Please help with this simple question!! In regards to how many canals to treat.

[birdybird]

Hi everyone. This might be a very stupid question but i really need to ask this. If there is apical periodontitis on one root only on the x ray. Do you still have to get all 4 root canals treated?

 

[MattKW]

Yes. An Xray that shows a periapical radiolucency is only confirming what is already known, i.e. that the nerve is dead. Not all teeth will show signs on an Xray. A dead nerve is usually defined by other signs and symptoms, e.g. pain to tapping, pulp testing, patient symptoms.

 

[birdybird]

Yes. An Xray that shows a periapical radiolucency is only confirming what is already known, i.e. that the nerve is dead. Not all teeth will show signs on an Xray. A dead nerve is usually defined by other signs and symptoms, e.g. pain to tapping, pulp testing, patient symptoms.

Thank you for the answer! But so if lets say on a 26 the palatal nerve on an x ray shows a radiolucency only in relation to the palatal rootchannel, you would still treat the buccal and mesial? is it because they are all connected in the pulp chamber so we consider the other 2 also as being infected?

 

[MattKW]

Yes. They are all connected so treatment of all is required.

 

[birdybird]

Thank you so much! I always just did the whole tooth in class but it just hit me this weird question and i had to simply ask !

 

[honestdoc]

You cannot diagnose apical periodontitis by x-rays alone. What if it is cemento-osseous dysplasia which looks like periapical lesions and the teeth will test vital?

 

[birdybird]

But i understand it so that usually you always do a clinical examination first. If there is a suspicion of a non vital tooth you first test it to see if it is vital or not. If it turns out that it doesnt respond and seems non vital, THEN you take x rays. So x rays is the last thing.

 

[MattKW]

Yes, that is the general way. When clinically treating emergencies in a limited time, I will at least take a bitewing first because it is more time-efficient. Then I will do other tests while the radiograph is processed.

 

[honestdoc]

When you perform a cold test, try to use a cotton ball instead of Q-tip. The Q-tip does not get cold enough and you may get false negative readings (unless you are production hungry or desperate to complete all your root canal requirements).

 

[MattKW]

Agreed, you need something that is not compact like a Q-tip. Loose cotton pellets are better, and foam pellets (Pele-Tim) are the best.