Do I need this root canal?
May 17, 2011 10:08 PM   Subscribe

Do I really need a root canal on a tooth that has no symptoms, but that the dentist is suddenly *very* concerned about?

I've recently been told by my dentist that he thinks, although he is not sure, that I may need a root canal on a premolar. This tooth has a large filling in it, and has not caused me a lick of trouble since the filling was put in about 7 years ago. I went in to a new dentist a year ago, who took x-rays and never said anything about that tooth. Two weeks ago, her colleague looked at the x-rays and told me he thought he spotted an abcess on the tip of the root (!), and that the tooth seems dead to him, needs a root canal, all that. So he's referring me to an endodontist, who I will see tomorrow. My question is, is this common? In the research I've been doing, teeth that need root canals make themselves known, and I just don't know what to think. I certainly don't want to have work done that doesn't need to be done. Does anyone have any experience with invisible abcesses that don't cause pain? Also, is there anything I should ask my endodontist when I see him? I don't know what I'm supposed to ask in regards to this procedure.
posted by I_love_the_rain to Health & Fitness (19 answers total) 3 users marked this as a favorite
One of my molars was capped six years ago, and the dentist has said it looks "stormy" on X-rays. He proposed a root canal five years ago and I declined it. It gave trouble intermittently for a couple years, nothing salt water rinses didn't fix.

Fast forward to last October, when I had some weird sinus symptoms including quite a bit of swelling. I called both GP and dentist; the dentist reiterated his proposal of the root canal. It turned out to be an infection in the sinus, which cleared up with Keflex.

The tooth has sensation, no pain, and it works just fine. I am considering finding a new dentist. I would get a second opinion. A root canal is not something one does casually, in my opinion.
posted by jet_silver at 10:24 PM on May 17, 2011 [1 favorite]

I had a root canal in 2008. It takes about an hour and a half if the endodontist decides work may be done. It's not a painful procedure, but it's incredibly long. The real pain is to your wallet, especially if you decide to have a crown done. Crowning is something you will want to ask either professional about. Otherwise it is pretty straight forward - the endodontist exams the site ans takes an X-ray. Then the root canal is done. There are follow up visits to make sure it was doing well. Good luck!
posted by Calzephyr at 11:12 PM on May 17, 2011

My root canal on a rear molar two years ago required adjustments and a re-do, after some missing roots were found on a subsequent x-ray. It was expensive and involved about three months of pain, and is not something I would do again without a second opinion.
posted by Blazecock Pileon at 11:58 PM on May 17, 2011 [1 favorite]

I've seen dentists predict as-yet-invisible problems.

I went to a new dentist "that wisdom tooth should come out". I said no, it felt fine.

I went back a year later with the tooth infected and in pain.We both agreed that it should come out.

I'm not saying it always works, but they do sometimes know what they're doing!
posted by curious_yellow at 12:25 AM on May 18, 2011 [1 favorite]

Perhaps I'm not remembering properly, but if the root is dead you'll both need a root canal, and be unable to feel anything.
posted by plonkee at 1:04 AM on May 18, 2011

I had a root canal about five years ago on a tooth where I felt nothing was wrong - eg it felt fine, no pain, no particular sensitivity.

I was convinced into since the tooth was one of my two big front ones on top, which are so thin that even in natural light I could see that the left one was darkening. My dentist indicated that was the root dying (which, in turn, explains why I didn't feel anything...well, apparently less than normal not feeling anything).

It wasn't that painful, but it could be because the tooth was already dead/ it was easy access. It was somewhat expensive, but dental insurance covered about 80% of the procedure for me.
posted by CharlieSue at 4:46 AM on May 18, 2011

I had a root canal on a tooth that had an obvious problem [to me, not only my dentist], but also didn't hurt before the procedure. It's possible your new dentist missed the problem on the x-rays and her colleague could be saving you from problems/pain down the road.

Nonetheless, when you see the endodontist, feel free to bring up that this wasn't spotted originally a year ago and, in his/her opinion, is there actually anything to worry about? Since the x-rays are old, the endo should want to do their own diagnostic to assess the current situation before going ahead with treatment. Also ask about what they intend to do after the root canal -- replacement filling, crown/cap, etc.

BTW, a root canal itself is not the horror that popular media makes it out to be IME, in case you're worried about that. It was a painless 90-ish minute procedure for me for a full root canal and filling. I had local anesthetic.
posted by asciident at 5:21 AM on May 18, 2011

I give the same advice in "is my dentist trying to take advantage of me?" questions.

If you think s/he is, or might be, it's time for you to get another dentist.
posted by bilabial at 5:23 AM on May 18, 2011

Like with anything else - get a second opinion from a uninvolved third party.

I've had dentists push for root canals because they didn't like the look of fillings.
I've had them push for root canals because they didn't want the tooth to break from a big filling.
I've had dentists for two decades push for wisdom teeth removal because they would "cause me trouble" -- I'm in my thirties and still have all four wisdom teeth.

I don't know if everyone's motives have been pure. I always question and want to see xrays myself.

