Root Canal or Pull the tooth?

[Adaryn]

Sorry to hear about your problem, Ant.
To me the lady seems to be rushing too fast. You said the x-ray didn't show any damage to the tooth.

Yeah, because of that, maybe it'd be safer to adopt the "wait and see approach"/err on the side of caution, and maybe take a second advice? Even if root canals are not the end of the world (FWIW, my Mom has several and never had any issue with them), it could cause problems if it got infected. In any case, it's good not to rush into any decision especially since you're not in an emergency situation right now. Hope you can find a solution pretty soon!

 

[cassandra]

Poor you, it sucks to have tooth problems. I learned the hard way that not all dentists are equal. I would take a bit of time to source a reputable one, even if it’s expensive. It’s money well spent, if the dentist does a good job and knows his/her business. If not, it’s misery down the line. Could you ask around for a really good one? I had a tooth pulled on the bad advice of one dentist and ended up with a gap between my top middle teeth you could have driven a double decker bus through - not a good look! And after braces, rubber bands to close gaps, which pinged when I laughed, etc., etc.,
Anyway, I’ll send good luck your way.

 

[Renaissance]

Having had some work done on my teeth - two root canals, one pulled tooth, and one of the root canal teeth also later being pulled, and having a bridge held to a grounded down/ mutilated healthy tooth, I've learned the hard way how incredibly valuable my teeth are. I don't mean in a monetary way, although that did drive home the point since I don't have dental insurance. These pieces of your body are yours and serve functions in ways we really don't fully understand. Our teeth are connected to the entire body through a complex nerve network that's highly concentrated in the jaw (and also explains why there is such immense pain when things go wrong). As silly as it might sound I actually felt the loss of having this work done, and there was regret and perhaps even a degree of mourning about it, even though I still think it was the right thing to do given my circumstances. I think you should fight for your tooth, and give it whatever efforts you can to bring it back to health. It might not work, but I think there's probably value in trying versus being directed by possible fears.

 

[hlat]

So my question is, should I just go ahead with the root canal and prevent possible issues in the future, especially if there's another lockdown? Or should I hold fire for now and see if the tooth is OK - taking the risk of pain and no access to dental services - or taking time off in a new job when I've already been given time off to solve the issue?

I think that you should get a 2nd opinion, and maybe a 3rd opinion. I would triple check before either a root canal or extraction of a natural tooth.

I would try all the alternative possibilities before root canal or extraction, eg DMSO, Lugol's, oils, hydrogen peroxide, antibiotics, etc. Meaning the last resort is root canal or extraction.

 

[Ant22]

Hey everyone, thank you very much for your responses, I really do appreciate it. It's so useful to read other people's testimonials and opinions to get a broader picture. Dentists can share their perspective from the medical viewpoint but I value the dental job recipient's take on those things just as much.

I'm quite protective of my teeth knowing how important they are to overall health so this situation is quite stressful for me. At this stage I'm leaning towards having the filling changed (as there is a very old and large filling there already) just in case it got messed up during the extraction rather than going ahead with the root canal but I haven't yet decided fully. The filling is above the root pulp so it may not be the right approach but I'll ask the dentist about that tomorrow. If anyone has any more thoughts on this then I'd be happy to hear them, the more "food for thought" the better

I'll reply to you individually when I get a chance later today but I wanted to address a few points you raised:

1. The tooth isn't exactly completely pain free. I thought it was because the wound after the wisdom tooth extraction masked any other pain in my mouth, but after playing with my two nieces yesterday quite intensely yesterday evening I noticed low level pain / throbbing still being present. It continues today when there's no wisdom tooth pain left. So that makes decision-making a bit more difficult becuase it may indicate a bigger issue that will soon come back anyway.

2. I was on antibiotics for the entire week after the wisdom tooth extraction when the toothache started so the current issue cannot be a bacterial infection. I have been also applying DMSO on it with no improvement.

3. Some of you suggested finding a very good dentist. My wisdom tooth extraction was done by the best specialist in the area, and the tooth in question was also assesses by one of the best dentists around. I consulted both of them about the tooth in question so that's two separate opinions. They both said I should ideally wait and see but since the pain was constant, worsened with pressure and wasn't worse at night but was equally intense 24/7, and the steroid injection didn't solve the problem completely, it indicates the tooth is dying - something an x-ray wouldn't show. By waiting and seeing I'm postponing the inevitable and I'm putting that tooth in the hands of dentists whose quality I cannot verify. In the UK they book you in and you are seen by whoever is available. I wouldn't be able to research the dentist in advance.

