Expert: Lawrence Spindel DDS, www.lspindeldds.com - 2/11/2009

Question
Dear Dr. Spindel, Would you please give me information regarding indications for root canal therapy?  I had a trauma to my upper teeth about 120 days ago from extreme overdrilling and removal of all enamel.  I had constant pain, couldn't sleep (sensitive hot, cold, air, breathing, etc.)  up until about a week or so ago. Now, the pain has lessened quite significantly, to where it is rare, minor and only brought on by extra hot showers or hot drinks--and then, it only lasts a very short time now.  Is there even a possibility that I have "beaten the odds" and nearly healed myself? Could that minor problem I still have with heat resolve or is it usually a sign of something irreversible? Also, around the time I started feeling better I had increased my exercise (I'm a runner) and felt the blood flow was helping me. I'd heard that it takes about 100 days for dentin to regenerate to protect the pulp.  Could the improvement be due to such regeneration? Because a number of experts link root canals to health problems I won't do a root canal--unless I'm objectively and literally at the point of serious harm.  Thank you very, very much for any information you have time to provide!
Jessie

Answer
Dear Jessie,

Teeth can be extremely sensitive and not require root canal. Once the bite has been properly adjusted if a tooth is still sensitive, usually it is not harmful to wait it out. Some teeth can take up to a year to calm down.  Some teeth remain sensitive for years.

Sensitivity to hot but not cold can indicate that a pulp has died, since sometimes gases build up inside the the tooth and expand when heat is applied. Your sensitivity may or may not indicate a necrotic pulp.  If you are comfortable, I would wait for 6 months to a year and have a periapical X-ray taken to see whether you have bone loss around the apex. If you have it, then you should have a root canal.


The only teeth that actually require root canal are those whose pulps have died.  The dentist can determine this by applying an ice test.  An ice probe is placed on the tooth and the patient is asked to see whether the tooth can feel the cold from the tooth(not the gums).  Adjacent teeth are also tested to see whether they respond differently.  An X-ray may confirm the diagnosis if the area around the apex has a black area where bone is dissolved by an infection(caused by bacteria in a necrotic pulp).


I am not sure whether exercise improved the blood supply to the tooth and helped your pulp to heal. Certainly all those good endorphins help make the pain go away!

I hope this information is helpful and please feel free to contact me again with any dental questions.