It's really not the horror that people make it out to be. I've had a few of them, and even had a dental student try to do one without properly numbing the nerve (how she got out of there without me punching her in the face, that's anyone's guess). But when it's done properly, it's mildly uncomfortable after (take a Tylenol). The real bear is the time you're in there with someone poking around in your facial cavity. Also the smell of drilling - ugh.
posted by jerseygirl at 5:48 AM on May 18, 2011

Get a second opinion. But if he's referring you to someone else, that makes it less likely that he's trying to rip you off; he could certainly be wrong, though.
posted by J. Wilson at 6:15 AM on May 18, 2011

I did have a decade-old filling that the dentist said looked like it had a cavity growing under it, so the filling came out and got refilled. At that point the dentist said that it might not work properly because the cavity might have gotten too close to the root, and there might be a need for a root canal, but we could wait. Three weeks later I wake up in the wee hours of the morning with my face throbbing. They call in pain meds and a few days later I'm in there for a root canal. I was terrified, but the actual process was painless; the worst part was how things smelled (grinding on teeth + bleachy smells!).

Overall, my two points are that 1) you definitely should get a second opinion if you feel that way, as this isn't something that you're going to miss a window on if you aren't yet feeling pain. If the pain hits, you'll know you have to do something asap, and 2) the root canal process isn't as scary as we often hear about (although it can be quite costly).
posted by bizzyb at 7:08 AM on May 18, 2011

I would never get a root canal as a preventative measure. I have had several root canals and discovered that now, several years later, those teeth have become brittle and one that I spent several thousand dollars on (root canal and crown) cracked and had to be pulled. The others are being watched. Because of this problem, I tend to take my dentist's recommendations on things other than fillings as advisory only and basically listen first to my body. Does it hurt? Is it infected? Is it bleeding? If not, I take a pass and figure I will deal with it when my tooth lets me know there's a problem.
posted by eleslie at 7:10 AM on May 18, 2011 [1 favorite]

I had a definite abscess that had no symptoms (the tooth had been injured in an accident and the nerve eventually died.

One thing my dentist did was apply ice directly to the tooth to determine sensation. The difference between having ice pressed against a live tooth versus the dead one was very unambiguous, the icing caused sharp pain in a live tooth very quickly and nothing at all in the dead one.

If I was getting offered a root canal (I've had 3, BTW, all long-term results of the same injury mentioned above) on a "maybe" abscess I would definitely want a more definite opinion, the procedure isn't as serious as full-on oral surgery but it's unpleasant and involved and costly.

On the other hand, I've had an abscess go on me very quickly as I scrambled to arrange for an emergency root canal and that is an experience I would do a lot to avoid again. The pain was excruciating. So I would definitely not just adopt a wait and see attitude.
posted by nanojath at 8:56 AM on May 18, 2011

As a comparison to eleslie's experience (not to discount it at all, just as a counterexample) I had my root canals nearly 20 years ago and got crowns (replaced the visible portion of the teeth with permanently attached prosthetic caps) about 10 years ago (the crown were in response to visible greying of the teeth and concerns about tooth integrity/strength which I gather is a very common long-term issue with root canals). None of these teeth have given me any further trouble.
posted by nanojath at 9:02 AM on May 18, 2011

It sounds to me like your dentist has taken a rather conservative approach to this. You are being sent for a second opinion for a questionable area on a radiograph.
Teeth become nonvital (dead) for a variety of reasons, sometimes there are symptoms, sometimes not. But a questionable shadow on an x-ray is what we call a 'sign' that there might be something wrong, and in this case the dentist believes it's worth a closer look. seems like you are being well taken care of.
As to what you should ask the endodontist; he/she should be able to walk you through the tests to determine whether the tooth is vital (alive) or not, and give you a prognosis on tredatment vs. nontreatment.
good luck
posted by OHenryPacey at 9:26 AM on May 18, 2011

I'll second everything said above - when the pain starts, it is BAD, so you want to avoid getting to that point. Getting an endodontist rather than a dentist to do the work is a very good idea. The procedure is (IME) painless with local anesthetic, it was not an ordeal. But you don't want to get one unless it's needed, because a root canalled tooth has a limited life span (which can be decades) -- ask your dentist and endo about this aspect, and get a second opinion or a third if you are still skeptical.
posted by LobsterMitten at 9:44 AM on May 18, 2011

I've had a root canal after being convinced it was necessary.
Although I have benefited greatly from dental care in controlling gum disease,
I also know for a fact that there is a huge behind the scenes industry which educates dentists, orthodontists and periodontists in marketing their services and maximizing their profits. I am therefore always suspicious whenever they recommend anything to me. My rule of thumb is always that I must experience some discomfort before I'll go for the procedure.

Get a second opinion from somebody else, mate!
posted by No Shmoobles at 1:21 PM on May 18, 2011

Got that second opinion today, and no root canal needed! Thanks for the responses, all. Definitely helpful. The spot that the dentist thought was an abcess was actually where one of the big nerves ended (leaving a sort of open space under one of the teeth). Nothing to be concerned about. Yay for saving money!
posted by I_love_the_rain at 5:11 PM on May 18, 2011 [1 favorite]

apparently dentists are legally obligated to offer you a solution/treatment, so always assume they are going to make it sound like the worst.

for anybody considering a root canal, i would read this and this first
posted by glassy sesames at 6:41 PM on June 1, 2011

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