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Dentistry/2nd opinion - Root canal and lack of ability to get local anaesthesia - need to get back to my dentist with my preferred course of action


Hi Dr. Backlund,

Thank you for your kind replies earlier. I need to get back to my dentist for the options  (from other opinions I received) regarding the various possiblities of my future treatment. I was hoping you could help me to summarize my options to get back to her. My dentist initially suggested root canal treatment, followed by the crown, but then said she was open to second opinions from endodontists.

Your basic opinion, from our previous conversation, from what I gather--is to try to do the crown, and then if necessary, to do the root canal.

I assume your opinion is based on the primary factor which is that the tooth is still alive since (1) X-rays in your opinion look completely normal, and (2) the tooth with temporary crown is sensitive to cold, etc.

Do you think you could explain to me the pros/cons of doing the root canal first vs later, so I can understand and be able to relay them to her? Why would another dentist prefer to do the root canal first? (A cynical answer would be because they offer root canal service and it collects revenue...)

With regards to the crown, would you recommending putting on the crown at first with temporary cement for a few months to test it? (I believe another dentist had suggested this to me)...

Sorry if I am asking too many questions. This is all very scary to me, and I'm just trying to get things straight to make the best course of action. Your help and guidance cannot be understated.

Also, I forgot to mention, when that Xray was taken (last friday), they did a cold test, and it was very sensitive to the cold as it was to the air (as I previously told you). Also they tested for pain on impact (or something like that), and I wasn't getting that at all, nor do I have pain on a regular basis currently.


Hi again Sean,

You are exactly right. I would cement the crown temporarily and 2-3 months to see if the sensitivity goes away. If it does, permanently cement the crown. If it doesn't, then you may need a root canal. The tooth is still alive....the question is can the pulp(nerve) heal itself or is it in the early stages of abscessing....only time can answer that question.

As for the reason for not just doing the root canal now.....root canals are not 100% successful so if you would opt to have it done now, there is the chance that the root canal could fail, so you are introducing another variable. If it fails, it would need to be re-treated, surgery done on the end of the root or, in a worse case scenario, extract the tooth. There is no reason to possibly create this situation at this time in my opinion. The only "pro" of doing the root canal now is that it will stop the cold tenderness right away. Why one dentist says one thing and one another is basically just a difference in philosophy, rather than cash flow I would suspect.

Hopefully this will help with your decision.

Gary Backlund DMD, MSD


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Gary Backlund, DMD, MSD


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.


25 years practicing as a specialist

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

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