Root canal for exposed root? Should I get a second opinion?

*eadaoin

Saw a dentist today for some pain and sensitivity in an upper molar. Tooth has been causing sharp pain with hot or cold liquids and food, as well as a small ache in it that just appeared today. The tooth has a filling in it that was replaced about ten years ago. No signs of infection or swelling, just pain with temperature change.

Dentist took a brief look and said the root is exposed from a receded gum, which is causing the pain. There is a small amount of yellow root visible where the gum and tooth meet.

He recommended a root canal or having the tooth removed, root canal and crown will cost about €1600, so bit of a punch to the gut. But root canal will mean no more pain in the tooth. He did not mention infection. Before showing me the price he got me to confirm how difficult it had been to find an appointment with a dental clinic as everywhere is booked up right now - that made me feel a bit like I didn’t really have much of an option but to pay for his suggested treatment.

My partner suggested going to another clinic for a second opinion, as jumping straight to root canal for exposed root seemed like a big leap. But neither of us are dental professionals, so I’m not sure if I should just trust this dentist or not (he is not someone I have seen before).

If anyone has advice on whether a second opinion is a good idea or not, I’d appreciate it.

bureau2009

Firstly, I am not a dentist

Absolutely go for a second opinion.

I have a sensitive upper molar with gum recession. At one stage it was significantly painful.

I now use a sensitive toothpaste daily and it's vastly improved. Just allowing time itself was useful.

A second dentist might have a different approach and suggest a different treatment. I don't like the idea of a tooth being removed because of sensitivity.

Best of luck with everything.

*eadaoin

Thank you! I think I just needed a bit of confidence that it was a good idea to check with another dentist. I’ve made another appointment with a different clinic tomorrow so hopefully that will be helpful. And if I end up needing a root canal anyway, that’s okay! I actually feel a wave of relief as there were just too many red flags with the first dentist, probably a good sign in doing the right thing for me.

CSSE09

Go for a second opinion, for the sake of the few quid it'll put your mind at ease, clinics are busy but you'll find another with a few calls don't let that comment put you off.

Dav010

The decision to have a tooth root canal treated is much easier when there is an abscess/swelling on the tooth and you are in a lot of pain, in order to relieve the pain, it’s either root canal treatment or remove the tooth.

Hypersensitivity is different, and the decision a little more difficult. In a lot of cases, the sensitivity is caused by the roots being exposed, or there being a deep filling close to the nerve chamber. Generally, the tooth is only briefly painful when extremes of hot/cold are applied to it. Unfortunately the treatment of exposed roots is not easy, you can’t pull the gum back down over the roots, you can’t push the tooth back up under the gum. So, you are faced with the prospect of putting up with sensitivity in an otherwise healthy tooth, or, having a treatment which removes the sensitive nerve. Sometimes, but only sometimes, a root varnish or a white filling placed over the exposed root can help to reduce the sensitivity, but this only helps in some cases and the benefit is temporary.

So op, when you go for the second opinion, the Dentist will ask how bad the sensitivity is, and whether it is bad enough to do something about it. You can try the varnish, if it works, great, if it doesn’t then it’s either RCT or extraction if you want to get rid of the sensitivity.

*eadaoin

Thanks Dav010, this is really helpful. I prefer to understand any treatment I need to have, it makes me feel more relaxed.

The dentist I saw just barely looked at my tooth and hadn’t seen an X-ray before making this decision, and he did not explain his thought process clearly. So I left feeling a bit confused. He gave me no advice but root canal or extraction for the sensitivity. Perhaps he didn’t need to do any of this stuff and the treatment was obvious to him, but it didn’t sit well with me.

He also reminded me of how difficult it had been to get an appointment with him, before showing me the amount of €1650 it was going to cost - which honestly made me feel a bit manipulated into thinking I had no choice but to pay this amount. I know root canal is expensive, but the way he went about it unsettled me.

On top of all of that, he seemed a bit pushy to get me to do the root canal ASAP - I take immunosuppressive medications, so I need to check things like dental procedures with my consultant first, and he questioned me on this. Which is unusual, because it’s usually the dentist who questions me when they see these medications on my file, but he seemed quite unaware or unconcerned about them, and that made me wary. The potential for infection can be bad news for me with these meds, I can’t afford to leave myself open to extra risk.

If it turns out I need the root canal, and have to pay a similar amount that will be fine, I’ll just have to deal with it. But at least I will be sure it is the best option and hopefully I’ll feel more confident in the dentist!

Dav010

At the moment, appointments are at a premium. There was three months of pent up treatments which are a hangover from the closure March to May, reduced capacity to see patients as a result of Covid protocols, all this on top of what is generally the busiest time of the year for Dentists leading up to Christmas. For patients who had there examinations today, we are booking them in January to begin treatment, we have stopped accepting new patients, that unfortunately is the reality of the current situation. So there is a reason for his advice to make a decision as soon as you can.

An X-ray will not usually tell a Dentist anything extra about a tooth with sensitivity due to exposed roots. A simple application of cold air to the exposed area is enough to confirm the source and reason for the sensitivity.

It sounds like he communicated the problem poorly to you.

In relation to the crown, root canal involves removal of the centre part of the tooth, this of course weakens it substantially leaving it more prone to fracture. This is why a crown is always advisable after a root canal on a back tooth. The Dentist will not be able to tell you when it would fracture, only that it is more likely to. It is extremely frustrating for patients when a tooth breaks after they have gone to the trouble and cost of having it root canaled, only to then lose it. That is a lot of money wasted and there will be no refund if the dentist advised you to have a crown, but you decided not to.

*eadaoin

Just said I’d put an update about the second opinion, in case it helps anyone in the future.

So I still need a root canal, but not for an exposed root. The second dentist took an X-ray of my tooth and did a full exam. She showed me on the X-ray how under the filling (giant filling apparently) my root pulp seems to be dying and there is an infection there that is close to the bone. I am also grinding my teeth at night, which is probably making this issue feel a lot worse since I’m grinding down on an already sensitive and sore tooth.

She explained that my options were root canal or extraction with implant, and went through the details of these treatments and their costs. She is giving me a week of antibiotics first, which will help the infection to clear up a bit, but it will not go away - it needs proper treatment to go away.

She was also considerate of the fact that I’m taking immunosuppressive medication, and we are working around my schedule with these drugs.

I think with the other dentist root canal would have had the same result and solved the issue, but he didn’t seem to care about the fact that I’m immunosuppressed and need to be careful. The fact that I have an infection is actually something I need to be aware of while taking these medications, I have to monitor these things carefully. He just wanted to do it ASAP, he was not aware of any infection (he did not see an X-ray).

This new dentist will cost less, but honestly I would have paid the same price, I just feel better having someone who explains everything, investigates properly and works with my health issues.