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Medical Forum / General / Dentistry / January 2008Root canal criteria?
Hi, I am scheduled for a root canal evaluation because of a nagging pain I've had in my upper right quadrant - not sure exactly which molar is affected, but suspecting one that has a crown. I would like to know what the evaluation involves, and is there a possibility that I'm told I need a root canal even if I don't. The reason I ask this is because the throbbing pain that was quite unpleasant two weeks ago, has now gone away altogether. I did not have temperature sensitivity in the area, nor was it sensitive to sugar, or pressure. I do believe I grind my teeth at night, though, so I would have ascribed the pain to that if it didn't persist for so long. Many thanks for your help with this! > Hi, > [quoted text clipped - 13 lines] > > Many thanks for your help with this! As a lay-person my only suggestions are: - If you need it, get it done by an endo, not a general dentist - Get two opinions from two different professionals who do not know each other. (It is human nature for someone to confirm the findings of their friend or collegue). btw - how long ago was the crown placed? > > Hi, > [quoted text clipped - 24 lines] > > - Show quoted text - Sorry, I should have mentioned it was an endodontist who would be doing the evaluation. The crown is about five years old, and has chipped in one spot, but x- rays haven't shown any issues. Admittedly, the last time I had an x-ray was about a year ago. I'm just concerned that this root canal determination might not be an exact science... > I'm just concerned that this root canal determination might not be an > exact science... You are right. It isn't :) How did you chip it, btw? Is it a full crown? The pros would know better of course, but unless the chip is really deep, I can't see how an infection could make its way all the way to the core. > Sorry, I should have mentioned it was an endodontist who would be > doing the evaluation. [quoted text clipped - 6 lines] > I'm just concerned that this root canal determination might not be an > exact science... It's not. Sometimes a patient will present in pain that can't be localized, and I see every tooth is decayed. Sometimes it's very difficult to single out the culprit. But most patients don't present like this. If a patient is not in severe pain and for one reason or another it's impossible to determine the culprit, you can wait and generally things become clear over time. Not rarely the tooth causing the pain is determined, but after doing a root canal it is discovered that there is a crack in the root, necessitating extraction. Unfortunate when it happens, but as it's become the standard of care for endodontists to have operating microscopes, cracks can be picked up while very small, and it's less likely that a fracture will be missed. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Sorry, I should have mentioned it was an endodontist who would be >> doing the evaluation. If an endo says you need RCT then you do. The likelyhood that a crowned tooth needs RCT happens very often. Those teeth usually have gargantuan restorations or are badly broken down. It may take some time but the preparation for the crown is the final insult to the pulp resulting in pulpal necrosis. >> The crown is about five years old, and has chipped in one spot, but x- >> rays haven't shown any issues. If the porcelain is fractured you are certainly a clencher/grinder. >> Admittedly, the last time I had an x-ray was about a year ago. >> >> I'm just concerned that this root canal determination might not be an >> exact science... It's exact as is humanly possible. It's tough enough to do RCT without treating teeth that don't need that therapy. No concientious practitioner would do RCT on a tooth that didn't need it. JMO, YMMV. > It's not. Sometimes a patient will present in pain that can't be >localized, and I see every tooth is decayed. Sometimes it's very [quoted text clipped - 10 lines] > >Steve On Jan 14, 9:02 pm, New...@bix.nex wrote: > On Mon, 14 Jan 2008 21:09:50 GMT, Mark & Steven Bornfeld > [quoted text clipped - 41 lines] > > - Show quoted text - Thanks everyone for your replies. You were all right in the various points you made, as it turns out. I had my evaluation today, and since the pain was not present, the endo took three x-rays of suspicious areas, and checked me for cold sensitivity as well as tapping on each of the suspected teeth, and finally decided that it was not possible to identify the tooth, and we would not go ahead with the RCT. I should come back again when/if the pain returns. As for why the crown chipped, I must be a grinder, as you mention, because there was no other identifiable cause for this, and I do know that I often wake up with my teeth tightly clenched. I appreciate everyone's input! This is a very useful newsgroup that I visit occasionally, and have always learnt a great deal when I had a question. > As for why the crown chipped, I must be a grinder, as you mention, > because there was no other identifiable cause for this, and I do know > that I often wake up with my teeth tightly clenched. Likely that you are more of a 'clencher' than a 'grinder', though people in either category do some of the other. You can certainly do a lot of damage to your teeth and cause episodes of pain and sensitity. It's even possible to need a root canal from the clenching alone. I would find someone who makes NTIs in your area. JMO, D > If an endo says you need RCT then you do. > The likelyhood that a crowned tooth needs RCT happens > very often. Those teeth usually have gargantuan restorations > or are badly broken down. It may take some time but the > preparation for the crown is the final insult to the pulp > resulting in pulpal necrosis. Interesting point. I always wondered whether the hard ceramic encasement around the core somehow "strangled" it. I mean a natural tooth I imagine can microscopically expand with heat. The ceramic crown does not allow the pulp any "breathing room", say, during some kind of pulpal inflamation. Does that make any sense at all? no Signature/ Amatus / >> If an endo says you need RCT then you do. >> The likelyhood that a crowned tooth needs RCT happens [quoted text clipped - 9 lines] > Does > that make any sense at all? >> If an endo says you need RCT then you do. >> The likelyhood that a crowned tooth needs RCT happens [quoted text clipped - 8 lines] >pulp any "breathing room", say, during some kind of pulpal inflamation. Does >that make any sense at all? Umm, in a word no. The current theory is that the pulp can withstand 2 - 3 traumas. ie. preparations or operations. The physical trauma associated with preparation is an insult to the pulp. Since the pulp is encased in dentin, inflammation which causes increased blood flow can cause pulpal strangulation. A previously operated tooth already has a compromised pulp and one more trauma may send it over the edge into pulpal necrosis. It's about the trauma. Pulps don't breath, lungs do that for all of our tissues. It's about oxygenation of the tissue. |
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