Do I need a root canal?

[Tula_fan]

I have a problem on #29. It’s been 10 weeks since I got my filling done the first time and it has been sensitive to hot/cold substances since then. The sensitivity lasts <5 seconds and it goes away, there are no other issues. It almost feels like a “snap” of pain and the sensitivity goes away almost immediately. There has been no improvement and it hasn’t gotten worse.

I got my part of my filling replaced (at my request) 2 weeks ago. The doctor only replaced the side of my filling, not the filling on top of the nerve. I said I just wanted to replace that side because it was cracked and I was hoping the sensitivity would go away after that. I was wrong and it didn’t help at all. I went back to the dentist and he refused to replace my whole filling because he didn’t want to keep drilling in the tooth and referred me to an Endodontist for a root canal. He said he’s a specialist and will do some 3D imaging or something so I can know for sure if I need one or not.

I feel like my case is borderline and I’d rather not get a root canal if I can help it. I’ll get one if I really NEED it, but the only issue I have is sensitivity to hot/cold that goes away after a few seconds. My dentist said my nerve is close to the top of my tooth and that’s why it’s sensitive. I feel like I’m not going to know for sure unless I get the whole thing replaced.

If I keep drilling in my tooth will it make my sensitivity worse? I’ve had 2 fillings done in the past 10 weeks on that tooth.

What will an Endodontist do differently than a dentist? Will he just immediately say I need a root canal because I was referred or will he examine my tooth on a case by case basis? On the referral my dentist wrote “evaluate 29 and treat as necessary”

 

[Dr M]

Usually for pain that is less that 5 seconds, this is only a reversible pulpitis. This is not usually an indication for a root canal treatment. Cases where you have episodes of spontaneous pain, or severe pain with heat and cold that last for +- 15 seconds, or any radiological peri-apical changes, would be more of an indication for root canal treatment.
Although the first permanent molar sometimes has pulpal horns that extend quite high and thus be so close to the filling that this reversible pulpitis becomes irreversible, I would perhaps seek out a second opinion first in this case. I would suggest replacing the resin filling with a temporary sedative filling and then follow-up over a period, in order to determine if the symptoms resolve.

 

[MattKW]

I'll go with Dr M and add to his suggestions. That doesn't look like a deep cavity.

• I would remove the whole filling and check for cracks. Transillumination and a FracFinder are the usual ways, plus a history of biting pain.
• If no obvious crack, then replace with same material (composite), or try a temporary sedative filling, or use amalgam.

 

[Tula_fan]

Usually for pain that is less that 5 seconds, this is only a reversible pulpitis. This is not usually an indication for a root canal treatment. Cases where you have episodes of spontaneous pain, or severe pain with heat and cold that last for +- 15 seconds, or any radiological peri-apical changes, would be more of an indication for root canal treatment.
Although the first permanent molar sometimes has pulpal horns that extend quite high and thus be so close to the filling that this reversible pulpitis becomes irreversible, I would perhaps seek out a second opinion first in this case. I would suggest replacing the resin filling with a temporary sedative filling and then follow-up over a period, in order to determine if the symptoms resolve.

My 2 dentists said the filling is close to the nerve which is causing the sensitivity and therefore replacing it won’t help and I need a root canal. So I’m not sure if I should bother replacing the whole thing

 

[Tula_fan]

Usually for pain that is less that 5 seconds, this is only a reversible pulpitis. This is not usually an indication for a root canal treatment. Cases where you have episodes of spontaneous pain, or severe pain with heat and cold that last for +- 15 seconds, or any radiological peri-apical changes, would be more of an indication for root canal treatment.
Although the first permanent molar sometimes has pulpal horns that extend quite high and thus be so close to the filling that this reversible pulpitis becomes irreversible, I would perhaps seek out a second opinion first in this case. I would suggest replacing the resin filling with a temporary sedative filling and then follow-up over a period, in order to determine if the symptoms resolve.

Both my dentists said the filling is close to the nerve and that’s why I’m having sensitivity and replacing the filling won’t help because of where the nerve is. I don’t know if I should replace the whole thing if the issue is the nerve. I’m going to see the Endodontist later this week and will confirm if I need one or not

 

[MattKW]

Well, the Xray you show is a periapical (PA), and is taken at an angle, so the apparent height of the pulp horns is misrepresented. A standard bitewing Xray would give a more accurate view (perpendicular). But that was all you had to show me so I had to rely upon experience and "guesstimate" how deep the filling might be. It bewilders me why people take PAs of a "live" tooth with acute signs and symptoms; there will be no periapical changes of any value. I stand by my suggestion of redoing the filling and looking for a crack.

 

[Tula_fan]

Well, the Xray you show is a periapical (PA), and is taken at an angle, so the apparent height of the pulp horns is misrepresented. A standard bitewing Xray would give a more accurate view (perpendicular). But that was all you had to show me so I had to rely upon experience and "guesstimate" how deep the filling might be. It bewilders me why people take PAs of a "live" tooth with acute signs and symptoms; there will be no periapical changes of any value. I stand by my suggestion of redoing the filling and looking for a crack.

I do have a bite wing x ray here but it was taken before I got part of my filling replaced (the part I circled in red on the side). This x ray is 2 weeks older than the recent one in my post, so I wasn’t sure if it’s appropriate to show it. My dentist didn’t give me the new bite wing x ray.

The filling on the side was replaced but not the one on top of the nerve.

 

[MattKW]

Replace the filling.

 

[Tula_fan]

Replace the filling.

I saw the Endodontist and he only did the Endo ice test on me and said it’s up me to if I want to get a root canal now if the pain the really bothering me. If not then I can leave it for now but if it gets worse definitely get a root canal. I suggested replacing the filling and he said no, it’s too close to the nerve and will cause more damage so I guess I will leave it for now.

Thanks for your input.

 

[MattKW]

OK. However, given that it's been 10 weeks of sensitivity, I sincerely doubt that a watch-and-see approach will improve the symptoms; I believe it will only get worse and an RCT will be inevitable. On the other hand, redoing the filling (by another dentist) will give you a better chance of improvement. Pls reply to this thread when anything happens; I'm interested to see which way your treatment and symptoms go.