Expert: Gary Backlund, DMD, MSD - 10/27/2008

Question
Different dentists and endodontists have disagreed on whether I should get RCT on an upper molar or wait & see if it gets better.  The tooth has been giving me pain on and off but responds normally to cold. Those who favor treatment say I risk an abscess & major complications if I don't get it treated right away.

I was wondering, if this tooth turns necrotic, how fast can an abscess develop?  Once the abscess can be seen on an X-ray, is it often too late to save the tooth through RCT - at what point does the prognosis go down sharply?  Can an abscessed tooth be life threatening even to someone in otherwise good health?

Answer
Hi Jonathan,

I'm sorry to hear you're going through this dilemma. I'll try to answer your questions as best I can, but NOTHING in the human body is ever for sure, but I can give you some general guidelines.

When teeth turn necrotic, it is a process that occurs over a period of time. In most cases, it is quite gradual taking weeks. Some teeth never even become painful and are only discovered on routine X-rays...that why dentists take full mouth X-rays about every 5 years. It is highly unlikely that your tooth would ever get to the point where it could not be saved by a root canal. About the only time a tooth is lost is when it is so badly broken down that there is nothing left to fill or when the support of the tooth has been compromised. Your biggest risk is pain and/or swelling. Even then, with treatment the tooth can be saved. The prognosis is really not affected by the length of time or when the tooth abscesses. Prognosis is affected by the number of roots, the difficulty of treatment and the skill of the dentist. The only real risk to your health is temporary and short term. Abscessed teeth are NOT life threatening in healthy adults if treated. Like I said, the problems associated with abscessed teeth are pain & swelling.

As an aside, as long as your tooth feels cold, it is NOT abscessed. You have an inflamed nerve and blood supply. The issue, as you have found out, is whether it will get better on it's own or will it need treatment. In my office, we routinely have this occur and we usually tell patients that the time to treat is when the discomfort is such that it affects your lifestyle. Some of these teeth heal themselves, especially if the cause of the problem can be identified, such as clenching and/or grinding, or a cracked tooth, and some get worse and need root canals. It is rare that these patients become true emergencies with full blown abscesses....we just don't see it.

Hope this helps.

Gary Backlund DMD, MSD