4. This is going to sound bad but if I am to have a root canal it's going to have to be done in Poland. Unfortunately, the NHS dentists have a really bad reputation among us Eastern European immigrants and there's a reason why we travel back to our own countries to visit a dentist pretty much by default. I know quite a few people who had to have their teeth pulled following a poorly done root canal, or ended up with issues due to a poor dental job. I'm sure there are very good dentists in London, but it seems to be a lottery with what you get and so far I've heard from quite a few people that they lost the gamble. Going private in the UK is not only mad expensive, it also isn't much better from what I've heard.

My dentist in Poland has done a few root canals on people I know already and there have been no issues whatsoever so I'd say this would be a safe procedure. And she only booked me in for the root canal becuase I called her a day after the steroid injection saying it was stil hurting and the pain was increasing (it was initially - but then it stopped/lessened). She said a root canal should be the last resort but clearly a continued pain was an indication of the last resort being needed here.

5. Bearing the above in mind, if the issue suddenly comes back while I'm in the UK it would be really hard to have it done in Poland. The pain was absolutely excruciating and I don't see myself putting up with it for days or weeks before I can travel back home.

6. Apart from the issue in question, my dental health is pretty much perfect so I'm not surprised the issue isn't caused by a cavity but by a mechanical trauma. I always get compliments about the condition of my teeth whenever I go for a checkup.
I don't do oil pulling or oregano oil because those never did much to me when I tried them in the past. Instead, I use the Sarakan toothpaste which contains salvadora persica, a little wonder for my teeth's cleanliness. I also use food grade hydrogen peroxide as a mouthwash and it keeps my teeth white and my breath fresh. I haven't had a cavity since 2012 when I ditched fluoride toothpaste and started using hydrogen peroxide. For those reasons, and becuase the issue started after pretty severe drilling around that area, I can see why the problem is more likely to have been caused by mechanical trauma than a cavity.

 

[hlat]

It seems to me that you should do what is medically best for you. A big concern is being able to have access to a good root canal or extraction dentist right away if needed. Do you think you'd be able to travel from London to the Poland dentist in 24 hours for emergency treatment if necessary? Are there disability laws in UK that would protect your job for emergency treatment?

At this stage I'm leaning towards having the filling changed (as there is a very old and large filling there already) just in case it got messed up during the extraction rather than going ahead with the root canal but I haven't yet decided fully.

I would replace the filling and see how that goes, before root canal or extraction. Pretty much anything before root canal or extraction.

They both said I should ideally wait and see

Medically, this seems to be the best course of action right now, so I would do this, before replacing the filling. The job, inability to access good dentists in London, and travel to Poland are non-medical factors that are clouding the medical issue.

 

[Ant22]

It seems to me that you should do what is medically best for you. A big concern is being able to have access to a good root canal or extraction dentist right away if needed. Do you think you'd be able to travel from London to the Poland dentist in 24 hours for emergency treatment if necessary? Are there disability laws in UK that would protect your job for emergency treatment?

Thank you hlat, those are good points. In my experience employers in the UK are pretty good when it comes to employees wellbeing. My new employer was already very accommodating allowing me to start a week later than agreed so I suspect they would be accommodating going forward - although probs not too excited. Their ‘care foundation’ seems really strong - which is to my advantage in those circumstances. Additionally, I’m a specialist in my field with a skill set that’s really in demand at the moment while there’s a shortage of those skills in the market. This would potentially make them more flexible to discourage me from looking for other employers.

Additionally, this job is fully remote so I wouldn’t need much time off. I can work while I’m travelling and only go offline for the duration of the flights and the procedure. That said, it would still be around a week before I could be seen. Good dentist’s have long waiting times.

However, it is the risk of another lockdown that makes me consider the root canal. It really freaks me out that the issue may come back in the middle of it. Like I said, I had two wisdom tooth infections during the last one and dental procedures were forbidden. I was lucky antibiotics helped then but they won’t help with this problem. I literally finished a course of antibiotics yesterday and the issue started while I was on them. If it returns during another lockdown I won’t get another steroid injection as that counts as a procedure. And that’s the main reason why I’ve decided to reach out to you guys for advice.

