Do I Need Root Canal Treatment? Tooth Pain and Care

Is root canal treatment necessary?

Hello Dr.
Tseng, I would like to ask you about a tooth that started throbbing with pain the day after I had my teeth cleaned.
It is sensitive to both cold and hot water, and the pain has kept me awake for two nights.
Taking Tylenol hasn't helped much.
Since the clinic was closed for the holiday, I went to the pharmacy to buy anti-inflammatory pain relievers, and the next day I went to the dentist for an examination.
The dentist found that the problematic tooth had been filled over ten years ago, and he suspected that there might be a cavity in the filling allowing bacteria to enter.
He prescribed me medication for three days and said that if there was no improvement, I would need a root canal treatment; if it improved, I wouldn’t need to return for a follow-up.
At that moment, I was in so much pain that I forgot to ask many questions, and now I remember I have some concerns.

I have researched a lot online, and my situation seems similar to acute pulpitis.
However, the information I found states that "after the acute phase of pulpitis subsides, the pulp nerve may completely die and enter a chronic phase, where it no longer feels pain from hot or cold foods or brushing.
If this is overlooked and left untreated, bacteria can continue to spread within the necrotic nerve root canal." So my question is, if I take the medication for three days and no longer feel pain, will not returning for treatment lead to more serious issues? The dentist did take an X-ray of that tooth but didn’t explain much to me.
Can X-rays be used to determine whether root canal treatment is necessary? Do I need to return for further examinations, or should I wait until the next episode of pain to address it? Thank you.

Jia Yin, 30~39 year old female. Ask Date: 2021/10/25

Dr. Zeng Guanghui reply Dentistry

After taking medication for three days, the inflammation of the dental nerve may have alleviated and returned to normal.
However, it is also possible that the dental nerve is gradually degenerating and dying, with bacteria still present in the nerve tissue.
Ultimately, this could lead to an apical infection and inflammation.
It is recommended that if the pain symptoms improve due to medication, you should still return to the dentist for further examination.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2021/10/25

More Info

To determine whether you need root canal treatment, it's essential to understand the underlying causes of tooth pain and the implications of delaying treatment. Based on your description, it seems you are experiencing symptoms consistent with acute pulpitis, which is an inflammation of the dental pulp often caused by decay, trauma, or previous dental work that has failed.

When you experience sharp pain in a tooth, especially after dental cleaning, it can indicate that the pulp inside the tooth is inflamed or infected. The fact that you have sensitivity to hot and cold, along with significant pain that disrupts your sleep, suggests that the nerve within the tooth may be compromised. If the pain subsides after taking medication, it might provide temporary relief, but it does not necessarily mean that the underlying issue has resolved.
You mentioned that your dentist prescribed anti-inflammatory medication and suggested that if the pain does not improve, a root canal treatment may be necessary. This is a common approach because root canal treatment is designed to remove the infected or inflamed pulp tissue, thereby alleviating pain and preventing further complications. If you experience relief from the medication, it might be tempting to skip a follow-up visit; however, this could lead to more severe issues down the line. If the pulp has become necrotic (dead), the tooth may not exhibit pain, but the infection can still spread, potentially leading to an abscess or systemic infection.

X-rays are a crucial diagnostic tool in dentistry. They can reveal the extent of decay, the condition of the pulp, and any signs of infection at the root of the tooth. If your dentist performed an X-ray and noted any abnormalities, such as dark spots around the root, this could indicate infection that may require root canal treatment. X-rays can also help identify any additional issues, such as fractures or other dental problems that may not be immediately apparent during a clinical examination.

In your case, if the pain returns or if you notice any swelling, fever, or persistent discomfort, it is crucial to return to your dentist for further evaluation. Waiting until the next episode of pain could lead to complications that may necessitate more invasive treatment, such as extraction.
In summary, while temporary relief from medication can be reassuring, it is essential to follow up with your dentist for a thorough evaluation. Root canal treatment is often necessary when there is significant pulp damage or infection, and delaying treatment can lead to more severe complications. If your dentist has recommended further examination or treatment based on your symptoms and X-ray findings, it is in your best interest to adhere to that advice to ensure the long-term health of your tooth and overall oral health.

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