Based on this x ray, root canal or not?


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have had a bump behind bottom front teeth, that will flare up and abscess occasionally. Dentist says root canal is necessary.. do you agree? I’ll purposely not mention what tooth.
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MattKW

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Not enough detail. "Dead" teeth don't necessarily show changes on the Xrays. The more important tests are: tenderness to percussion, non-response to cold stimuli, colour changes, increased mobility, draining sinus (gumboil). Gumboils on lower incisors have always been out to the front (lip-side) of the teeth in my experience.
What do you mean by, "will flare up and abscess occasionally"? How does it manifest itself within the above parameters? Other possibilities for "bump behind bottom front teeth" could be lingual tori (most likely), salivary gland infection (very rare).
 

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Dentist did a tenderness percussion test, as well as sticking some needles into my gums behind #24/#25.. ??Checking for pain.. Not sure what the name of that process would be.
I’ve had this hard lump appear on the gum line right below ( closest to floor of mouth under tip of tongue) my bottom front teeth. It has been a harmless slight bump, but with excessive sugar intake or a decline in proper oral hygiene, it will become inflamed, painful and leak blood and pus.
This last time came with a slight looseness in one of the teeth. Not enough to be alarming tho.
I’m not sure how to answer your question on how it manifests itself (I’m assuming you meant the symptoms it’s showing) correct me if I’m wrong there.
I have been told I am on perio maintenance. Leading me to think this is periodontal abscess. Dentist mentioned childhood trauma to the teeth but I haven’t cracked or broken any teeth in my life. Dentist prescribed amoxicillin for infection.
I understand the job of a dentist can be very stressful and I wish dentists were not expected to figure something out in such a short exam time. I do appreciate you taking time to answer.
 

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MattKW

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  1. OK, so I imagine they didn't hurt when he tapped them?
  2. A vitality test is very important: it means either putting something very cold (usually an icy pellet) or Electronic Pulp Tester on the teeth. Was this done, and what was the result? I'd be testing at least the 4 front teeth and looking for one that has no response (no "ouch"!).
  3. I see no sign of perio bone loss on the Xrays.
  4. Childhood trauma can ofetn mean as little as being hit on the teeth with a ball but no breakage. However, a blow like that can cause a "nerve" to die. This can show up on Xrays as a dark area at the tip of the tooth, or may show as a discoloured tooth.
  5. I wouldn't've prescribed antibiotics in this case, but... did they make any difference? Sometimes by the time the antibiotics are finished, the "infection" or whatever may have subsided anyway, so it's not a reliable method.
 

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  1. OK, so I imagine they didn't hurt when he tapped them?
  2. A vitality test is very important: it means either putting something very cold (usually an icy pellet) or Electronic Pulp Tester on the teeth. Was this done, and what was the result? I'd be testing at least the 4 front teeth and looking for one that has no response (no "ouch"!).
  3. I see no sign of perio bone loss on the Xrays.
  4. Childhood trauma can ofetn mean as little as being hit on the teeth with a ball but no breakage. However, a blow like that can cause a "nerve" to die. This can show up on Xrays as a dark area at the tip of the tooth, or may show as a discoloured tooth.
  5. I wouldn't've prescribed antibiotics in this case, but... did they make any difference? Sometimes by the time the antibiotics are finished, the "infection" or whatever may have subsided anyway, so it's not a reliable method.
I appreciate the reply.
So the percussion test was not insanely painful, as painful as banging on someone’s teeth with metal would be. It wasn’t a sharp or alarming pain.
No cold testing was done, that I know of. This dentist was very vague and wasn’t explaining what and why during exam. I do not recall a cold test being done. No questions about cold sensitivity during exam.

Yeah I can’t think of any significant times that I have my teeth/mouth have been struck in any way. Do you see any sign of childhood trauma to the teeth here? Despite the lack of detail..

Regarding amoxicillin, I have only just begun the antibiotics as of yesterday. This is the first time I’ve taken antibiotics for this issue. “Infection” seemed to resolve itself, as you said.

I have spoken to a different dentist and will be getting a second opinion. Your insight is much appreciated
 

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