I had a patient in last week … we did an onlay prep on #30. Now she’s in pain. From what?! I adjusted the bite and told her we need to wait 24 – 48 hours to see if it’s a bite problem.
If it’s not the bite, then maybe it needs a root canal. She’s been online and doesn’t want a root canal because of all the information about root canal failures due to infection.
And, I agree … root canals fail more often than we recognize. We only ‘see’ the failure after its extracted and there is a granuloma or a cyst hanging off the end of the root canal tooth. And we think … well, this tooth hasn’t been successful for quite some time. The infection probably remained from the initial root canal procedure but didn’t show up on radiograph (or symptomatically) for a long time.
So, back to the patient above … this patient is battling some health issues and didn’t want a root canal. I understand. Why take the chance?
The rub: this tooth was prepped for an onlay … it was fractured (no caries). I addressed the fracture and hooded the working cusps. My differential diagnosis: it appears that the provisional may have been leaking and caused the sensitivity; or the nerve may have been insulted by the heat of the drill; or I just got too close to the nerve (or all of the above). No infection seen. Is the tooth in need of a root canal? Maybe. Time will tell.
If your 9-year-old fell over the handlebars and hit the pavement and broke #8 off into the nerve (not infected, just a traumatic incident), would a root canal be more successful?
I think … yes. You?
Dr. Peter Evans is a practitioner, author, speaker and international dental coach. He is the President of The BioCompatible Difference, LLC