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Root Canals

Is a root canal always necessary?

02/20/2004

Question:

I`m trying to decide whether or not I should get a root canal.

About 2 years ago, I had an old large filling replaced in my lower left backmost molar replaced by a crown since a portion of my tooth cracked. At that time my dentist ground the existing tooth down pretty far, so there was barely enough tooth to support the crown. I also noticed there was a slight discomfort when I would bite down while chewing. The discomfort disappeared within a few weeks. Recently, while eating some nuts I cracked the crown and since then I have been unable to bite down on that side without some discomfort. My dentist has removed the old crown and replaced it with a temporary, pending the new crown. He suggested that I get a root canal, but I wonder if this is really necessary since the pain isn`t that severe and the cold/hot sensitivity tests normal.

I`m trying to do what is best for my mouth/tooth. Would it be better to get the new crown and just wait and see if the root canal is really necessary. I still feel slight discomfort while chewing with this temporary tooth, but am hopeful that it will go away like it did the first time the crown was added.

I`ve been reading some information on the internet that makes me think I may not really understand the benefits of root canals in saving the tooth. I`d really like another opinion on this issue.

Thanks.

Answer:

That is a tough question to answer. Without seeing radiographs or the tooth I really cannot tell you what to do. However, here is some information that may help you.

If you bit down hard enough on something that you cracked a crown, that is a lot of force. The pain you are experiencing can be due to trauma to the ligament that holds the tooth in your jaw, like a sprained ankle. This will take some time to heal. Since you have a temporary crown on the tooth, you may consider waiting to see if your pain on chewing subsides with time (4 weeks or so). If not, you may have cracked the tooth or root. This may not be apparent on an x-ray, but may be seen on clinical examination. Your symptoms would not subside if the tooth is cracked and may get worse. If the pulp of the tooth is involved with the crack, a root canal may help relieve the symptoms. However if the crack is substantial and extends below the level of the bone, the tooth may not be able to be saved and will need to be extracted.

An endodontist could evaluate the tooth to help determine the actual source of your symptoms and, with your general dentist, give you treatment options. If a root canal is needed, it would be easier to do it prior to the new crown being cemented in place.

I hope this helps. Thanks for the question.

For more information:

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Response by:

John M Nusstein, DDS John M Nusstein, DDS
Associate Professor of Endodontics
College of Dentistry
The Ohio State University