Although radiographs often do show a widening of the ligament at the apex when an endodontic infection is present, not all teeth that require root canal treatment do show this tell tale sign. Some non vital teeth do not show any sign at the apex of an infection, but if challenged with an ice cube probe, feel no cold sensitivity. Teeth that are non vital, whether they show an area of infection present at the apex, should have endodontic treatment.
Also some teeth, especially those with an acute pulpitis, do not show any apical pathology yet, but patients can be in acute pain. If this pain is not associated with a high bite from a recent dental restoration then often it is best alleviated by starting a root canal. Some of these teeth have beginning abscesses in their pulps but the pathology has not reached the apex yet.
When I do start a root canal on these teeth, sometimes a small bleb of pus can be seen, overlying an otherwise still vital pulp. Other times the pulp is entirely necrotic. Most dentists would agree that these teeth should have root canals even without any evidence of a radiolucency around the apex of the tooth.
Good morning Mr Spindel.
ReplyDeleteI have just read this article which is excellent. I have had numerous problems with my teeth due to heavily filled teeth and in a nutshell I have had 8 teeth found to be non-vital in the last 2 years!
I recently had a very painful UR3 which has a 40mm root. Right at the tip of the root it has been very sensitive for sometime and for the last year there has been a definite bump which could be felt if pressed next to my nose. About 2 weeks ago the area started with a bad throbbing pain but did not hurt to tap it. My dentist said the xray looked but because the root end was unbearable to touch he would take out the filling (which is very deep) and perform RCT.
He informed me upon completion that when he took out the nerve there was no bleeding at all suggesting it was dead. The pain (especially the throbbing) has now greatly decreased but the sensitive "bump" still remains and is very painful.
Would this "bump" have showed up on the x-ray if there was no bone involvement?? I am very confused as to why nothing showed up when there is an obvious physical sign. The last root canal treatment I had showed no signs whatsoever and my dentist refused to do a root canal and I ended up living with the pain for a whole year! Once he entered the tooth he said it a large amount of pus in it....needless to say I was very annoyed!
Thank you for reading my post!
With best wishes,
Joanne.
(ps I am in the UK where our dentistry is not as advanced as yours!)
Most non vital teeth that have related adjacent swelling do leave a tell tale signature on a radiograph. Sometimes it can be difficult to discern, but if a patient has a non vital pulp ( as evidenced by a lack of sensitivity to an challenge with an ice cube probe) and periapical tenderness, there is almost always involvement and some breakdown of periapical and/or lateral bone.
ReplyDeleteI got hit in the mouth and caused a trauma in on of my front teeth now I have chronic pain and discomfort, taken 3 x rays in the past month, nothing found.. 1 teeth was loose in the front and as soon as it healed the one next it felt uncomfortable and I get the chronic pain.. dentist don't give me a straight answer
ReplyDeleteMay be nerve pain
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