Broken Tooth, Likely Cracked Tooth Syndrome- Does a Root Canal resolve the issue?

[DentalNewbie]

Hello everyone - newbie here so please forgive me for any silly questions. I’m looking for a better understanding of potential treatments for an issue I’ve had, so hope I am posting in the correct place.

Around two years ago, whilst eating breakfast a piece of a lower molar broke off - I’d estimate maybe around 30% of the tooth.

I visited my then dentist, who carried out a filling for me.

However as time went on, I found I wasn’t really comfortable chewing on that tooth, and eventually any time I chew on hard foods I almost got a sharp or shooting pain, as if hitting a nerve. Not nice at all.

I’ve since moved house and moved to a new private dental practice. I asked them to review and he advised that we start with the least invasive treatment, and see how we go from there.

X-rays have not shown any visible cracks, and therefore the suggestion was:

- new filling (apparently a different material to the first one to see if it helped)
-if that fails, try a crown
- if that doesn’t fix the pain, do a root canal.

So far, the filling didn’t work- the dentist suggesting that there may be a hairline crack that could be flexing when biting down.

We’ve now put a permanent crown on, but again it still hurts to chew hard food. I don’t have any pain other than when biting or chewing, but I have noticed sensitivity to hot, cold, and sugary foods. I sometimes feel as if I’m feeling not a pain or an ache, but just a very very light throbbing - perhaps as you would towards the end of gums healing after dental surgery. It’s hard to describe.

It’s very costly to keep going through each treatment - Root Canal is the next option- does it sound like a sensible treatment for this particular issue? The dentist has suggested that it essentially removes the nerve and therefore the pain should disappear if a root canal is performed successfully. I’m just slightly worried about drilling through a tooth that’s already lost a piece of itself and been filled and crowned already.

One final question- does a root canal have to be done with a rubber dam used? I have a big fear of them. At my first filling with the new dentist for this broken tooth, we had a scary incident where the rubber dam clamp pinged off mid surgery, and something went down my throat which I swallowed and was very uncomfortable as I felt it slide down through the chest

The dentist advised me to go to A&E, fearing it could have been the clamp I ingested. X-rays didn’t locate it, so we can only assume it might have been filling or tooth that I swallowed, but I’m obviously worried now after that. I thought the dam was actually there to stop anything going down the throat?

Any helpful information on these things would be greatly appreciated.

 

[Dr M]

Yes, a rubber dam is required, since it prevent you from swallowing any instruments or materials that might be harmful, and also helps to isolate the tooth, to prevent moisture contamination of the root canal system, which might lead to future failure if not done adequately.
It is important to note, that although a root canal might remove the nerve, they don't last forever, and if there is indeed a crack, and the crack involves any part of the root of the tooth, the tooth will need to be taken out.

My opinion would be to ask for a referral to an endodontist. It might be more expensive, but they have access to 3D CBCT scans, which might increase the chance of spotting a crack in one of the roots, and increase the likelihood of the root canal lasting an extended period.

 

[Brause]

I have a similar history. Tooth 46 cracked (2nd last on the lower right). Dentist tried to fix it with a filling, but it cracked again.

I was referred to an endodontist who did CBCT and X-ray for the periapical diagnosis, and palpation/percussion and cold test for the pulpal diagnosis.

The imaging revealed "rarefying osteitis", which is a general term for any infection around the apex. A root canal treatment was performed, which failed from the getgo: my pain never subsided. Reason was most likely a root fracture, which was not visible in the imaging.

After 11 weeks of aggressive non-treatment ("waiting"), the tooth was extracted.

If the root canal treatment had been successful, I would have needed a crown after a few months as the treated ("dead") tooth would become brittle over time and prone to fracturing.

Since tooth 46 is in a strategically important position (taking up a lot of chewing stress), I regret having attempted root canal treatment. Time and money wasted in my opinion.

A friend of mine had one of his second molars extracted...and never replaced with an implant. I will have my first molar replaced, though. Expensive.