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QUESTION: Hello Dr. Backlund,

My elderly parents suddenly got some bad dental news, and i'm trying to give them the best advice.  1) Must you extract a crowned tooth with a post if there is some bleeding and deep gum pockets (depth of six)?  In other words, the post prevents doing another root canal?  2) Can you still do a successful root canal on a dead tooth?  Even if it has been dead for a couple of years?  3) Can you have such wear on your front teeth that require fillings (D2335) that would result in the need for root canals if left untreated?  4) Is it unusual none of these issues were brought up at the cleaning six months ago?  

Thank you for your time and consideration.

ANSWER: Hi Linda,

I'm sorry to hear your parents are going through all this...it's REALLY nice of you to help out! Let me try to help here, but it's hard to give you definite answers without being able to see X-rays and do an exam. Here we go....

1# Must you extract a crowned tooth with a post if there is some bleeding and deep gum pockets #depth of six#?  In other words, the post prevents doing another root canal?

If a root canal has a post in it, it is possible to retreat the root canal, but you need to remove the post, which usually means cutting off the crown, then redoing the root canal, post and crown AND there is no guarantee this will solve the problem. This can also be quite costly. Since it also sounds like the tooth has some gum disease, extraction may be the best option. However, it also depends on how the tooth is going to be replaced and I can't help there.
The only other option would be to do surgery on the end of the root, but that requires cutting off part of the root which further compromises the support of teeth with gum problems.


2# Can you still do a successful root canal on a dead tooth?  Even if it has been dead for a couple of years?  

There is really no reason a tooth needing a root canal is limited by how long the abscess has been there. When the debris inside the root canal is removed and a root canal filling is placed, the toxins that were coming out the end of the root stop and the body can heal around the end of the root. The process will happen no matter how long the problem has been there.


3) Can you have such wear on your front teeth that require fillings #D2335) that would result in the need for root canals if left untreated?  

It is certainly possible, but without xrays or being able to do an exam, it's hard for me to give you a good answer. Usually, as the wear occurs, the pulp recedes. But if the wear is faster than the receding, the pulp could become exposed and the tooth would need a root canal.


4) Is it unusual none of these issues were brought up at the cleaning six months ago?

If a complete exam, with full mouth X-rays, were done 6 months ago, then the answer is yes. However, if the 6 month check only involved a visual exam, a cleaning and the kind of X-rays that you bite on looking for decay in the back teeth, then most of these problems would not show up.

I hope this helps. Best of luck to your parents...it's a tough situation for them at this point.

Gary Backlund DMD, MSD


---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Backlund!  I REALLY appreciate your time and all the info, it helps give me more clarity on the proposed treatment plan.  I'm learning a lot.

A follow-up to question 2) about dead teeth - so does a dead tooth mean there is an abscess?  In addition, since length of time should not limit treatment success, does that also mean it is okay to wait until you feel pain to do the root canal then?  The teeth involved are a cuspid (suddenly died for no apparent reason) and second molars.  Since my parents haven't felt any pain or sensitivity, they are very skeptical any work needs to be done until such time.  The cuspid is needed for a bridge, but i'm thinking it might be better for them; since they're older, to just extract the second molars without replacement when they hurt? (Until now, i didn't realize root canals can "fail" and require retreatment.)

Answer
Hi again Linda,

When we refer to a dead tooth, we talk about one where the pulp, nerve and blood supply, are no longer alive. In most cases, this terminology is lumped together with an abscessed tooth, but this is not technically correct. An abscess implies a bacterial infection and some "dead teeth" are not infected, only dead. However, it's a mute point as no matter what you call it, it still needs treatment with a root canal.

The risk of not treating a dead tooth is that at some point it will become symptomatic and that can be extreme pain and swelling and all the bad things you hear about root canals. If it were my parents, I would encourage them to not wait....they might really regret waiting if they are all swollen and in terrible pain the day before they are headed out on a trip. That is especially true for the cuspid if it is going to be used for a bridge. As for the 2nd molar, without being able to exam them, I really can't weigh in on that issue.

Since your parents are having a hard time dealing with all this occurring all at once, they might get some help by getting a 2nd opinion. You might ask their dentist for a referral to an endodontist for evaluation. At least then they might feel more comfortable if they hear the same thing from another source....just a thought.

Finally, yes, root canals can fail, but only a small per cent. Part of that depends on the skill of the dentist. Most general dentists can do a cuspid, but a 2nd molar may need an endodontist. And, you might consider having an endodontist do the cuspid too since it will be supporting the bridge.

Good luck!

Gary Backlund DMD, MSD

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Gary Backlund, DMD, MSD

Expertise

I am an Endodontist ( root canal specialist ) and can answer questions about root canals and their treatment. I cannot diagnose or treat online, but can answer general questions. I have been a specialist for 25 years and am Past President of the Washington State Association of Endodontists.

Experience

25 years practicing as a specialist

Organizations
American Association of Endodonists, Past President Washington State Association of Endodontists.

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