Root canal: Now or later?

January 28, 2006 8:00 AM

Root canal: Now or later?

Woe is me. Found out yesterday that I'm probably going to need my very first root canal. Scary in and of itself, but the problem? I'm heading out of the country on Thursday for five weeks. And I'll be in Romania, too, which is not the sort of place where you want to have emergency dental work done! At this point I don't know how "bad" it is, all the dentist was able to tell me was that he suspects one may be needed so he referred me to an endontist.

I've made an appointment with said local endontist for an evaluation on Monday. The receptionist I spoke with said that if I wanted - and the evaluation confirms it's just a routine root canal needed - the doctor may be able to perform the procedure on the spot that very day so the problem could be taken care of before my trip. But I can't help but wonder if it's risky to do that so soon (less than 72 hours) before I hop on a plane overseas? Might it be better to wait until I get back? My ultimate goal here: To under no circumstances have to set foot in a Romanian dentist's office. So all other things being equal, what is the bigger risk: To have a root canal done now and have it potentially become infected while I'm gone, or to let it go for over a month and have whatever nastiness is inside my tooth just keep getting worse and worse and worse? The latter option would require copious amounts of pain medication to boot because this thing already hurts like the dickens. Which leads me to believe that letting this go untreated for another 5-6 weeks could be very bad news, possibly much worse news that having an post-root canal infection.

I of course am going to let the endontist and my dentist be the primary advisors in this decision. But I won't be able to talk to them until Monday, and if this decision is presented to me I suspect I'll have to make up my mind right there as I'm sitting in the chair. So I'm trying to arm myself with as many questions for them as I can so my snap decision feels at least somewhat less snappy. Any thoughts for things I should take into consideration, anecdotal or otherwise, are most appreciated!

posted by globetrotter30 to health & fitness (19 comments total)

IANAD and IHNHARC (never had a root canal), so in a way I'm a lot like you. Weighing the options, I would have the procedure done first and take a bevy of meds with me, thinking that dealing with an infection and Romanian dentistry is more palatable than dealing with an emergency root canal and Romanian dentistry. You will have to be careful about oral hygeine and all, but Romania isn't so backwoods that that would be much more difficult than any other place as long as you are well-prepared and attentive. I would also think that the long plane flight might be easier on post-op pain killers - though I hope you will not be travelling alone.
posted by dness2 at 8:16 AM on January 28, 2006

If you are going to be in rural Romania, then get it done. But if you will be in a major city, it really won't be as bad as you think. What is this mental image you have of a Romanian dentist that terrifies you so? My girlfriend, who grew up in Timisoara, has had major dental work done and dentists here in the states have been impressed with the workmanship. Relax. It's not all shepherds and peasants there...

If you can't relax, then Budapest is one place you are sure to find a great dentist—it's where all the Germans go for their dental work as it is significantly cheaper there than in Germany. In fact, that's where a lot of the good Romanian dentists set up shop...
posted by lovejones at 8:19 AM on January 28, 2006

Getting a root canal as soon as possible is a good idea. I had one and i was totally amazed, the root canal didn't hurt much at all, though it was ooky and creepy feeling. I know other people who have differing reports but I'll just say that it's possible for them not to be painful. I am not a dentist but I think most root canals make your tooth better off than they were which means chances of infection are lower post root canal than pre. They'll give you antibiotics and, unless things have radically changed in Romania since I was there, you will be able to get antibiotics and/or pain meds once you're there.

One thing to be aware of. Once you have a root canal your tooth is dead and empty and brittle. You need to take very good care of it after you get a root canal and before you get a crown or some sort of permanent covering to make sure the tooth doesn't crack. If you get a root canal but no crown [which would take longer than you have time for] be careful with that tooth, don't bite on really hard things, crunch on ice, etc. Normal foods should be fine.

Also, totally OT, I'd love a postcard from Romania. I used to live there and miss it a lot. I'll send you my details.
posted by jessamyn at 8:20 AM on January 28, 2006

You don't want to need an emergency root canal. I had to have a not-quite-emergency one and my tooth really hurt a lot. When you've got to have one, you'll know it by the horrifying, stabbing pain in your jaw. So I'd say, get it done now.

My endodontist offered percocet to me, but I didn't need it and never got it filled. If I recall correctly, they will give you a temporary crown at the endo's office and then your dentist will give you the real one after he makes a mold of the tooth in question. I had my temp for something like three weeks with no problem.

