Should You Cap or Root Canal a Blackened Tooth? Expert Insights

If a tooth has turned black but is not painful, should I consider root canal treatment or getting a crown?

Hello Doctor, my lower right molar, the last tooth, has a large cavity and is black.
The doctor said it is due to gum necrosis.
I have seen three dentists.
The first dentist suggested extracting the tooth and getting a dental prosthesis, which I refused, and instead had a temporary material placed in the tooth.
The second dentist reviewed the X-ray and deemed it unnecessary to extract the tooth or perform root canal treatment, suggesting I wait until it starts to hurt, which could be years later.

After six months, since my second-to-last tooth has undergone root canal treatment four years ago, a friend advised me to get a crown to prevent the tooth from breaking down and needing an implant.
Therefore, I consulted a third dentist (due to studying in another county) to see if I need a crown.
The dentist reviewed the X-ray and indicated that the second-to-last tooth needs a crown, while the last tooth (the black one) could either undergo root canal treatment or be capped directly without root canal treatment.
I would like to ask if I should also cap the black tooth.
If I do not cap it and leave it untreated, what problems might arise in the future? If I cap it without root canal treatment, will I still need root canal treatment later, making the crown unnecessary? I apologize for the lengthy question, and thank you, Doctor.

Tina, 20~29 year old female. Ask Date: 2016/06/25

Dr. Lin Jiayong reply Dentistry

Hello, since the last tooth is a wisdom tooth, the root canal system of wisdom teeth is more complex and unpredictable, and they usually do not retain significant function.
Some dentists may take a more aggressive approach and recommend extraction, while more conservative dentists may suggest monitoring it and allowing it to naturally reach the end of its life.
However, for a proper treatment plan, it is still advisable to visit a medical facility for a detailed examination and discuss with a dentist.
Thank you.
Wishing you peace and health.
Sincerely, Dr.
Lin Chia-Yung, Director of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/06/25

More Info

When dealing with a blackened tooth, particularly one that has a significant cavity and potential gum issues, it’s essential to weigh your options carefully. Based on your situation, it seems you have already consulted multiple dentists, each providing different recommendations regarding your tooth's treatment. This can be quite confusing, but let's break down the considerations for capping (placing a crown) versus root canal treatment.

Understanding the Condition of Your Tooth
1. Blackened Tooth: The discoloration of your tooth indicates that it may have undergone significant decay or damage. The fact that it has a large cavity suggests that the tooth structure is compromised. The black color could be due to decay, but it might also indicate necrotic (dead) pulp tissue if the decay has reached the nerve.

2. Gum Health: The mention of "gum death" or necrosis is concerning. If the surrounding gum tissue is unhealthy, it can lead to further complications, including infections that may affect the tooth and adjacent teeth.

Treatment Options
1. Root Canal Treatment: This procedure is often recommended when the pulp of the tooth is infected or necrotic. It involves removing the infected pulp, cleaning the interior of the tooth, and sealing it. If your tooth is indeed necrotic, a root canal may be necessary to prevent further infection and preserve the tooth.
2. Capping (Crown): If the tooth is structurally sound enough and the pulp is healthy, placing a crown can provide protection and restore function. However, if there is a risk of pulp infection, capping without addressing the underlying issue may lead to complications later on.

Considerations for Your Decision
- Long-term Viability: If you choose to cap the tooth without performing a root canal, there is a risk that the tooth may develop pain or infection later, necessitating a root canal after the crown has been placed. This could lead to additional costs and procedures.

- Monitoring: If you decide against immediate treatment, it’s crucial to monitor the tooth closely. Any signs of pain, swelling, or changes in color should prompt you to seek immediate dental care.

- Consultation: Given the conflicting opinions from different dentists, it may be beneficial to seek a fourth opinion, preferably from an endodontist (a specialist in root canal treatment). They can provide a more definitive assessment of whether the pulp is healthy or if a root canal is warranted.

Conclusion
In summary, the decision to cap or perform a root canal on your blackened tooth should be based on a thorough evaluation of the tooth's health, including the condition of the pulp and surrounding gum tissue. If there is any indication of pulp necrosis, a root canal is likely necessary to prevent future complications. If the pulp is healthy, capping may be a viable option, but it’s essential to consider the long-term implications of either choice. Always prioritize your dental health and seek professional advice tailored to your specific situation.

Similar Q&A

Understanding the Black Line at the Gum Edge of Your Dental Crown

I have four front teeth, two on the upper left and two on the upper right, that underwent root canal treatment for the first time 20 years ago. This year, they received a second root canal treatment, and all four teeth were fitted with posts because I did not have crowns placed p...

Dr. Lin Jiayong reply Dentistry
Hello: Based on what you mentioned, the physician's statements and actions are both reasonable and normal. Additionally, there are currently no other reasons (such as swelling or discomfort) that would necessitate the removal and remaking of the dentures. It is recommended t...

Post-Root Canal Care: Understanding Tooth Discoloration and Gum Pain

I apologize, but I would like to ask a question. About six months ago, I had a tooth that underwent root canal treatment. The dentist recommended that I get a crown to protect it from cracking, but I didn't do it because I will need braces later. Now, I have noticed that the...

Dr. Huang Tingfang reply Dentistry
Dear Ms. Yun, Hello! Regarding your first question, teeth may become discolored and appear darker after root canal treatment. If there is no pathology in the main root, this is generally not a concern. As for your second issue, gum pain is often related to gingival inflammatio...

Understanding Dental Concerns: Black Lines and Tooth Discoloration Explained

Dear Dr. Lin, Hello. I have a concern regarding my upper left second molar. There is a "U-shaped" black line on the outer side, and when I touch it, it feels like a depression, resembling a seam. Additionally, the tooth underneath the black line appears to be "dar...

Dr. Lin Jiayong reply Dentistry
Hello: 1. Old and new fillings cannot achieve a complete seal, so if removal and replacement are necessary, it is generally recommended to remove all of the old filling material. Otherwise, the junction between the old and new materials may still become discolored or darken. 2. I...

Understanding Abscess at Tooth Root: Treatment Options Explained

Hello! I had an X-ray taken of my front tooth, and there is a dark shadow at the root apex. The doctor said it is an abscess at the root tip and recommended a root canal treatment. The tooth is not causing any discomfort. Are there any other treatment options available? Thank you...

Dr. Lin Jiayong reply Dentistry
Hello: Based on your description, it is evident that there are signs of pulp necrosis. It is strongly recommended to proceed with root canal treatment. Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.