Why do I need a root canal if I have no pain?

I am frequently in the position of informing a patient that they need a root canal based on the objective clinical presentation and not based on their subjective symptoms(pain). When a patient comes to my office for a cleaning or an exam and they have pain due to a dead or dying nerve, it is easy to explain the cause of the problem and the cure that will stop the pain is a root canal. Although I am very aware that the word "root canal" brings up images of Dustin Hoffman from the movie The Marathon Man or just the public perception that root canals are "excruciatingly" painful, I must try to inform the patient of the need for root canal treatment without undue anxiety.

The previous situation should not be a concern now a days with 95% of people needing this treatment experiencing little to mild discomfort. Albeit, this negative perception is reinforced by Hollywood and other media forums. Unfortunately, this causes anxiety for too many patients.When a root canal is needed, I first explain that the patient will not experience pain during the procedure and with proper precautions the day or two after should be only mild discomfort alleviated by an anti inflammatory most times.

My patients of record trust me and rely on that to ease their fears so that they can get the appropriate treatment. For the new patients that I need to inform of this procedure, I must ask them to take a leap of faith and believe in me enough to feel relatively at ease before the procedure.

However, the hardest thing to explain to a patient is that they need to get the perceived "dreaded" root canal when they are not having ANY pain! Why is this the case? Here are a few examples that may precipitate the need for root canal treatment that may not be pain.

1. The tooth may have a chronic infection that the body has accommodated enough that they have not gone beyond their pain threshold. I can see the area of concern on an xray and test the nerve to determine its need for treatment. The patient can see and feel a difference so they can accept the rational behind my recommendation.

2. A tooth may have broken enough that I do not have the amount of tooth structure to hold a crown on the tooth long term. I then need to explain that I need to place a post inside the tooth to allow me to build up the tooth for a crown. But I can not put a post in a tooth if the nerve space has not been treated with a root canal. So… the patient needs a root canal so I can place a post so that I have enough tooth structure to support a crown. I try to keep it simple and logical. My patients understand and usually do not question the reason a root canal is needed if they are not experiencing pain.

3. Another situation that may occur is when a tooth has an enormous old filling that has recurrent decay that requires a crown for rehabilitation. In this situation, if I remove the entire filling, I will no longer have sufficient tooth structure to support a crown long term. Or the procedure may precipitate a tooth ache because of the removal of the old filling and cavity. Or lastly, I may be able to place the crown, but have seen this situation so often that, I know that this tooth will eventually become sensitive or develop a detectable nerve condition requiring a root canal.

If that occurred, then our options would be to try to remove the crown but face a potential catastrophic fracture of the tooth. Or the patient can opt not to take the chance of a tooth fracture upon removal of a crown and have a root canal performed with access through the recent crown. This last option is completed routinely by general dentists and endodontic specialists. I  explain that if may behoove the patient to consider the preemptive root canal to maintain the integrity of an intact crown and the corespondent more aesthetic appearance.

In closing, please be aware that a root canal my be indicated for a tooth or indicated due to an expected course of degradation of the dental nerve even if you have no pain.. So listen to your Dentist and if you are still unsure of why you need a root canal when you are not experiencing pain, just ask more questions.

Here at Smile Solutions we pride ourselves on being the friendliest office around and for being very patient friendly, So ask as many questions as you need and we will be more than happy to explain our treatment recommendations. Please call if you have any questions or concerns. 302-999-8113.