Tooth Pain: When to Consider Root Canal Treatment

Dental filling, root canal treatment, trigeminal neuralgia?

Hello Dr.
Huang: I would like to ask you about my teeth.
My lower left molar suddenly started hurting a lot, to the point where I couldn't sleep.
I went to see a dentist, and during my first visit, I had an X-ray taken.
After the X-ray, the doctor asked me where it hurt, and I told him it was near the molar and the tooth with the crown in front of it.
The doctor checked and pressed on my gums, which didn't hurt, but he did notice that my gums were red and swollen.
He filled the cavity in my molar, but when he pressed on it, I told him it hurt a lot.
The doctor said it seemed to be the gums between the molar and the crown, and he prescribed medication for me and told me to monitor the situation.

During my second visit, I was in a lot of pain again, and the doctor examined me and said that my molar was indeed hurting and that I likely had gum inflammation.
He prescribed more medication and told me to observe it again.
By the third visit, two days later, the day before, my tooth had stopped hurting.
That morning, pressing and tapping on it didn't cause any pain, and there was no redness or swelling.
I asked the doctor to check again, and he found that tapping didn't hurt much anymore, so he didn't perform a root canal and told me to come back if the pain returned.

I would like to ask you, given this situation, do I need a root canal? If there is a cavity, shouldn't it have shown up on the X-ray? Also, since the doctor filled the cavity, wouldn't he have been able to tell if it had reached the nerve? Please help clarify this for me.
Thank you.

Nìmíng, 20~29 year old female. Ask Date: 2017/08/04

Dr. Huang Tingfang reply Dentistry

Dear Anonymous Miss,
Hello! As mentioned, it is indeed severe pain! We just need to determine which tooth it is! For the third time, it is possible that the nerve has died, as there is no pain when pressing or tapping.
Additionally, cavities under crowns may not always be visible on X-rays; multiple images from different angles may be necessary! Please communicate more with your dentist! Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2017/08/04

More Info

Tooth pain can be a distressing experience, often leading individuals to seek immediate dental care. In your case, it seems that you have been experiencing significant discomfort in your lower left molar, prompting multiple visits to the dentist. Understanding when to consider root canal treatment is crucial, especially when faced with persistent pain that disrupts daily life.

Root canal treatment is typically indicated when the pulp of the tooth becomes inflamed or infected, often due to deep decay, trauma, or repeated dental procedures. The symptoms you describe, including severe pain that affects your ability to sleep, suggest that there may be an underlying issue that requires further investigation. While your dentist initially suspected gum inflammation, the fact that you experienced intense pain during the examination and treatment indicates that the problem may be more complex.

In your case, the dentist performed an X-ray, which is a standard procedure to assess the condition of the tooth and surrounding structures. However, X-rays may not always reveal the full extent of the problem, especially if there are small fractures or if the infection is located deeper within the tooth. The fact that you experienced pain during the filling process suggests that there may be an issue with the nerve or pulp of the tooth, which could necessitate root canal therapy.

It's important to note that even if the pain subsides temporarily, it does not necessarily mean that the underlying issue has resolved. In some cases, the pain may diminish as the inflammation decreases, but the infection could still be present. If the pulp is infected or necrotic, it can lead to further complications, including abscess formation, which can cause more severe pain and swelling.

You mentioned that your dentist advised you to observe the situation and return if the pain recurs. This is a reasonable approach, but it is essential to remain vigilant. If you experience a resurgence of pain, especially if it is accompanied by swelling or fever, it would be prudent to return to the dentist for further evaluation. In some instances, a referral to an endodontist (a specialist in root canal treatment) may be warranted to ensure that all aspects of the tooth are thoroughly assessed and treated.

Regarding your concerns about cavities and the potential for nerve involvement, it is indeed possible for decay to progress to the point where it affects the pulp. If a cavity is deep enough, it can reach the nerve, leading to pain and sensitivity. Your dentist's examination during the filling process should have provided insight into the extent of the decay, but if there are doubts, a follow-up X-ray or additional imaging may be necessary to rule out any complications.

In summary, while your dentist's initial assessment may have indicated that root canal treatment was not immediately necessary, it is crucial to monitor your symptoms closely. If you experience any return of pain or other concerning symptoms, do not hesitate to seek further evaluation. Early intervention can prevent more severe complications and preserve your tooth's health. Remember, your comfort and well-being are paramount, and it is always better to err on the side of caution when it comes to dental health.

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