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“My top right molar has been acting up for over a year now. It was first sensitive to cold, but then I used special toothpaste and this stopped, but recently it has started to hurt when I bite. I haven’t been able to chew with the left half of my teeth for months now. It does not otherwise hurt, has no visible cavities, and is not particularly sensitive, either. The tooth has been filled before, and I have gotten an antibiotic root filling, and the tooth has received fluoride treatment as well. I had it x-rayed and there is no sign of an infection or cavitation anywhere.
What should I do, what are my options? I have been considering getting it pulled, it has cost me so much trouble, and I do not know if a root canal treatment will help.
Thank you for your time,
Erica
Dear Erica,
The type of pain you have described- a strong, sharpe pain that only occurs when biting down- seems to me to imply a problem with the periodontal ligament. if the sensitivity to cold is completely gone, but the pain is still present when biting or chewing, then it is likely that the part of the tooth that lies underneath the root fillings has died.
X-rays are mostly two dimensional, so certain areas can remain hidden. The other issue is that some time has to elapse before an infection that deep in the periodontium will be visible on an x-ray- basically, when it has started to affect the bone already, something you should not wait for.
A fresh infection will not be visible on an x-ray. To determine whether or not your tooth is dead, you should go to a dentist for a checkup, as there are visible signs, and a sensitivity test should yield results. If the tooth is indeed dead, a root canal treatment is necessary, an extraction is only needed if the tooth structure itself cannot be saved.
The patient can of course decide whether or not they want to undergo a root canal treatment, if they want to give the tooth another chance, or if they find it easier to not have to deal with it anymore. Root canal treatments can be unsuccessful in curing sensitivity, as the extent of the infection, the resilience of the bacteria, the quality of the antibiotics, and the anatomical characteristics of the roots themselves are all factors that can affect the outcome.
An extraction does not need to take these factors into account. If you do decide to get the tooth pulled, know that getting your tooth replaced is not just an aesthetic decision, it has positive health effects as well. Replacing teeth is another issue entirely, and it raises as many questions and concerns as it solves.
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