Do I Really Need a Root Canal at 21? Dental Decisions

Q: Do I Really Need a Root Canal at 21? Dental Decisions

Hello, Xiao Bao：<br>In your letter, you mentioned that the tooth has severe decay but does not cause pain, which makes you hesitant about undergoing root canal treatment. <br>Generally, I would recommend that you first try to clean out the cavity and place some restorative materi

Is it necessary to perform a nerve block?

Hello Dr.
Lin, I apologize for taking up your valuable time.
A few days ago, during my dental cleaning, I inquired about orthodontics and had a full set of X-rays taken.
The dentist who cleaned my teeth reviewed the X-rays and informed me that I have two cavities, one of which may require a root canal.
I do not experience any pain, so I asked the dentist if the decay had reached the nerve.
He said it had not, but it was very close.

Having some experience as a dental assistant, I looked at the X-rays and noted that the areas he pointed out (tooth positions 2 and 4) were near the dentin but had not yet reached the pulp chamber.
My teeth are quite large, and I typically do not have significant issues with them.
I understand that the dentist wants to thoroughly remove the decayed areas, but I am only 21 years old and in good health.
If the nerve is removed, the tooth will no longer be alive and may become weak over time.
This dentist was my first visit, and there were quite a few patients.
Online reviews indicate that the dentist is very nice, but it seems no one has encountered similar issues.
After discussing with friends, I realized that many have undergone root canals (and they consider it normal).
Some colleagues rationally stated that the need for a root canal is not age-dependent, but I keep thinking, "I’m only 21 and need a root canal..."
I researched online and found that dentin can regenerate and help resist cavities.
My questions are: Is a root canal absolutely necessary? (I see many people online with the same concern, but most are in pain, which makes a root canal seem reasonable; however, I haven’t reached the pulp chamber yet.)
Here are my thoughts:
1.
Go ahead with the root canal and filling.
2.
I’m considering orthodontics; if a root canal is needed (and possibly braces), it might be better to get braces first and extract that tooth as it would be deemed non-functional.
3.
Get the root canal and filling, then wait until other teeth also need root canals before extracting again and getting braces.
4.
Find a more skilled dentist to carefully excavate the cavity with a high-speed drill, even though it may not be completely clean, and then fill the tooth.
What is your recommendation? I found a reference that states teeth are nourished by the gums and that nerves do not regenerate, which makes me hesitant to proceed with the root canal without thorough understanding.
I have a friend who, at 18, has already had four root canals and has crowns on all of them, which is quite alarming to me.
He says it feels normal...

Xiao Bao, 20~29 year old female. Ask Date: 2016/05/14

Dr. Lin Jiayong reply Dentistry

Hello, Xiao Bao:
In your letter, you mentioned that the tooth has severe decay but does not cause pain, which makes you hesitant about undergoing root canal treatment.
Generally, I would recommend that you first try to clean out the cavity and place some restorative material that can promote dentin remineralization.
After a period of 3 to 6 months, we can assess the condition of the tooth and then decide whether to proceed with root canal treatment.
However, if the pulp nerve of the tooth is already in a state of chronic necrosis, then root canal treatment should be performed immediately.
Whether the tooth has chronic necrosis needs to be determined by the treating dentist through some examinations.
Additionally, since you mentioned wanting orthodontic treatment, I would suggest that you first have the dentist evaluate whether the tooth in question needs to be extracted before deciding on root canal treatment.

Reply Date: 2016/05/14

More Info

When it comes to dental health, particularly at a young age like 21, the prospect of needing a root canal can be daunting. It's understandable to feel apprehensive about the idea of having a tooth nerve removed, especially when you have no pain and your teeth seem to be functioning well. However, it's essential to understand the reasoning behind your dentist's recommendation and the implications of your dental condition.

Firstly, the presence of cavities, especially those that are close to the pulp (the innermost part of the tooth containing nerves and blood vessels), can lead to significant issues if not addressed promptly. While you may not currently experience pain, cavities can progress, and the risk of infection increases as they approach the pulp. If bacteria reach the pulp, it can lead to pulpitis, which is painful and may require a root canal to save the tooth.

Your dentist's suggestion to consider a root canal is likely based on the X-ray findings and the proximity of the cavities to the pulp. While you are correct that the dentin (the layer beneath the enamel) can regenerate to some extent, it is not a foolproof defense against cavities. Once a cavity forms, it will not heal on its own, and the longer it is left untreated, the more extensive the damage can become.

Here are some options to consider based on your situation:
1. Root Canal Treatment: If the dentist believes that the cavities are too close to the pulp, it may be wise to proceed with the root canal. This treatment can save the tooth and prevent further complications. After a root canal, the tooth can still function normally, but it may require a crown to protect it from fractures.

2. Monitoring: If you are not experiencing any pain and the cavities are not yet affecting the pulp, you might choose to monitor the situation closely. Regular check-ups can help ensure that the cavities do not worsen. However, this approach carries the risk of the cavities progressing without your knowledge.

3. Second Opinion: If you feel uncertain about your current dentist's recommendation, seeking a second opinion from another dental professional can provide you with more insight. Different dentists may have varying approaches to treatment, and it can be helpful to hear another perspective.

4. Preventive Measures: Regardless of the decision you make, focusing on preventive dental care is crucial. This includes maintaining good oral hygiene practices, such as brushing twice a day, flossing daily, and visiting the dentist regularly for cleanings and check-ups. Additionally, consider discussing fluoride treatments or dental sealants with your dentist, as these can help protect your teeth from further decay.

5. Orthodontic Considerations: If you are considering orthodontic treatment, it's important to address any existing cavities before starting braces or aligners. Orthodontic treatment can complicate dental issues if they are not resolved beforehand.

In conclusion, while the idea of a root canal at a young age may seem alarming, it is a common procedure that can save your tooth and maintain your oral health. It’s essential to weigh the risks and benefits of each option and to communicate openly with your dentist about your concerns. Remember, taking proactive steps now can prevent more significant issues in the future.

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