Root Canal FAQ.

Or: I'd rather have a root canal than...

Despite its mostly undeserved reputation, the popularization of root canal treatment is one of the most significant revolutionary advances in the endeavor of saving teeth.

Q: Are there alternative treatments for root canal? Should some people get a second opinion? Is misdiagnosis possible in root canal?

A: Root canal treatment is most commonly used to treat infection originating in the pulp (nerve) of a tooth. (There are other reasons for which root canal is performed, usually to permit restorative or prosthetic treatment, but this is not germane to this discussion.)

Such an infection originating in the pulp may be treated in one of three ways:

  1. Root canal treatment
  2. Endodontic surgery (apicoectomy with retrograde apical filling)
  3. Extraction

Depending on the presenting condition of the tooth in question, one or another of these approaches may be appropriate. Sometimes only one alternative is possible, which narrows the choice. Of the three techniques, the first two are an attempt to save the affected tooth; the extraction should be reserved as a last resort when salvage is not possible.

Second opinions are advisable when either the diagnosis is not certain or there is any doubt on the part of the patient of the doctor's competence, trustworthiness, or openness to all potential alternative treatments. Many times a general dentist will refer a patient to a root canal specialist (endodontist) if there is an equivocal diagnosis. Yes, misdiagnosis is possible; after all, dentists are human.

Q: I had a root canal done 6 days ago on molar #19 (if that helps). I still have the dull ache off and on in that tooth that brought me to my endodontist in the first place. He said the x-rays were inconclusive, so suggested a root canal. It's a very dull throb, doesn't even keep me up at night, or so far hasn't gotten worse. I was hoping it would go away after the root canal. I'm now discouraged. It is off and on several times throughout the day. Why? I'm beginning to think it didn't even help. Any ideas?

A: Performing a root canal on a hunch is, by our estimation, rather presumptuous. It is always safer to proceed from a diagnosis to a treatment, rather than to use a treatment to confirm a diagnosis. There are three possibilities:

  1. The diagnosis was correct, the root canal was performed properly, and you're experiencing normal postoperative pain which will disappear with time. This is common.
  2. The diagnosis was correct, but for some reason the root canal did not eliminate the problem.
  3. The diagnosis was incorrect, the root canal treatment was inappropriate, and the original problem remains untreated.

Only time will tell which of the three possibilities applies; let's hope it's #1. If the symptoms persist, a return trip to the endodontist is indicated.

Q: Are pain pills and antibiotics an acceptable substitute for root canal?

My reason for asking: I have had the same experience with the same tooth, four years apart. On a holiday weekend, I had an intense, almost unbearable toothache. Every dentist in town (including mine) was gone for the weekend or otherwise unavailable. In desperation, I called my family doctor, and he called in a prescription for pain killers and antibiotics.

The next day, the pain was gone, and my dentist later told me, "That tooth is dying, and you are going to need root canal". (And practically everyone I know who has had root canal had it while under these same circumstances - they were still in pain and desperate for relief.)

So I am wondering, if this only occurs every few years, and pain pills and antibiotics control it, will it hurt anything to treat it that way, instead of having root canal?

A: Your infection is not occurring every few years; it is a continuous, chronic infection, with periodic acute flare-ups. The problem with your way of treating the problem is twofold:

  1. You never know when the next flare-up will be, nor how severe it will be. A severe dentoalveolar abscess can land you in a hospital.
  2. Chronic abscesses progressively destroy the root of a tooth and its supporting bone.

We can assure you that if antibiotics and analgesics could successfully treat these infections, dentists would not go through the trouble of performing root canal treatment on their patients. If you want to keep your tooth in the long run, you will need to have root canal treatment.

Q: Hi..I don't know if I am explaining this right or not, but once the dentist drills the decay away and sees where the root and tooth meet (which means, the root is not exposed yet, and the tooth still lies over the root) (something like that) the procedure would be to not root canal at all...the dentist would lay some sort of protective coating between the root and the tooth and then fill the remaining top part of the tooth. DOES THIS procedure EXIST?

A: You have it mostly correct, but...

When there is deep decay, it is sometimes difficult to determine whether it has entered the pulp (nerve) of the tooth. The clarity of the image on the x-ray, or the spatial orientation of the decay relative to the pulp is sometimes difficult to interpret with precision. In this case, the removal of the decay (excavation) is both therapeutic and diagnostic. If an exposure of the nerve cannot be seen, it will generally indicate that the nerve has escaped injury, and the tooth will not need root canal treatment. Despite this assumption, the nerve may indeed be injured and later need root canal treatment, as evidenced by the development of symptoms at a later date. This is because a microscopic exposure may escape visual detection by the dentist. In any case, if the symptoms are sufficiently suggestive of a pulpal infection, it is usually assumed that root canal treatment is necessary, even if no exposure can be seen.

In equivocal cases, where there is deep decay that approaches the pulp but there are no symptoms indicative of infection, and there is no pulp exposure in evidence, the dentist may place a cement base under the filling in order to provide a measure of thermal insulation; if it's really deep, this is sometimes referred to as an "indirect pulp cap." There are situations where the same situation presents WITH a small exposure; there are some dentists that will perform a similar procedure in an effort to head off a root canal. This is called a "direct pulp cap." The direct cap is a controversial procedure, which is widely believed to be unsuccessful over time, leading to the eventual recurrence of infection.

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