Worried about recommended root canals

Dear Dr. Copeland,

My question is about a root canal done many years ago (at only 31) and the dentist really did not do a good job. I had to go back and have it redone. The new dentist found that the tooth next to it has had a lot of food collection and has caused it to erode. I believe my home care is generally pretty good. The dentist says that it, and perhaps another tooth, needs a root canal and that I have a handful of small cavities.

I am concerned with the cost. My insurance will cover the small fillings and extraction, but not root canals. I was thinking of just having them extracted, but that seems to me that my overall function would be profoundly compromised. Can you offer any advice?

With laughter and light,
Irene

Dear Irene,

The recommendation only for root canal is less information than you need.

A definitive diagnosis as to whether the teeth in question are VITAL (alive) is needed. If they are not vital, an extraction or root canal therapy are the only choices.

However, if the tooth is vital, then other factors should be ascertained:

1. Is the tooth symptomatic?  If so, does it need a stimulus? If the tooth EVER aches or is symptomatic without a stimulus, it’s prognosis is very poor. Again…removal or root canal therapy.
2. If only with a stimulus, what kind, for how long, and where on the tooth?
3. Does the radiograph or scan show evidence of decay close to the pulp? and periodontal defect? or infection at one of the root tips?

A good dentist can test the teeth objectively, individually, and cross test with other teeth in the mouth and put that clinical information together with the radiographic evidence and oral habits such as hygiene to give estimated prognoses of the different treatment option.

Then it is up to the patient to choose what option best fits her needs, based on all the evidence.

I do frequently see teeth recommended for root canal which are vital and do well after addressed with disinfection, a sedative filling and ozone, which after several months have proven their ability to be vital and asymptomatic which can then receive a final restoration and be quite happy.

I hope this helps. If you’re in the area, I’d be happy to take a look and give you a second opinion.

Best,
Dr. Cynthia Copeland.