Healthy Smile: They Told Me That I Needed a Root Canal

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

I met this woman just a few days ago in our office as a reader of this column but never a patient of mine. She told and showed me about a tooth on her upper right side, which broke a little while ago. Fortunately for her, the tooth never hurt her, allowing her to weigh her treatment options carefully and leisurely.

When I looked into her mouth, I observed a common phenomenon. The entire outer surface of her bicuspid, one of the teeth midway between the front and the back, was gone. The only thing remaining was a large silver filling and tooth structure on the side toward the roof of the mouth. She knew she needed a crown to fix the tooth but was concerned about what preceded the crown. Her previous dentist referred her to someone who would do a root canal procedure before the crown.

Before we go on, let’s discuss a root canal procedure and when it is indicated. A root canal procedure is a method that allows a tooth, which otherwise would be lost stay in the mouth. One of the most common reasons for doing this procedure occurs when pain or infection is present. A tooth is composed of layers, and the innermost layer is soft tissue. This central tissue is filled with blood vessels and nerves, which formed the basis of tooth formation when we were children. Once we become adults, the central tissue is only an alarm system. That means that if the tooth is in danger from tooth decay, the soft tissue hurts, and we seek help before too much damage occurs. We employ a root canal technique to stop the pain and save the tooth.

There is another indication for a root canal procedure. If a tooth is severely fractured, we cannot make a crown for it unless we have some solid base. One way to create this base is with a large supporting post in the tooth. The ultimate location for the post is in one of the channels of the tooth. Accomplishing and performing a post requires removing all the contents of the channels or canals of the teeth. Once the canal or canals of a tooth are empty, we place a post upon which to build a crown. Even though a fractured tooth without pain does not need a root canal procedure to make the patient feel better, we still perform it for the final crown on the tooth.

I used this technique extensively during my early years in dentistry. It works and works well. There is another way to deal with a tooth that is broken badly. Today we remove that tooth and place a dental implant which gives more years than a root canal and post. I discussed this option with the patient; she did not want to lose the tooth.

With that fact in mind, I told her I had another way to save the tooth that did not involve a root canal procedure. Remember earlier, I said that a root canal procedure was necessary to put a post in the tooth for the crown. The indication for a root canal was a tooth with a horizontal fracture down to the gum area; our patient did not have a horizontal fracture. She had a vertical fracture on the outside of the tooth. I presented an alternative method that bypassed a root canal technique and saved the tooth. I would employ a provisional crown with some gum work to make this a reality for her.

As the expression goes, there are many ways to skin a cat. Sometimes, the different ways may be right or wrong. Other times, each way is valid, and the trick is to find the right approach for the particular situation that resonates with you and your wants. If you have thoughts about your mouth and want to hear different approaches, please call us at 440-892-1810. I will discuss options with you and find what works for you. I look forward to meeting you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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