If you are concerned about oral hygiene -- my understanding is that peroxyl is what you're going to want for rinsing. This was recommended to me after an oral piercing and was way better than Listerine.
posted by Medieval Maven at 8:26 AM on January 28, 2006

I've had two root canals. One went off without a hitch. The other did not. I needed a follow-up root canal (so I guess I've had three.). The dentist had not completely removed all the tooth root the first time around, and I had a little bit of nerve in there that still caused me pain.

The upside of the botched one was that it wasn't excrutiating pain, just minor annoying pain.

Questions to ask about drugs:

1) If you have to take any drugs after the procedure, can you take enough for your entire trip?

2) If you don't have it done right away, what painkillers are available, and can you take enough for your entire trip?

Info on traveling with medications here and here
posted by SuperSquirrel at 8:29 AM on January 28, 2006

Do it now. The danger of putting it off is not just continued pain, but a serious abcess (and possibly losing the tooth).
posted by words1 at 8:35 AM on January 28, 2006

I've only had one root canal, but I'd recommend doing it before you travel. It's no fun being in a hotel room in a strange city at 3am panicking over finding a local dentist b/c your whole head is in pain. This happened to me, but luckily (weirdly) the pain calmed until I got home and required an emergency root canal. Like Medieval Maven, I didn't have to fill my prescription for pain meds. The procedure wasn't fun and took a while, but wasn't nearly as horrible as I'd imagined.

Perhaps they'll give you a sample pack of antibiotics incase you need it while traveling.

Another thought: my insurance covered 80% and if yours does the same, I would imagine getting it done locally would be easier $-wise than figuring that all out in another country.
posted by jdl at 8:51 AM on January 28, 2006

Gosh, you guys are fast - and smart! Thank you all for the advice. I had gotten a vibe from the dentist that he thought it was a bad idea to do it so soon before leaving, so I had been leaning a little that way myself. But after your responses I think I'll pursue the possibility of ROOT CANAL: STAT!! more aggressively with the endontist on Monday.

And to the first three commenters, I was being a bit overly dramatic with my fear of Romanian dentists! No offense to the country was meant. I love Romania, this will be my fifth extended trip there, I know it's not all shepherds and peasants! But I have heard enough first-hand dental horror stories from friends there (much of the "If it hurts, we pull it" variety) to make me a bit leery of needing to be treated there myself. With a little work I'm sure I'd have no problem finding a referral to an excellent dentist there, but still I'd like to avoid being treated overseas for other obvious reasons as well: The potential language barrier, time being taken away from volunteering with the kids, the inevitable insurance mess afterwards, etc. etc. etc. I was just trying to simplify things in my already-too-long question!
posted by globetrotter30 at 9:00 AM on January 28, 2006

Why does the doctor tell you that you need a root canal? Usually that's not something you need to be told, as you should be experiencing some symptoms, no?

If it's just "I don't like the looks of this loose crown" or whatever, or "you better keep an eye on this," I wouldn't worry too much.

Speaking of travel, I am saving up some dental work for the next time I am in a country where people have really small hands.
posted by StickyCarpet at 10:11 AM on January 28, 2006

It doesn't really matter where you are going; what matters is that you are getting on an airplane. If it's an abscess that has been spotted on an X-ray, I can tell you from experience that the changes in pressure that come with air travel can affect the abscess in painfully unpleasant ways.

Just. Do. It.
posted by ambrosia at 11:06 AM on January 28, 2006

remember that the infected tooth will NEVER get better on its own. you mention that it already 'hurts like the dickens'? you've already waited too long. do it as soon as possible. tooth-nerve pain is horrid, and doesnt respond to OVT pain killers, btw.

so, i had one root canal done over the summer and it wasnt bad at all. basically no pain. the worst part is that it is just a long process, and i had to go to the office for two sessions over the span of three days. It took about 4 hours total to remove the root, clean the decay and fill it again.

my endodontist didn't do the whole process right away because he said removing the root is such an invasive, traumatic process, that the tooth needed 24 hours to calm. they first removed the root and cleaned the decay out for the first session. the second session was an additional, deeper cleaning, and then a filling with a temporary paste. maybe this is why your endodontist was concerned that it might have to wait until after you return? there simply may not be enough time to perform the process correctly before you depart?