 

[Alejo]

Hey Ant22,

Just chiming in, from what I've learned the pain in the tooth is caused by an inflammation of the pulp that surrounds the nerve in your tooth. Which I think explains the reason why steroids worked so well, they reduced the inflammation of the pulp.This may be caused by several factors:

• cavities or tooth decay, which causes erosion to the tooth
• injury, such as an impact to the tooth
• having a fractured tooth, which exposes the pulp
• repetitive trauma caused by dental issues, such as jaw misalignment or bruxism (tooth grinding).

Now, the fact that it’s improved to me indicates that it may not be an infection as it hasn’t gotten worse (which coincides with what was seen on the X-ray), steroids would not treat the infection, only the inflammation AFAIK.

But despite the inflammation being reduced, the infection, if it were there, would continue to grow and the inflammation would continue to come back, but it seems to have been behaving in the opposite direction. So perhaps the pulpitis or the pain in the tooth was caused by the trauma experienced during the wisdom tooth removal. I don't know how likely it is that one would develop bruxism after a surgery as such, but it may be worth paying attention to how your jaw and teeth feel in the morning and see if you're grinding your teeth overnight.

The other possibility could be a simple cavity, so at this stage I would say your options are:

1. Wait it out as it’ll eventually get better, your tooth is pretty much sore from the surgery, and if it’s a tooth that had been root canaled before, then it would make sense that it would be more sensitive than others.

2. A visit to the dentist, but maybe not a root canal, maybe it’s a simple cavity and filling.

Either way, I think visiting them on Monday is the way to go, specially since the quality of service you're bound to receive is so different in Poland than in the UK. If you must visit a dentist, whether it is today or 6 months from now, then maybe it's better to have the ability to choose which one, maybe being proactive will make a difference, as opposed to having to react to sudden pain and end up with whoever the system throws at you.

I think the pain experienced after playing with your nieces can be explained by impact, it's essentially a sore or inflamed nerve that is being roughed up, so it may not necessarily indicate an infection.

From the link below, there’s a few things that would indicate or are used to diagnose pulpitis, but I think one would indicate bacterial overgrowth as opposed to inflammation due to injury, your tooth would react to:

• Cold
• Hot
• Tapping (tap your tooth/ pressing on it)
• Sweets

So I am not sure if you've had any sweets that might've touched that tooth, but if so and if you experienced pain, then the enamel has been damaged enough and it could be a bacterial overgrowth. But since it has gotten better since the steroids, it may not require a root canal and it may be a cavity that needs to be cleaned.

Just my two humble cents.

Here's the link mentioned above: Pulpitis: Treatment, Types, Symptoms, Causes, and More

 

[Tauriel]

I was also thinking about the impact and the trauma involved when a tooth gets pulled. A long time ago I was silly enough to have all 4 wisdom teeth pulled in one go. The aftermaths were horrible.

These pieces of your body are yours and serve functions in ways we really don't fully understand. Our teeth are connected to the entire body through a complex nerve network that's highly concentrated in the jaw (and also explains why there is such immense pain when things go wrong).

After reading Rennaissance's post I also thought about the possibility of phantom tooth pain and found this article:
Phantom Tooth Pain – Its Characteristics and Treatment

 

[hiker]

At this stage I'm leaning towards having the filling changed (as there is a very old and large filling there already) just in case it got messed up during the extraction rather than going ahead with the root canal but I haven't yet decided fully. The filling is above the root pulp so it may not be the right approach but I'll ask the dentist about that tomorrow.

If the filling is old and large, and if it also were "leaky" (there would be microscopic fractures between the tooth and the filling), replacing it with a new one would probably be a good idea. The dentist could place a "medicinal" material in the bottom of the cavity, which would "soothe" the irritated nerve: Biodentine and MTA (these can actually be placed in contact with the nerve without it dying) come to mind, maybe also IRM. Especially Biodentine is supposed to be quite convenient: you can fill the whole cavity with it and down the line (months from now), a little bit of the stuff can be removed from the surface, and composite filling can be placed in that area, as Biodentine will wear down a bit quicker than the enamel/ composite.

Your dentist sounds like a true professional, and will likely know which approach to pick. Good luck tomorrow!