Tooth Sensitivity and Root Canal Treatment Options

Tooth sensitivity and root canal treatment?

Hello, Doctor! I originally had a sensitivity issue with my front teeth, and it's a long story.
On the night of November 25, I experienced hyponatremia and was admitted to the emergency room, then spent three days in the intensive care unit.
Since I was lying down for those three days, I didn't have the chance to maintain oral hygiene.
After being transferred to a regular ward, I noticed that the three front teeth were unable to properly occlude.
After being discharged on December 1, I visited a dental clinic on December 3.
The dentist examined my teeth and found no cracks.
I explained that I had a seizure during the emergency, after which I couldn't remember anything.
The dentist suggested that there might have been external force applied to prevent me from biting my tongue during the emergency.
After a cleaning, I was advised to use a desensitizing toothpaste.
The dentist also noted some mobility in the teeth and advised me to observe them for up to three months.
He mentioned that if there were no cracks, the issue was likely due to external force, and the occlusion would gradually improve.
If it did not improve, the teeth might eventually fall out within three months, necessitating dentures.
About a week later, I started experiencing pain when eating cold or acidic foods, so I went back for another check-up.
The dentist examined me closely and found no issues, no periodontal disease, or gum problems.
He performed disinfection treatment and advised me to continue monitoring the situation.
I then visited another clinic where X-rays were taken, and the dentist again confirmed no cracks or periodontal issues, recommending the use of desensitizing toothpaste.
However, I felt I had regained some biting strength.
Now, drinking cold water causes pain, but it subsides quickly.
I applied desensitizing toothpaste a few times, and when I felt slightly better, I gently tapped the teeth (the dentist advised against applying external force, but I did it to confirm the condition).
I found that the pain, which previously affected all three teeth, is now mostly concentrated in the middle one.
The other two occasionally feel sensitive, but the desensitizing toothpaste works for them.
The middle tooth has biting strength, but if I push it from the outside with my finger, it feels slightly uncomfortable and painful.
Later, I went to the hospital, and after taking X-rays, they first extracted the upper left wisdom tooth because the adjacent tooth had a deep cavity.
I did not feel any pain, but the dentist said that the decayed tooth would require root canal treatment and a crown.
After reviewing the X-rays of my front teeth, the dentist indicated that the middle front tooth seemed to have some issues, with possible pulp inflammation.
If it does not heal on its own, root canal treatment will be necessary.
After the wisdom tooth extraction, I was prescribed antibiotics for three days, which I have completed.
There is minimal pain at the extraction site, but regarding the adjacent tooth with a deep cavity...
does it really need a root canal? Can't it just be filled? The clinic dentist said it was close to the nerve (but not yet there), while the hospital dentist directly stated that it needs to be done.
As for the front teeth, I am uncertain whether to proceed with treatment.
Will they heal on their own? How long should I continue to observe? Currently, the front teeth are no longer mobile.
Thank you!

ken, 30~39 year old female. Ask Date: 2015/12/29

Dr. Zeng Guanghui reply Dentistry

The lower front teeth may have been subjected to excessive force, affecting the periodontal ligaments and potentially impacting the dental pulp nerves within the teeth, leading to symptoms of tooth sensitivity.
If the dental examination shows no cracks, as long as excessive occlusal forces are avoided, there is a chance for the affected nerves to gradually recover.
However, it is also possible that nerve inflammation could be irreversible, which may result in increasing pain in the future, potentially necessitating root canal treatment.
After the extraction of the upper wisdom teeth, it is advisable to perform root canal therapy on the adjacent tooth that has deep decay to prevent bacterial infection at the root apex.
Regular follow-up examinations with a dentist are recommended.

Reply Date: 2015/12/29

More Info

Tooth sensitivity and the need for root canal treatment can be complex issues, especially after experiencing trauma or dental procedures. Based on your detailed description, it seems you have been through a significant amount of dental evaluation and treatment, and I understand your concerns regarding the sensitivity of your teeth and the potential need for root canal therapy.

First, let's address the sensitivity you are experiencing. Tooth sensitivity can arise from several factors, including:
1. Enamel Erosion: This can expose the underlying dentin, leading to sensitivity, especially to hot or cold stimuli.

2. Gum Recession: If the gums recede, the roots of the teeth may become exposed, which can also lead to sensitivity.

3. Dental Trauma: As you mentioned, the trauma from your medical emergency could have affected the teeth, leading to inflammation of the pulp (the innermost part of the tooth containing nerves and blood vessels).

4. Dental Procedures: Any dental work, including fillings or crowns, can sometimes lead to temporary sensitivity as the tooth adjusts to the new material.

In your case, it sounds like the middle tooth is particularly sensitive, and while the other two teeth have shown some improvement, they still experience occasional discomfort. The fact that your dentist has not found any visible cracks or periodontal issues is a positive sign, but it does not entirely rule out the possibility of pulpitis (inflammation of the dental pulp), which can occur even without visible damage.

Regarding the need for root canal treatment, it is essential to consider the following:
- Pulp Vitality: If the pulp is inflamed but still vital, it may heal on its own with time and proper care. However, if the inflammation persists or worsens, root canal treatment may become necessary to prevent further complications, such as infection or abscess formation.

- Extent of Decay: If the decay is close to the nerve, as indicated by your dentist, it may be wise to proceed with root canal treatment to prevent future pain or infection. While some dentists may suggest filling the tooth if the decay has not yet reached the nerve, others may recommend root canal treatment as a precautionary measure.

- Observation Period: If your dentist believes that the tooth may heal on its own, they might suggest a period of observation. This could range from a few weeks to a few months, depending on your symptoms and any changes in the tooth's condition.

As for your front tooth, since it has shown improvement and is no longer mobile, it may not require immediate intervention. However, if you continue to experience sensitivity, especially with cold liquids, it would be prudent to keep monitoring the situation. If symptoms persist or worsen, a root canal may be necessary.

In summary, while it is possible that your teeth may heal with time and care, it is also essential to remain vigilant. Using desensitizing toothpaste can help alleviate some of the sensitivity, but if the pain persists, consulting with a dental specialist for further evaluation and possibly a root canal treatment may be the best course of action. Always communicate openly with your dentist about your concerns and symptoms, as they can provide tailored advice based on your specific situation.

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