No one likes to hear the news that they “need” a root canal. But NEED is a broad, relative term that needs qualifying. When your dentist recommends a root canal, here are some questions to ask in order to help you make the most informed decision.
Why are you recommending I get a root canal on this tooth?
There are several reasons a dentist might recommend a root canal, and it’s important that you both are on the same page, because the reasons may vary in degrees of severity and urgency. Obviously, as a biological dentist, I agree with some of these reasons more than others. But again, our job is to give you the information so that you can decide.
- The nerve is necrotic (dead). This tooth likely won’t have any symptoms, but the necrotic root can leak infectious matter around the root into the bone (and therefore, into your bloodstream). These type of infections are filled with the same bacteria that inhabit the blood clots that cause heart attacks.* So while it might not be in-your-face urgent, you want to address the situation for your overall health. Follow up questions you might want to ask are: “How much bone have I lost around this tooth?” “Is the infection affecting the neighboring teeth?” “How urgent do you think treating this tooth is?” “What will happen if I do nothing?”
- The nerve is dying a painful death, called irreversible pulpitis. This is noted by intense pain that happens out of the blue (“spontaneous pain”), throbbing, and/or lingering pain (pain that lasts for minutes or longer, rather than seconds). It is sometimes accompanied by swelling and fever. These infections are no joke, and you may need to take an antibiotic before you can even treat the tooth. But it’s urgent, and not something you’ll want to ignore. But be careful when making any kind of decision while you’re in severe pain, especially if it doesn’t align with values you held before you were hurting. If you were strictly in the “I’ll never get a root canal” camp, and now suddenly you’re begging to have one done, run the decision by a friend or loved one who can help you rationally go through your options. Follow up questions you can ask: “Should I take antibiotics before having treatment?” “How soon do I need to make a decision?” “What will happen if I take antibiotics and start feeling better; will I still need treatment?” “What are my other options?”
- The nerve is inflamed, called reversible pulpitis. As the name suggests, this condition is technically reversible. But it may be really a no-fun time, marked by tooth pain that can be pretty intense. But the pain is only brought on by chewing, cold, or pressure, and ends almost immediately after the painful stimulus is removed. This situation does not NEED a root canal…yet. The nerve in this case can still heal. But your dentist may plan for one if they feel the tooth is going to worsen instead of get better, or if you have been particularly distressed about your symptoms. Yes, sometimes your reaction to your symptoms can make good dentists suggest treatment that might not be clinically necessary. So it’s so important to ask lots of questions if this might be you. Follow up questions to ask: “What are the chances this tooth will heal without a root canal?” “Are you suggesting a root canal because it’s clinically necessary, or more so because I’m upset?” “How long can we wait this out and see if it heals?” “Is there anything else we can do to try to avoid a root canal?”
- There is large decay in the tooth, approaching or into the nerve. The dentist is assuming that while removing decay, they will expose the pulp chamber and nerve. Once that happens, many of us were taught that the nerve has been irreversibly damaged, and the tooth needs to be devitalized (aka, needs a root canal). This is absolutely a judgment call by the dentist, his experience, and how aggressively he wants to treat. Many times dentists want to plan for the worst, but hope for the best, in their treatment plans. No one likes needing a root canal, but a surprise root canal is even worse, so this is sometimes the kindest way for your dentist to proceed. Follow up questions to ask: “How sure are you that this tooth will need a root canal?” “Is an indirect pulp cap an option here (more on direct and indirect pulp caps in another post)?” “If we try a pulp cap, what are the chances that I’ll still need a root canal?”
- You’re in the middle of dental treatment, and the dentist says the decay went farther than he thought, and now you need a root canal. Yikes. We all hate when this happens, but it’s a possibility whenever you have dental work done. It’s listed as a potential complication in the consent form you signed (but maybe didn’t read) for a reason. It’s really important here to ask the dentist to stop the procedure for a moment so that you can discuss what happened, and what your options are. Hopefully you had this discussion beforehand, but if you didn’t, now is the next best time. If this has happened to you, and you are really uncomfortable with proceeding, ask if the dentist can place a temporary filling in the tooth for you so that you can gather your thoughts, evaluate your options, and make a good decision.
Regardless of the reason your dentist recommends a root canal, there are other questions you may want to ask.
What are my other options?
What will likely happen if I do nothing?
If I pull the tooth instead of doing a root canal, what are the risks involved?
If I take antibiotics, but then don’t do the root canal, what will possibly happen?
What is the chance (in percentage) that this tooth will heal without a root canal? What might I do at home to help it along?
As dentists, it’s our responsibility to make sure you are given INFORMED consent before you receive any dental treatment. But sometimes we gloss over parts of the information, or assume too quickly that you understand what’s involved. So I encourage you to ask these questions, especially if you don’t feel comfortable with your treatment recommendations, and pause on any treatment until you do.
*https://www.ahajournals.org/doi/10.1161/circulationaha.112.001254
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