Biting pain disappears after rinse with salt water. Root canal still needed?

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Feb 13, 2023
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Five months ago, when I was traveling, my upper molar (#15) started to have severe sensitivity pain when drinking hot or cold water. It also had biting pain when I eat. The local dentist said the root area was exposed from brushing too hard, and he could see the nerve. He put composite material around the root that stopped the sensitivity. For the biting pain, he gave me 3 days of antibiotic (amoxicillin) then biting pain was gone.

Two months later I returned back to US, the biting pain returned. I rinsed with salt water 3-4 times a day and the pain went away in 2 days. This happened again a couple of months later. Again, salt water stopped the pain.

When it was time for my regular cleaning, my dentist took a whole mouth X-ray. I told him about the pain history. He looked at the X-ray of #15 said I need a root canal, and referred me to an endodontist.

My question is, right now there is no pain when I bite, but I am careful only use that side for soft food. If the pain ever comes back, I can manage with salt water again, so how bad is it that I have to have a root canal now? Can people live with such condition for a while?
 

Dr M

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Most likely the dentist saw an area of peri-apical pathology in order for him to suggest a root canal treatment. Do you perhaps have copies of the x-rays you could share?
In most cases, the tooth firstly develops pulpitis or inflammation of the nerve. Sometimes this can be reversible. Sometimes it becomes irreversible. When it is irreversible, you can have stages of spontaneous pain that comes and goes, with or without a stimulus. Gradually the nerve dies, and then the pain seems to disappear completely. The issue is not solved however, since as the tooth becomes dead or necrotic, abscess formation starts and pressure builds up. This sometimes takes weeks and sometimes days. Once the pressure is high enough, swelling and pain can occur again.

Again, would really help to see an x-ray.
 

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MattKW

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  1. Sensitivity can only occur with a live tooth. Cold pain roughly suggests the decay is of moderate size and the "nerve" (pulp) is still salvageable (reversible pulpitis).
  2. Hot pain generally suggests deeper decay and more likely that the nerve is dying (irreversible pulpitis).
  3. The antibiotics were an inappropriate and useless prescription for sensitivity and the pain settling may have been coincidental.
  4. As Dr M says, the nerve may die quietly and your symptoms subside temporarily. The problem then becomes that patients delay further treatment and the hole gets even bigger. By the next visit, the tooth may be so structurally weak that it has to be extracted.
  5. Go see the endodontist now.
 

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Joined
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I finally went to see an endodontist about my molar. He did a cold test, and I have no feeling of that molar whatsoever. He did the same on a healthy tooth, and I could feel cold. So, looks like the nerves are dead. There is no pain nor sensitivity right now. He said I may have strong immunity. I am not sure he meant as a joke or not.

He showed me the X-ray, and also the CT-scan. The area at the tip of the roots is dark so that appears to be an infection area. So the root canal is scheduled next week. There are total 4 pulps looks like. My body will self heal the root infected area later on, he said.

I am not looking forward to this ordeal, to my body and my pocket. But, this is what needs to be done, I guess.
 

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