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Dentistry/Root canal on lower wisdom tooth


QUESTION: Dr. Buckland,

My wife was recently told she has deep decay under a filling on tooth #17, and  it looks like it's close to the pulp.  The tooth has not been symptomatic.

My first question is, if it's close to the pulp and a new filling is attempted, should a sedative filling be placed in as a matter of course, or is that not done if the tooth has not been symptomatic?  Also, do you think it's better to leave some decay in if it's close to the root, put in a sedative filling, and give it a few months to try to lay down more dentin?

My second question has to do with how to proceed if it turns out the tooth is in need of a root canal.  Knowing my wife, it would be very traumatic for her, psychologically, to lose the tooth, even though I understand it is not necessary for normal function.  Also, we thankfully do not have problems paying for dental treatments, and wouldn't let money factor into treatment decisions.  She would prefer to keep the tooth even if it means getting RCT and a crown.  I had previously been told that RCT on wisdom teeth has questionable success rates - is that true?  Or would most experienced endodontists be able to treat wisdom teeth with similar success rates to other molars?  Does it help that this tooth came in completely normally and at least visually, appears no different from her other molars?

Many thanks!


ANSWER: Hi Jonathan,

When we deal with situations like this, the first thing is to remove all the decay. Leaving any will just potentially cause more problems. If the decay exposes the pulp and is a VERY exposure, then it might be possible to try a pulp cap, a sedative material that may help the pup recover. If symptoms begin, then a root canal would be needed. If the decay removal exposes a large amount of the pulp, then most likely a root canal would be necessary. All this depends on what the dentist finds when he/she cleans out decay.

As for the difficulty of doing 3rd molar endodontics, it really depends on the root anatomy. Wisdom teeth ate notorious for having very curvy roots and are often seen with more roots than normal molars. Without seeing an x-ray, that hard for me to help with. I would advise you that if it comes to doing a root canal, it should be done by an endodontist to give your wife the best chance of things working. Prior to doing the root canal, the endodontist may want to see her for an examination to make sure the root canal is reasonable to attempt.

Hope this helps...good luck to your wife!

Gary Backlund DMD, MSD

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

QUESTION: Dr. Buckland,

Thanks for the quick response.  I just had one additional question:

Under what circumstances would a sedative filling be indicated?


Hi again Jonathan,

In my opinion, placing a sedative filling does more harm than good, so I would say, it is never indicated. The reason is that anytime you treat a tooth, it irritates the pulp and can cause it to become inflamed which is the 1st step to needing a root canal.

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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