Dental Issues: When to Worry About Cavities and Root Canals

Issues Related to Dental Fillings After Cavities

Hello, my dental situation is as follows: About three weeks ago, I experienced pain in the upper left teeth (I couldn't pinpoint which tooth, but I suspected it was the one that had undergone root canal treatment and had a crown placed on it, which is the third tooth from the back on the upper left).
However, after inquiring, I was told that tooth no longer has a nerve, so it shouldn't hurt.
Due to time constraints, I visited a nearby dental clinic (Clinic A).
The diagnosis was that the second tooth from the back on the upper left had a cavity.
The dentist mentioned that the cavity was somewhat deep, so they removed the decayed portion and filled the tooth, advising me to monitor the situation and that if it hurt, I would need a root canal treatment.
A few days later, I began to feel itching and swelling in the area (similar to an allergic reaction, and sometimes it felt like it was the third tooth from the back, and other times the second).
I returned to Clinic A for a follow-up, and they explained that since the filling was close to the nerve, it might cause discomfort, and advised me to keep observing.
A few days ago, I finally made an appointment with Clinic B, where I had been receiving treatment for another, less severe cavity.
Since I occasionally felt swelling and itching in the area (the second and third teeth from the back), I explained my situation to the dentist.
After examining me and taking X-rays, the dentist concluded that the sensations were likely due to gum irritation, stating that the X-rays showed no issues with the two teeth (the second and third from the back), and suggested that I continue to monitor the situation.
Here are my questions:
1.
If the X-rays show no issues, can I assume there is nothing to worry about? Or is it possible that since I have already had a filling, it may not accurately reflect the cavity situation?
2.
Can X-rays be used to determine if a root canal treatment is necessary? The dentist mentioned that pain could indicate the need for a root canal, but I personally feel more of an itching sensation rather than pain, which makes it difficult for me to determine (the clinic only advised me to observe).
I would like to know if there are other methods to assess this (not just based on sensation).
3.
Given my current situation, if I need to follow up on that tooth, would you recommend returning to Clinic A (where I had the cavity treated, but it was a temporary visit) or going back to Clinic B (where I have been regularly treated and had my previous crown done)? Currently, I occasionally feel swelling and itching in the teeth (the frequency is decreasing), and both clinics have only advised me to keep observing.
However, I am concerned that delaying treatment might lead to the need for a root canal.
I would like to know if there are more proactive treatment options (such as seeing another dentist) or if I should just relax and not worry (I also fear that being overly concerned might lead me to misinterpret the situation as merely a post-treatment reaction).
Should I schedule regular follow-up appointments (and if so, how often)?
These are some of my questions, and I appreciate your response.
Thank you!

Shu Shu, 20~29 year old female. Ask Date: 2019/08/29

Dr. Huang Tingfang reply Dentistry

Dear Ms.
Shu Shu,
Hello! As mentioned, the main issue is pain in the upper left teeth (the third molar from the back, and sometimes the second molar).
A clinical examination is essential for diagnosis and immediate treatment.
The third molar has undergone root canal treatment, and if it is painful, there may be a possibility of root fracture.
If the second molar has decay and is painful, please seek root canal treatment promptly to avoid further discomfort.
You may also visit a hospital for a detailed examination.
Take care! Wishing you peace and smooth recovery!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2019/08/29

More Info

When it comes to dental issues, particularly those involving cavities and root canals, it is essential to understand the nuances of dental health and when to seek further treatment. Based on your description, it seems you are experiencing discomfort in your upper left teeth, specifically around the second and third molars, which have undergone previous treatments. Here’s a comprehensive breakdown of your concerns and recommendations based on established dental practices.

1. Understanding X-ray Results: If your X-ray shows no visible issues, it generally indicates that there are no significant cavities or infections present in the areas examined. However, X-rays can sometimes miss early-stage cavities, especially if they are located in areas that are difficult to visualize. If you have had recent dental work, such as fillings, it is possible that the sensitivity you are experiencing is a normal reaction to the procedure, particularly if the filling is close to the nerve. It’s important to communicate with your dentist about any ongoing discomfort, as they may need to monitor the area more closely.

2. Determining the Need for Root Canal Treatment: The need for a root canal is typically determined by the presence of pain, swelling, or sensitivity that persists, especially to hot or cold stimuli. While X-rays can help identify issues such as abscesses or bone loss, they are not always definitive for diagnosing the need for a root canal. If you are experiencing a sensation of itching or swelling rather than sharp pain, it could indicate gum irritation rather than nerve damage. However, if the discomfort persists or worsens, further evaluation may be necessary, potentially including a referral to an endodontist (a specialist in root canal treatments).

3. Choosing the Right Dental Provider: Given your ongoing symptoms, it may be beneficial to return to the B dental clinic where you have had previous treatments, especially since they have a history of managing your dental care. They may have a better understanding of your dental history and can provide a more comprehensive evaluation. If you feel that the A clinic did not address your concerns adequately, seeking a second opinion from another dentist or returning to B clinic could be a prudent choice. It’s crucial to feel comfortable with your dental provider and to have open communication about your symptoms and concerns.

4. Monitoring Your Symptoms: Since you mentioned that the sensation of swelling and itching has been decreasing, it may indicate that your body is healing from the recent dental work. However, it’s essential to remain vigilant. If the symptoms return or worsen, do not hesitate to seek further evaluation. Regular check-ups are vital, and if you notice any changes in your symptoms, such as increased pain or swelling, it may warrant an earlier visit.

5. Managing Anxiety and Expectations: Dental anxiety is common, especially when dealing with complex issues like root canals and cavities. It’s important to manage your expectations and understand that some discomfort can be a normal part of the healing process. However, if you feel that your concerns are not being taken seriously, or if you are not receiving satisfactory answers, it is entirely reasonable to seek a second opinion.

In conclusion, while X-rays can provide valuable information, they are not the sole determinant of dental health. Continuous communication with your dental provider, monitoring your symptoms, and seeking further evaluation when necessary are key to ensuring your dental health remains optimal. If you have any further questions or concerns, do not hesitate to reach out to your dentist for clarification or additional support. Your comfort and health are paramount, and proactive management of your dental care will help you achieve the best outcomes.

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