Expert: Frederick R. Liewehr DDS, MS, FICD - 7/14/2005

Question
Hello Dr Liewehr,

I felt slight throbbing under my lower left molar and the dentist says it's partially or completely dead.  The dentist put something cold on it and it didn't sting.  An x-ray showed no abscess, but some calcification of the canal.  Because of finances (it'll cost a second hand car) I want to put off root canal.  What are the risks involved if I wait.  Can I just monitor the molar every six months? There is no pain at the moment. Thanks.
Regards,
Usuff

Answer
Hi Usuff,
    If your dentist tested your tooth and it is completely non-responsive, that is, you didn't feel the cold at all, then we must assume the pulp ("nerve") of the tooth, is necrotic ("dead"). The problem with dead tissue is that is becomes infected easily. These bacteria will then pass out the root end of the tooth and into your bone. Your body may contain them so you are not even aware of the problem, or you may develop a chronic or an acute abscess. If it is chronic, the bacteria grow and spread slowly, so your body makes a path for them into your mouth, and you wind up with a "gum boil" that drains pus. If the bacteria grow faster, you develop an acute abscess, which is extremely painful, and you may develop swelling, a temperature, and could even die if the infection dissects into the wrong place. That is a dental emergency.
    So, you should get the tooth treated. At the very least, have what we call a "pulpectomy" where the dentist removes the necrotic pulp, and have him place calcium hydroxide to kill the bacteria. This plus a good temporary restoration of IRM should last at least six months, possibly longer. That should buy you some time to save up for the root canal treatment. If you do nothing, you are risking having a dental emergency, when it is difficult to find someone to treat, and usually expensive, not to mention painful for you. Good luck!

Dr. Liewehr