Tooth Decay: Insights on Root Canal Treatment for Molars

Cavity in the upper left third molar?

Hello, Doctor: I regularly visit the dentist for cleanings and have had issues with cavities for many years, with the upper left third molar being the most severe.
Last year, the dentist suggested a root canal, but I refused because I have never experienced pain (in fact, none of my cavities have hurt, although I used to bleed when brushing thoroughly, which later stopped).
Instead, I had it filled with silver amalgam, but it fell out a few days later, so I had it refilled with resin.
During this year's routine check-up, about a month before my appointment, a small piece of the filling came out.
Since then, I have noticed that sometimes when I bite down on harder foods (like chicken noodles) or when food gets stuck between my second and third molars, my gums become swollen and slightly painful.
Otherwise, my teeth and gums don’t hurt, but I experience soreness when biting down.
These symptoms are bearable and don’t significantly affect my daily life (if it hurts too much, I just chew on the other side).
This situation doesn’t happen every day, but it’s quite bothersome to report back to the dentist.
Upon hearing my report, the dentist said there is pus and that I need a root canal.
However, I wonder if simply refilling the area where the filling fell out would suffice.
Other people experience excruciating tooth pain, but I only started feeling a little pain after losing a small piece, and the dentist didn’t take any X-rays.
Is it really possible that the decay has reached the nerve? After all, a root canal involves a series of treatments, and once done, my tooth cannot return to its original state.
I would also need a crown in the future, and if that doesn’t go well, I might even need an extraction and implant, which is quite frightening to think about.
P.S.
I previously used dental floss (with wax), but I couldn’t get it into the gaps between my teeth no matter how hard I tried, and forcing it caused bleeding, so I gave up.
Additionally, my teeth are hard to maintain due to the molars and wisdom teeth, and there is a family history of periodontal disease.
Please help me with some advice; there is a lot of conflicting information online, and my dentist has too many patients to explain things to me, not even how a root canal is performed...

A Mang, 20~29 year old female. Ask Date: 2021/12/02

Dr. Zeng Guanghui reply Dentistry

If the third molar has extensive decay, and there was a previous filling that has chipped off slightly, resulting in occasional sensitivity or pain, it is advisable to consult a dentist for an examination.
An X-ray can be taken to assess the depth of the decay and determine whether it is close to the dental pulp, which will help decide if a new filling is needed or if root canal treatment should be considered.
Dr.
Tseng Kwang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2021/12/02

More Info

Tooth decay is a common dental issue that can lead to significant complications if not addressed promptly. In your case, it appears that you have been experiencing ongoing problems with your left upper third molar, which has been diagnosed with decay that may require root canal treatment. Your reluctance to undergo this treatment due to a lack of pain is understandable, but it’s crucial to recognize that tooth decay can progress silently, often without noticeable symptoms until it reaches a more advanced stage.

When a tooth decays to the point where the pulp (the innermost part of the tooth containing nerves and blood vessels) is affected, it can lead to pulpitis, which is inflammation of the pulp. This condition can eventually result in infection, leading to the formation of an abscess, which is likely what your dentist is referring to when they mention the presence of pus. The symptoms you describe, such as occasional swelling and tenderness in the gums, especially when biting down on hard foods, are indicative of potential pulp involvement or periodontal issues.

The decision to perform a root canal treatment (RCT) is typically based on the extent of decay and the condition of the tooth. If the decay has reached the pulp, RCT is often necessary to save the tooth. During this procedure, the dentist will remove the infected pulp, clean and disinfect the root canals, and then fill them with a material to prevent further infection. Following RCT, a crown is usually placed on the tooth to restore its function and appearance.

You mentioned that your dentist did not take X-rays during your last visit. This is concerning, as X-rays are essential for diagnosing the extent of decay and determining whether the pulp is involved. I recommend discussing this with your dentist and requesting an X-ray to assess the condition of your tooth accurately. If your dentist is not willing to take this step, it may be prudent to seek a second opinion from another dental professional who can provide a thorough evaluation.

Regarding your concerns about the permanence of RCT and the potential need for future treatments, it’s important to understand that while RCT is a highly successful procedure, it does not guarantee that the tooth will remain problem-free indefinitely. Factors such as the quality of the initial treatment, the tooth's structural integrity, and your oral hygiene practices play significant roles in the long-term success of the tooth.

If you choose to postpone RCT and only have the visible decay filled, you risk allowing the decay to progress further, potentially leading to more severe pain and complications that could necessitate extraction. Given your family history of periodontal disease and your current dental challenges, it is crucial to take proactive measures to maintain your oral health.

In summary, while the fear of dental procedures is common, it is essential to prioritize your dental health. I encourage you to have an open and honest discussion with your dentist about your concerns, the necessity of X-rays, and the implications of delaying treatment. If you feel that your current dentist is not addressing your needs adequately, seeking a second opinion can provide clarity and help you make an informed decision about your treatment options. Remember, early intervention is key to preventing more extensive and costly dental work in the future.

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