Expert: Mark Bornfeld DDS - 10/15/2007

Question
QUESTION: I have a mildly throbbing tooth ache in a lower left molar. One endodontist said I need a root canal, another said I should wait. Have you ever heard of a root infection healing on its own with antibiotic treatment? I am at a loss as to whether to have the treatment done right away or not, or to try some antibiotic therapy first, considering the endo's disagree with each other.

ANSWER: Dear Neil,

I suspect that the problem is not that you have a dental infection and there is a disagreement of how it should be treated, but that your endodontists can't agree whether there is a dental infection present.

Now, obviously I can't determine if you have a dental infection without access to the diagnostic data, but I do believe that the use of antibiotics as a diagnostic tool is unwarranted. In fact, I believe that antibiotics are inappropriately used all the time, and they are worthless in subacute or subclinical dental infections. Either you need root canal treatment, or you don't-- and antibiotics are irrelevant.

Unfortunately, some of these subclinical conditions are difficult to diagnose, but antibiotics will not clarify the situation one iota. Your choice now would be either to proceed with a root canal or not, based on the perceived rationale of your respective endodontists. The antibiotics are just a distraction, and are not going to be of value in either determining the presence of infection or causing one to resolve.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

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

QUESTION: Well, I am happy to say that I rarely use antibiotics, but can you explain why they are not effective in treating root infections?

On a related subject, what are your thoughts of root canal versus extraction? Because of decay and the crown there is very little of the original tooth left.

Thanks again.

Answer
Dear Neil,

There are no general rule that can be applied to all situations; the decision as to the approach that makes the most sense depends entirely on the individual circumstances. Some teeth are clearly beyond the point where they can be saved, and any effort wasted in the service of these teeth is indeed foolish. However, each tooth usually plays some role in the overall functioning of the mouth, and depending on that role, the replacement of the tooth may be more or less important, so the extraction of the tooth is not always the end of the story. Replacement of an extracted tooth can be difficult, expensive, or more potentially problematic than salvaging a damaged tooth, so a practical assessment of the consequences of extraction should be made before the fact, and not after.

In your case, you should have a candid discussion with your dentist about whether your tooth is salvageable. If not, the decision is already made for you. If it is salvageable, the question becomes whether it is practical to save the tooth from the perspective of the needed effort, expense, and time, and whether the predicted result will be durable and reliable. It does little good to "save" a tooth only to have it break off in your next sandwich. If you question your dentist's judgment, you should seek an independent second opinion.

Good luck!

Mark Bornfeld DDS