Expert: Tony Appleton BDS DPDS - 2/9/2009

Question
Dr. Appleton,

My daughter, a college student, besides, daily oral hygiene and twice a year dental check-up and cleaning, during her regular dental checkup on November 26, 2008, she was told by her dentist a cavity requiring a filling during her winter break. During the filling appointment on December 29, her dentist drilled her tooth and said it was too late for a filling and immediate root canal was instructed.  She had her root canal performed by an Endodontist on the next day (DEC 30, 2008)  

My daughter’s tooth was fine clinically prior to the discovery of cavity and root canal – she was not experiencing any pain or associated symptoms of an abscess (tenderness, swelling in the area of the tooth).   It was very hard to accept her dentist’s warning of immediate root canal.   We requested her Endodontist to evaluate the necessity for root canal.  The answer from the Endodontist was not helpful at all.  Basically, the Endodontist was just to perform a root canal as it was referred by a dentist.  

My daughter cried and we felt we were pressured to have a root canal immediately otherwise she would have to face severe pain as the dentist had just warned.   Up to now, we are still not convinced that my daughter’s tooth was treated appropriately and professionally for the following concerns, and we appreciate your professional evaluation and comments.

First, Is the case possible?  With daily oral hygiene, routine dental checkups and cleaning, and lack of any clinical symptoms (pain and/or abscess), suddenly, she had a cavity and end up with an immediate root canal.

Second, In her case, could the Endodontist evaluate the tooth and determine if indeed the immediate root canal was the appropriate treatment for her tooth?  

Answer
Hi Ann

It is perfectly possible to need a root canal treatment without having any symptoms whatsoever.  When a cavity gets close to the pulp in the middle of the tooth the pulp can respond in a number of ways - commonly you will get toothache first, but it is just as possible that the pulp will die without any pain at all.  The tooth then needs either root canal or extraction.  Once a pulp has died it is then a potential source of infection, so can just sit there with no pain for a long period of time.  However, it can become infected at any point and become a dental abscess then you get swelling/pain/redness etc.

Consequently. although when you have such symptoms it is easy to reconcile the need for root canal, when you have had no symptoms/pain and are told you need root canal it can be rather baffling!

I'm sure that your daughter was treated correctly, and maybe the dentist could show you x-rays to help you understand the initial problem?

Regards

Tony Appleton