Expert: Frederick R. Liewehr DDS, MS, FICD - 6/28/2007

Question
Hello Dr. Liewehr,
In your professional opinion, can a root canal possibly help my crowned #4 tooth that is very painful to chew on yet not sensitive to hot or cold?  I've received 3 different opinions from three different dentists; "definitely yes", "definitely no" and "maybe".  All x-rays show nothing wrong.  I'm so confused!  Do you recommend only allowing an Endodontist to perform RCT?  Thank you so much for your help.  Lynnette

Answer
I would need to know more, and really to examine you and look at your radiographs. Pain to biting is not the nerve in the tooth, it is the nerves in the bone surrounding the root. So, this can only be the result of a problem with your pulp ("nerve") if it is necrotic ("dead"). A simple cold test or electric pulp tester will tell you if this is the case. If you don't feel either one, then the pulp is necrotic and you need a root canal.

It is possible, however, that it is due to something else. Why was the crown placed? If the tooth was cracked to begin with, it may have worsened and be sensitive to biting for that reason. If the crown is new, it may be overcontoured and in premature occlusion, i.e. hitting before the other teeth and sore for that reason. If you cant bang your teeth together without pain, then this may be the case.

There can be a problem in the bone but it takes destruction of the medullary bone and almost complete perforation through the cortical bone before it shows up on the x-ray, so a negative x-ray does not exclude the problem. I would absolutely have an endodontist perform the treatment.