Root Canal Filling – If in doubt don’t take it out

This case highlights the need, sometimes, to let things take their course before making an irreversible decision. The patient presented with pain and swelling from the lower right side of the jaw and our first thoughts were that the back tooth (LL7) was to blame. This tooth has suffered extensive bone loss through gum disease so was a likely cause of infection, especially as the adjacent teeth had not been heavily filled. Because of the extensive nature of the pain and swelling the planned extraction of LL7 was left for another day.

Once the antibiotics had worked however the swelling had begun to localise to the tooth next door (LL6) and testing of this tooth showed that, despite the lack of any dentistry done to it and no signs of infection of x-ray, the tooth was most likely dead. A small test cavity revealed a “pin prick” exposure to the nerve through a small erosion pit in the tip of one cusp and further examination of this exposure revealed that the tooth was in deed quite dead and the cause of the infection. A root canal filling and central fibre reinforced composite core were used to treat the tooth, which is now symptom free and functioning well. The original suspect, LL7, is firm and symptomless as well but remains on probation given the extent of bone loss around it.

The moral of this story is that it can be very difficult for patients to accurately locate the source of their pain and infection can track away from the primary site and appear adjacent to another, unrelated, tooth. These two facts mean that we sometimes have to wait for the true picture to show and not be too hasty to take teeth out, lest we take the wrong one and leave a patient down one tooth and still suffering from infection from another- never a happy day in practice for anyone!

Cases like this show how sometimes we need to take more time to arrive at the right treatment plan and why it is sometimes difficult to give people what they want or think they need on day 1. It is always our aim to give the best, most appropriate care and this can, on occasion, mean waiting before we act. If you are at all worried about any teeth that are troubling you please call us on 01580 752202 and we will be happy to try and help.