Getting the right tooth...


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I have had sensitivity in an upper left tooth for almost a year now. The sensitivity is there most of the time, but occasionally subsides.
The sensitivity only presents itself when eating/chewing on food on the left side.

I'll spare you a detailed history of what transpired in this area of my mouth for now.

I had a root canal done on (26) (Canadian numbering system) on June 11, 2015.

When I consulted my regular dentist about the sensitivity on May 2, 2019 he did tests on the teeth in the upper left
and said he was 99% certain the problem tooth was the root canal tooth (26).
He recommended I go see the endodontist who did the root canal.

I saw the endodontist on May 9, 2019 and he did his own tests as well as take two X-rays (attached).
He concluded that (26) was fine and that the problem tooth was the one next to it (27).

When I went back to my dentist, told him what happened and showed him the X-rays, he did more tests and now agreed that
the problem tooth was (27). He is recommending having a root canal done on the tooth.

Before I do any work, I'd like to be certain the correct tooth is being worked on. Before the root canal was done on (26), my previous dentist
misdiagnosed a pain problem as coming from (27), (took out filling and re-did work on the tooth), when the problem tooth was actually (26).

When I chew on the left side of my mouth, it feels like the sensitivity is coming from (26) or (25).

Any advice?
 

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MattKW

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From the Xrays alone, there has been a deep composite filling in the 27. So that makes it a prime suspect. If you're only having mild sensitivity, then a root canal is not required. Either the composite is leaking because the bonding is failing at the gumline (most likely), or the tooth has a crack. As a first step I would refill that tooth with an amalgam. Doing a composite at that depth is risky.
 
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From the Xrays alone, there has been a deep composite filling in the 27. So that makes it a prime suspect. If you're only having mild sensitivity, then a root canal is not required. Either the composite is leaking because the bonding is failing at the gumline (most likely), or the tooth has a crack. As a first step I would refill that tooth with an amalgam. Doing a composite at that depth is risky.
Thanks Matt for your help!
Yes, all the testing (including cold tests) have fingered 27 as the culprit, but whenever I feel the sensitivity it seems to be coming from a neighboring tooth.
My regular dentist was shying away from re-doing the filling. I think he said the tooth was cracked and a filling wouldn't be possible.
 

MattKW

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Pain is elusive and misleading. What you personally feel is only one factor to consider.
I would go somewhere else. If your current dentist did this filling, then I doubt he likes/wants to do amalgams. Find someone who does amalgams. I teach 1x day a week at my local uni, and all the students want to do is composite. This really limits their skill set, and means they can't do an amalgam when the situation absolutely calls for it as the superior material.
To jump into an RCT when all you have is sensitivity is totally unjustified. Once you do an RCT on that sort of tooth, you have taken further risks (what if the RCT fails?), AND you will have to do a crown.
 
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Pain is elusive and misleading. What you personally feel is only one factor to consider.
I would go somewhere else. If your current dentist did this filling, then I doubt he likes/wants to do amalgams. Find someone who does amalgams. I teach 1x day a week at my local uni, and all the students want to do is composite. This really limits their skill set, and means they can't do an amalgam when the situation absolutely calls for it as the superior material.
To jump into an RCT when all you have is sensitivity is totally unjustified. Once you do an RCT on that sort of tooth, you have taken further risks (what if the RCT fails?), AND you will have to do a crown.
OK thanks Matt I have made a note of this.
My current dentist didn't do this filling.
I mentioned in my first post "I'll spare you a detailed history of what transpired in this area of my mouth for now."

I'll fill you in with a little more information.
Around five years ago I started seeing a new dentist. I complained about a pain somewhere in the upper left.
She determined the problem tooth was way at the back (27).
She took out existing filling, and re-did a new filling (first temporary, then permanent).
But the pain didn't go away, so she had worked on the wrong tooth!

When she determined the problem tooth was 26 she recommended an endodontist to do a root canal.
I went to this endodontist and he did a root canal on 26.

So the last work that was done on 27 was not done by my dentist. He just feels that the tooth at this stage "can't be saved".

I will try to see another dentist to see if they will put an amalgam in 27.

I would also add that I was told the fillings in 27 are so close to the nerve that redoing the filling would be very risky.
Could this be true?
For example, if problems arose when doing the amalgam, could that rule out a possible root canal?
 

MattKW

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You are having sensitivity now. That is irritation to the nerve, and the longer you leave it, the less chance of recovery with just a filling. Sure, taking out the filling and redoing will entail some risk of it stirring up the tooth a bit more and may well tip it into doing a root canal. But you're heading towards that certainty UNLESS you do something. You would still be able to do an RC if necessary, but here's the biggest problems:
  1. That 27 is already structurally very weak...
  2. If it turns into an RCT, then it will be further weakened...
  3. If you do an RCT for the 27, then you would need to do a crown to prevent fracture...
  4. A crown that deep is risky.
  • So, if the FILLING can be done done for the 27 WITHOUT ending up in an RCT, then accept that it will break one day and will have to be extracted. Don't do a crown on the 27, but do a crown on the 26.
  • If the 27 gives you trouble and an RCT is suggested, then I would instead have it extracted, and spend my money on doing a crown for the 26. You can survive happily with one molar, but don't lose both. The 2nd molar is the least desirable tooth to spend money on and keep.
 
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Just remember time is of the essence Mark. If it is a cracked tooth. You dont want to waste time. An infection inside your gums can happen in no time based on your diet and brushing. So fix it asap.
 

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