the after-care is extremely extremely simple. you will have a tiny bit of residual soreness in the tooth, that should go away within 48 hours. i was told not to eat hard food on it for a week, but i waited until i was able to get a permanent cap put on. so after-care for me was basically eating fruit, soft cereals, and other such things.

the only time i needed painkillers was during the week before i was able to get an appointment with my endodontist. once he removed the root, there was no pain at all...

btw, i paid $1,500 out of pocket for mine, as i went with the head endodonist in the entire state. i was told not to fuck around with root canals, as you risk re-infection if the decay isnt properly cleaned. so i pass on the same advice...
posted by naxosaxur at 11:49 AM on January 28, 2006

Why does the doctor tell you that you need a root canal? Usually that's not something you need to be told, as you should be experiencing some symptoms, no?

Not necessarily. If, for example, a cavity is pretty close to a nerve the dentist may recommend a root canal before the cavity gets any larger and causes pain. Or sometimes if the tooth needs a crown, then they'll do a root canal first. It's not always an "emergency" measure.

But if the tooth hurts, as the poster says it does, then it shouldn't be put off. But you will almost certainly go to Romania with a temporary filling in, so chew gently.
posted by jrossi4r at 12:25 PM on January 28, 2006

I'm in the "do it now" camp. I had a molar break just before a vacation and stupidly ignored it and spent the whole trip avoiding certain foods and packing that weird pain-killing gum stuff in the hole, which I would end up chewing, thereby numbing my whole mouth. If I could do it over again, I would get the root canal ASAP.

That said, I've now had 2 root canals and been amazed at how little pain was involved. After the first one I atually went back to work since my mouth was still numbed up and I was feeling fine.
posted by Biblio at 12:50 PM on January 28, 2006

Do it now.

Especially if you are going to en Endodontist.

I've had 4 root canals in the last few years. I can tell you that the pain from a root canal is nowhere *near* the pain you will be in with an infected tooth in the middle of Romainia.
posted by punkrockrat at 1:23 PM on January 28, 2006

Make sure they send you to a good endodontist. You'll have to trust your dentist for this one. Mine was done the same day, and the guy was very quick. I've had a few done by different people (was in different states) and always was put on antibiotics afterwards and pain medications. It wasn't bad, and at least the tooth pain that I had prior to it was gone.
posted by 6:1 at 2:22 PM on January 28, 2006

Another vote for doing it now. Once it's done, a root canal should cause you next to no trouble. Compared to the pain of needing one, it's insignificant. I've never been given pain meds for afterwards either, and I didn't need them. Maybe a Tylenol, but that's it. And the actual process isn't that horrible either, if you're properly frozen. For me, the worst part was the smell, of all things. And that damn rubber dam. Overall, no biggie. The fear of a root canal is also worse than the actual experience.
posted by cgg at 3:01 PM on January 28, 2006

Now, now now now now now now now. An abcessed tooth is bad enough. Having one in a foreign country is, like, one of my recurring nightmares. Gently bite the bullet and get it over with. Get it done before you go.
posted by crunchland at 3:26 PM on January 28, 2006

You're having to choose one of two undesirable alternatives. The possibility of having a tooth absess while you're overseas is much less desirable than the choice of getting the root canal done and over with before you leave.

Go with the endodontist's recommendation as to whether you should go ahead Monday or wait til after the trip. And take a supply of antibiotics and pain killers with you (though those should be easily available in Romania).

I've had maybe ten root canals (my teeth are like chalk) and nowadays they're not all that bad. In fact, I had one done a couple of months ago and it was actually a very relaxing experience--except for the cost. So don't worry too much.
You might ask for nitrous oxide--it calms you down, and is really helpful.
posted by gg at 3:30 PM on January 28, 2006

Although I'm apparently the odd one out (story below), I'd still get it done before leaving the country.

I'm two-thirds of the way through a root canal (my final appointment is Wednesday). Because of my extreme fear of pain I've avoided doing this for over five years. However, I've been lucky and hadn't had much pain in these five years. Your pain may vary.

I have to say my dentist rocks and I've used four, maybe five, Tylenol 3 to help with the pain. Also the pain has been more from where he put in the novocain and the awkward positions my mouth was put in.

If anyone wants a referral to a dentist in the Fraser Valley area of British Columbia, my email address is in my profile.
posted by deborah at 7:12 PM on January 28, 2006