AboutFrederick R. Liewehr DDS, MS, FICD Expertise I can answer your questions about root canal therapy in general. PLEASE DO NOT ask me to diagnose your particular problems or recommend treatment as I cannot do this without examining you and seeing your x-rays.
Experience I am a Board-certified endodontist, former university department Chairman, teach dental residents, and have a private practice.
Question Hello. i'll apologize in advance in case this post becomes too long.
Tooth #18 (bottom left molar, right next to my wisdom tooth) has had a large silver filling in it since I'm a teenager. (I'm 37 now.)
About six months ago, one piece (I guess you call it a cusp) broke off while I was eating grape nuts. It didn't hurt, and because I am TERRiFIED of going to dentist, I didn't go.
About a month ago the tooth started to hurt, not constantly though, the pain was coming and going. Sometime the pain was worse than other times, so I finally decided to go to the dentist before the pain became unbearable as I've had happen before with a different tooth I got taken care a 3 years ago after putting it off as long as I could.
So my dentist took an x-ray and examined my tooth, and said it has a crack in it that goes below the gumline. She said she was 95% sure it could be saved but she wouldn't know 100% until she actually drilled and got in it and removed the decay that was there below the old silver filling.
She said she believed that because the crack went below the gumline I would need a crown lengthening in order for there to be enough room to place a crown.
So I scheduled the appointment to have the work started (and because I really was not in pain anymore and I was so nervous I rescheduled the appointment a few times.)
I finally went yesterday, after staying up all night terrified and barely being able to get out of my car to go inside the dentist's office due to my fear.
She gave me novacaine, and as she was working I kept feeling jabs of pain and she had to give me shots 2 or 3 more times. As she was working she said the decay went down to the nerve and I would need a root canal. She did a lot of the crown lengthening procedure and made me an appointment for the root canal for this Friday.
Yesterday afternoon I became in the worst pain I've ever experienced. (I get migraines, and have had back surgery, but yet nothing compares to the pain I was in.) I had to take 800 mg of advil to feel even just a LITTLE relief. I called the dentist and she said I was in so much pain because I needed a root canal. But I didn't have pain lie that the day before, so I feel that the reason I was in so much was not just because I needed a root canal but because I had work done on a tooth that needed a root canal, and because she did most of the crown lengthening procedure. (She said there is a little bit more of soft tissue she has to do but will do that after I have the root canal.) So now the pain and swelling I had is a little better than yesterday, but it's still there, and I feel like even my ear on that side hurts.
So finally, here are my questions.
1) Does this mean that this is a "hot tooth" and that the root canal will be painful? (The tooth barely hurt before she worked on it yesterday but has hurt tremendously since then.) I am worried it will hurt during the appointment, and especially afterward like what I went through last night.
2) I was warned about having to wear dental dam during the root canal procedure, which terrifies me? What can I do to relax while I have the damn on and also while they are putting it on me? Will I feel like I can't breathe? Will I gag or feel like I am choking?
3) The endodonist's office said that the root canal appointment will take two appointments. Each one taking about one hour. Then afterward I go back to my dentist for the completion of the crown lengthening and for the crown. So if the endodontist doesn't do those things, what exactly does he do? What will he do at the first appointment, and what will he do at the second appointment?
Thank you so much for any advice. I am really really really terrified. Crying over the thought of this. I truly need some support.
Answer a. I don't know why crown lengthening, which is a periodontal procedure would affect the pulp of your tooth. The pain may simply be from that surgery. I also don't understand why she didn't finish the surgery; that makes no sense to me.
b. Some people don't like the rubber dam, for some reason. When they gag, it is because it is difficult to swallow with that on and with a jaw support. I find that making a hole for breathing helps people who can't breathe through their noses, but it might not help your psychological problem with the dam. You can ask about sedation; that might help.
c. I generally do most teeth in one appointment; usually takes about an hour. Only in severely infected cases or if there are extremely difficult morphological problems do I need two visits. Your endodontist is just slower than I am. An endodontist does the root canal therapy, a periodontist would do the crown lengthening.
