Root Canal Treatment: Addressing Concerns and Alternatives

Nerve necrosis, root canal treatment?

Hello, doctor.
I have been experiencing pain in my teeth when exposed to hot or cold temperatures, so I sought medical attention.
An X-ray showed shadows at the roots of my front tooth and the adjacent tooth (which has undergone root canal treatment).
There was no response during the cold test.
The doctor believes this may be due to a previous trauma, which, combined with physical fatigue, has led to inflammation.
They suggested root canal treatment for the front tooth and redoing the root canal for the adjacent tooth.
However, my mother strongly opposes this, stating that root canal treatment makes teeth weak and prone to fractures.
She hopes I can ask the doctor for alternative solutions (such as just filling the tooth without performing a root canal) or seek another dentist's opinion.

Given my situation, are there any other treatment options available? If the dental nerve is already dead, does that mean the tooth is in a weakened state, or is it true, as my mother says, that it only becomes weak after extraction? This issue has been ongoing for a while; sometimes it hurts, sometimes it doesn't, and it seems to flare up or improve depending on my fatigue level.
I am somewhat inclined to ignore it, but I am also worried that delaying treatment could lead to worse outcomes.
I would appreciate your insights to help me communicate better with my mother and the dentist.
Thank you!

Yachi tong de huanzhe, 30~39 year old female. Ask Date: 2018/07/19

Dr. Zeng Guanghui reply Dentistry

If the dental nerve is already necrotic or if the tooth has undergone root canal treatment and there is a shadow at the root, with no response to cold or heat stimuli, it is recommended to undergo re-treatment for the root canal.
Otherwise, the apical lesion will not completely resolve on its own and may even lead to a periapical abscess, continuing to damage the surrounding soft and hard tissues of the tooth root.
If there are concerns about the tooth becoming brittle and prone to fracture after root canal treatment, considering a crown may be advisable.

Reply Date: 2018/07/19

More Info

Root canal treatment (RCT) is a common dental procedure aimed at treating infection or damage to the pulp of a tooth. In your case, the presence of shadows on the X-ray and the history of trauma suggest that the tooth may be experiencing inflammation or infection at the root level. The cold sensitivity you are experiencing indicates that there may still be some nerve activity or irritation, even if the nerve is considered "dead" due to previous treatment.

Your mother's concerns about the tooth becoming weak after root canal treatment are not unfounded but can be addressed with proper understanding. After a root canal, the tooth can indeed become more brittle over time, especially if it is not properly restored with a crown. However, the alternative of leaving the tooth untreated can lead to more severe complications, including abscess formation, further infection, or even tooth loss.

Alternatives to Root Canal Treatment
1. Observation: If the tooth is asymptomatic and the X-ray does not show significant issues, some dentists may recommend a wait-and-see approach. However, this is risky, as untreated infections can worsen.

2. Medication: In some cases, antibiotics may be prescribed to manage infection temporarily. However, this does not address the underlying issue and is not a long-term solution.

3. Extraction: If the tooth is deemed non-restorable or if the infection is severe, extraction may be the only option. This would prevent further complications but would also lead to the loss of the tooth, which can affect your bite and lead to other dental issues.

4. Pulp Capping: If the pulp is still vital and only slightly inflamed, a dentist might consider a pulp capping procedure, where a protective dressing is placed over the pulp. This is more common in younger patients with developing teeth.

Communication with Your Dentist
It’s essential to have an open dialogue with your dentist about your concerns and your mother's apprehensions. Here are some points to discuss:
- Explain the Risks: Ask your dentist to explain the risks of not proceeding with root canal treatment, including the potential for worsening pain and the need for extraction.

- Discuss Restoration Options: Inquire about how the tooth will be restored after the root canal to minimize the risk of fracture. Crowns are typically recommended after RCT to provide strength and protection.

- Seek a Second Opinion: If you or your mother are still unsure, consider seeking a second opinion from another dentist or an endodontist (a specialist in root canal treatments). They can provide additional insights and options.

Conclusion
While your mother’s concerns about tooth fragility post-root canal are valid, the potential consequences of not treating an infected tooth can be far more severe. Root canal treatment, when performed correctly and followed by appropriate restoration, can preserve the tooth and maintain its function for many years. It is crucial to address this issue sooner rather than later to avoid complications that could lead to more invasive treatments or tooth loss.

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