Expert: Mark Bornfeld DDS - 10/18/2007

Question
QUESTION: I had a composite restoration done in an upper molar 2 months ago because I had a cavity near the root, between two molars.
Immediately after the restoration, the tooth hurt a lot when drinking or eating something hot, and this lasted for weeks. The pain lingered on for several minutes.
Now, the molar is still sensitive especially for cold (hot too but not like in the first weeks), but less severe. It still lingers for several minutes though.
The pain is localized to the spot where the cavity was.
My dentist checked the vitality with a cold liquid last week and this was very painful but according to him meant that the nerve was still alive.
I do have exposed roots due to gum recession. My dentist thinks the pain might come from that. I have used Sensodyne for weeks now and the dentist put some desensitizing agent on the roots but it didn't help.

This week I have an appointment with the endodontist. Still, I have doubts. Won't the nerve heal by itself since it has become better this last weeks? Does RCT help with exposed roots or sensitive teeth? The waiting list is long (7 weeks) and if I cancel now, I can only come back begin December...

I went to 3 different dentists and they all tell me they don't know. I seldom have spontaneous pain, only sometimes in the evening, never at night, never throbbing...


ANSWER: Dear Aileen,

Sometimes, the need for root canal therapy is unequivocal, and sometimes it is a subjective judgment. For example, the development of a dark area at the tip of a tooth root as visualized on an x-ray is usually reliable evidence that the tooth is infected. Likewise, if your dentist drilled out the cavity and saw an opening into the pulp (nerve) of your tooth, it is a given that you will need root canal therapy if you intend to keep your tooth.

The interpretation of subjective symptoms is more problematic, since it is both unreliable, and, well, subjective. However, thermal sensitivity can occur for reasons other than pulpal infection-- deep fillings, roots exposed due to gum recession, or dentin exposed due to wear can also cause sensitivity to heat and cold.

The fact that your narrative implies a gradual lessening of sensitivity suggests that the tooth is recovering. So, unless your dentist has additional information that would lead him to favor root canal, I would interpret your symptoms as indicating that you don't need root canal. However, as I said, these subjective symptoms can be misleading, and I think you should at least have a quick discussion with your dentist to see what he thinks, based on the current trending of your symptoms.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

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

QUESTION: Hello, thanks a lot for your previous answer. I went to the endodontist yesterday and she felt that a root canal was necessary so I had one done on element 26 (it had 4 canals). It was immediately filled up with gutta-percha and has a temp. filling.
Today however I woke up and my whole jaw is sore. It feels like a gigantic bruise... Is this normal?

Answer
Dear Aileen,

Yes--- the sad truth is that root canal's reputation is not totally without basis in truth. There is ample opportunity during the procedure to provoke irritation of the tissues immediately adjacent to the tooth root, and this irritation usually manifests as postoperative pain.

I recommend that you call your endodontist for assistance if you cannot adequately control the pain on your own with over the counter analgesic medication.

Good luck!

Mark Bornfeld DDS