Tooth Pulp Health: Signs of Possible Necrosis

Q: Tooth Pulp Health: Signs of Possible Necrosis

Hello： Sinusitis is not directly related to gingivitis or pulpitis, and there is no need to discuss them together unless a panoramic or CT scan has confirmed that the source of the sinus infection is caused by the pulp or teeth. <br>Otherwise, if the pulp is removed hastily and s

It is difficult to determine whether the tooth is necrotic?

Last year during a dental check-up, it was discovered that my upper right first premolar had a deep cavity.
The dentist informed me that the filling would be deep and could be sensitive due to its proximity to the dental pulp.
For the past six months, I have been avoiding certain foods and minimizing my intake of hot and cold items (I haven't dared to eat ice), and I have been using warm water to brush my teeth (cold water causes discomfort).
I haven't had significant issues until a few days ago when I suddenly experienced sharp pain in the tooth while sleeping, which seemed to coincide with my heartbeat.
After getting up and brushing my teeth with warmer water, I felt pain at that moment.
Since I couldn't see the dentist immediately on the day I went to work, I waited a couple of days, and I noticed that the pain had subsided.
However, when I pressed on my sinuses, I felt soreness.
During my follow-up visit, I informed the dentist that after the two days of pain, I could eat hot and cold foods without any issues.
The dentist mentioned that it could be that the filling was successful, or the pulp might be necrotic.
At that time, the dentist used ice to test the sensitivity (I couldn't undergo electric pulp testing due to orthodontic treatment), and I could slightly feel the cold, suggesting that the pulp might not be necrotic, so I should continue to observe.
Later, I researched online and found information from a dental website stating that dental pulp necrosis occurs in several stages: 1.
Inflammation causes pain, 2.
Pulp necrosis leads to sudden tolerance to hot and cold, 3.
Inflammation spreads to the root.
Based on this description, I feel that my situation aligns more with the second stage, especially since I had been avoiding hot and cold foods for six months, and suddenly being able to tolerate them seems unlikely.
I went back to ask the dentist if it was possible to see any signs of partial pulp necrosis on the X-ray (I was hoping to get an X-ray because I read online that necrotic pulp could show up as dark areas).
However, the dentist explained that unless there is a later development of an abscess, the X-ray would not show inflammation in the root, and currently, the only tests available are electric or cold sensitivity tests, which cannot determine if the pulp is necrotic.
The dentist advised that I should wait to see if the tooth recovers; if it does not and an abscess develops, I may need root canal treatment.
Ultimately, I was prescribed medication and advised to monitor the situation.
I do not doubt the dentist's judgment; preserving the vitality of the tooth without needing a root canal is certainly preferable.
However, if there is already necrosis, it would be better to address it directly to prevent more severe issues like sinusitis.
If the tooth can recover and tolerate hot and cold foods, that would be great, but since I still feel discomfort when pressing on my sinuses, it seems like it hasn't fully recovered, which makes me a bit worried.
The dentist mentioned that it is currently impossible to determine anything further and that I should wait to see if the situation worsens before taking action.
I am wondering if it is truly impossible to detect partial pulp necrosis at this stage? Should I follow the dentist's advice and observe for a while longer, or should I consider seeking a second opinion at another clinic? PS: Currently, I still feel some sensitivity when gently pressing on the tooth, but I can eat hot and cold foods normally, so I am unsure whether there is necrosis or not.

Chen Yan, 20~29 year old female. Ask Date: 2024/03/16

Dr. Lin Jiayong reply Dentistry

Hello: Sinusitis is not directly related to gingivitis or pulpitis, and there is no need to discuss them together unless a panoramic or CT scan has confirmed that the source of the sinus infection is caused by the pulp or teeth.
Otherwise, if the pulp is removed hastily and sinusitis symptoms persist, how can this be explained and managed? Currently, it cannot be determined whether pulp inflammation will necessarily lead to pulp necrosis.
It is recommended to be gentle with your body and have a bit more patience to allow for healing, rather than rushing into treatment.
If invasive treatment is absolutely necessary, consider consulting with an endodontist at a medical center to see if there is an opportunity for vital pulp therapy, which involves placing regenerative materials directly on the pulp, rather than proceeding with root canal treatment without objective evidence of pulp necrosis (unless there are other necessary indications for intensive endodontic treatment, which should be explained by the treating physician).

Reply Date: 2024/03/16

More Info

Tooth pulp health is a critical aspect of dental care, and understanding the signs of possible necrosis can help you make informed decisions about your oral health. Based on your description, it seems you are experiencing a complex situation with your tooth, particularly the right upper first premolar, which has a deep cavity close to the pulp.
When a tooth is affected by decay that approaches the pulp, it can lead to pulpitis, which is an inflammation of the dental pulp. This condition can manifest in various ways, including sensitivity to temperature changes, pain when biting, and spontaneous pain. The fact that you have been avoiding cold and hot foods due to sensitivity is a common response to pulpitis. However, the sudden onset of pain that you experienced while sleeping, which seemed to correlate with your heartbeat, is concerning and suggests that the pulp may be in distress.

The stages of pulp necrosis you mentioned are indeed accurate. Initially, inflammation can cause pain, which may subside as the pulp begins to die. In some cases, patients report a temporary relief from pain, which can lead to a false sense of security. The ability to tolerate hot and cold stimuli after a period of pain does not necessarily indicate that the pulp is healthy; it may suggest that the pulp is necrotic or dying.
Your dentist's approach to monitor the situation is prudent, especially since the symptoms can fluctuate. The use of ice to test sensitivity is a common practice, as it helps determine the vitality of the pulp. If you can still feel some sensation, it indicates that the pulp may not be completely necrotic. However, the presence of discomfort when pressing on your sinus area could suggest that there is an underlying issue, possibly related to the tooth or adjacent structures.

Regarding your concern about X-rays, it is true that X-rays can sometimes show signs of infection or abscess formation at the root of the tooth, but they may not always reveal early stages of pulp necrosis. The absence of visible changes on an X-ray does not rule out the possibility of pulp necrosis. Therefore, your dentist's recommendation to observe the tooth for any changes is reasonable. If symptoms worsen, such as increased pain, swelling, or the development of a fistula (a small pimple on the gums), it would warrant further investigation and possibly root canal treatment.

If you are feeling uncertain about your current treatment plan or the diagnosis, seeking a second opinion from another dental professional can provide additional insights. It is essential to feel confident in your care, especially when it comes to potential complications like sinusitis, which can arise from untreated dental infections.

In summary, while it is possible that your tooth may not be completely necrotic, the symptoms you are experiencing warrant careful monitoring. Continue to follow your dentist's advice, but do not hesitate to seek further evaluation if your symptoms change or worsen. Maintaining open communication with your dental provider about your concerns is crucial for your peace of mind and overall health.

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