Expert: Mark Bornfeld DDS - 7/11/2005

Question
My dentist recently prepared a cracked molar for a temporary crown, and said after he had chiseled it down that the decay was all gone and I probably wouldn't need a root canal. After the temporary was on, I had constant throbbing pain in that tooth. I went in a week later and the dentist said he hit a nerve when preparing the tooth for the crown--and now I have to have a root canal on a tooth that didn't even need one! The pain isn't subsiding. How common is this to happen during crown-preparation, which seems fairly routine, and should I go ahead with the root canal now?  

Answer
Dear Caitlin,

It is sometimes necessary to intentionally expose the pulp of a tooth in the course of crown preparation. Usually it is possible to predict in advance when this will happen, and it is customary to inform the patient in advance if this determination is made. However, the pulp of a tooth is sometimes unintentionally exposed during crown preparation, usually due to unexpected pulpal anatomy that causes parts of the pulp to extend into unusual parts of the tooth. This is not common, but is certainly not unprecedented.

If the particulars of your narrative are accurate, this is perhaps at best an academic argument. The fact that the tooth became symptomatic immediately after placement of the temporary crown (the "constant throbbing" to which you refer) suggests that the pulp was already inflamed, and probably needed root canal treatment from the outset. An operative procedure such as a crown preparation is often all that is needed to push such a tooth over the edge and become acutely inflamed.

Once it is established that a tooth suffers from acute pulpitis, you have no other option but to have root canal treatment if you intend to retain the tooth. Certainly, it would have been preferable for your dentist to have anticipated this fact, but this points out the sometimes unpredictable nature of dental care.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn,NY