser period of time--sometimes forever. There may be signs on the x-ray that indicate that (despite the absence of pain) there is an infection present; or there may be no x-ray signs at all. Because I took over another dentist's practice at the beginning of my career, I was able to see a patient who presented with pain of indeterminate origin--there was no decay, and no sign of infection on x-ray. But 15 years earlier she had been treated by the retired dentist, who notated on the chart that the nerve was exposed, and that he'd done a direct pulp cap--a now discredited procedure (generally doesn't work). She had been symptom-free for 15 years. Two days later her face was swollen like a grapefruit, with a large abscess, and because I had the patient's history it was easy to figure out what had happened. Why did the tooth suddently blow up 15 years later? Who knows? But we have to assume that the original insult to the nerve was old, and that the patient had been walking around those 15 years with a low-grade infection. This doesn't mean you're heading for an infection. But considering your symptoms, IMO this tooth must be followed closely, and you may well need a root canal treatment sooner or later. Steve Acute abscess - - - -> chronic abscess ..... The problem may not be over! Joel sam Wrote: > ....That is, if an xray does NOT show a clear and obvious problem > despite a severe toothache (which responds well to aspirin). [quoted text clipped - 33 lines] > VERY unlikely isn't it?)......I'll wait a few more days then probably > see another dentist to ask what was going on -- Joel34 |
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