Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Worried About My Tooth

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I had an bit of a fall that resulted in losing about 1/3 of a front tooth. Even the nerve was exposed. I was visiting a friend in a different state at the time. She took me to her dentist who did a root canal treatment. When I got home my dentist checked out the work and said that everything looked good and he put a crown on the tooth, which the last dentist did not do.

Fast forward a year and the crowned tooth became very sensitive to both hot and cold. After a few months, the tooth gradually calmed down, but was still a little sensitive for cold. I’d finally saved up enough to go in and the dentist did an x-ray and exam but could not find anything wrong with the tooth. He decided I needed to see a specialist and sent me to an endodontist.

This specialist did not see anything wrong with the tooth either and thought maybe the problem was me clenching my teeth which could cause pain. He felt I was feeling pain on the tooth next to it. Nothing is being done and I’m worried I can lose this tooth. Have you heard of a situation like this?

Evelyn

Dear Evelyn,

blonde woman holding the side of her jaw in need of an emergency dentist

I’m more puzzled with why neither your dentist or specialist can figure this out than I am about your tooth. First, if I understand what you said correctly, then you had a root canal treatment on a front tooth that removed the nerve. It was also checked by another dentist. In that case, that tooth cannot be the one having sensitivity to hot or cold because it should not have feeling. That doesn’t mean you are not feeling pain, just that it is referred pain, which means coming from a different tooth.

Second, not seeing anything on the x-ray does not surprise me because it would be inflamed. Until it blows up into an infection, there would not be anything to see.

Third, you had a traumatic injury to a front tooth that was rather significant. It is very unlikely that the tooth next to it was not impacted even though it did not lose any structure. Often when a tooth experiences trauma, the damage from that is slow to become obvious. It is not uncommon at all for it to be fine for a few years and then blow up.

I do not think you have a dental emergency on your hands. Because you are not having pain now it either means the tooth has recovered or the adjacent tooth is dying. My suggestion is that you leave it, but have an x-ray at your next check up and then every few years after that. If the tissue does die, then it will mean another root canal treatment on the adjacent tooth.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

How Long Can You Put Off a Root Canal Treatment?

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I have a tooth which is in need of a root canal treatment. I am in a bit of a bind financially at the moment. Do you have an estimate of how long a root canal treatment can be put off before it becomes a problem?

Jack

Dear Jack,

A man holding his jaw in pain.

I am sorry that you are having to deal with so much right now. First, the financial bind and then the infected tooth. I’m sure this is adding more stress. It would be hard to tell you how long you can wait without examining your tooth. However, I can give you some guidelines.

If the tooth is not hurting and has not been hurting for a bit you can likely put it off without much of a problem. I know of a patient who put off a root canal treatment for several years but there were no problems. When they did finally get the root canal treatment, they did mention they felt better in their general health, which surprised them. Most people do not realize that their general health is impacted by their oral health. One thing to be aware of is that waiting for a long period of time puts you at risk for external resorption. This is where the root of the tooth is slowly eaten away and the tooth can no longer be saved.

If there is any pain with the tooth, even just a little, then you have an active infection and you should not put this off. It will continue to spread. Another sign of an active infection is a pimple on your gums. Again, don’t put off treatment in that case. Believe it or not, people still die from tooth infections. This is because your teeth are very close to your heart, lungs, and brain. If an infection reaches there, then an infected tooth becomes life threatening. I say this to make sure you understand an active infection must be dealt with. I would consider this a dental emergency.

The good news is that there are affordable dentists who would be willing to work with you on payments in the situation where you need urgent dental care. I would do an internet search using the term affordable dentist, then call them and explain your situation. One of them should be willing to help you.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Something Is Wrong With This Dentist’s Advice

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I have a tooth that has been aching me on and off for a couple of weeks. It will be fine for a long while and then hurt for about ten minutes or so. I finally got worried enough about it to go and schedule an appointment with a dentist who does same-day appointments for urgent dental care. He examined me and then said it was hard to tell so he did an x-ray. That told him that there was an infected tooth where there was already a dental filling. He said it was so far gone that only 10% of the tooth was viable. He recommends I have the tooth extracted and then schedule a follow up appointment for a dental implant. He wanted to extract the tooth right then, which sort of freaked me out. I told him I’d let him know. Is this really necessary? Is there no way to save a tooth that is infected?

Cathy

Dear Cathy,

blonde woman holding the side of her jaw in need of an emergency dentist

I am glad you wrote. There are some things that make me suspicious of this dentist’s advice. First, if the tooth were really that far gone not only would you have been in serious pain for a long time, but your dentist would not have needed an x-ray to tell. In fact, the filling would have fallen into the tooth.

Thankfully, you didn’t go through with the tooth extraction. My suggestion is that you get a second opinion from another dentist. When you do that, make it a blind second opinion. By that, I mean don’t tell them who gave you the first diagnosis or what it was. Many dentists know one another and you wouldn’t want them feeling torn about saying a colleague was wrong. If they don’t know who it was, they are free to give their unbiased opinion.

As for your question as to whether an infected tooth can be saved, the answer is generally ‘yes’. A root canal treatment can save a tooth that is still viable. If that turns out to be not possible for you and the tooth does need to be extracted, then a dental implant is a great tooth replacement. Just make sure the dentist has post-doctoral training in implants. It is an advanced procedure that is not adequately taught in dental school.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.