Should I do root canal? Cold sensitivity

[JcMac]

This is the second time this happens to me. tooth gets quite sensitive to cold, dentist says it's due to a small cavity, fixes it, tooth still as sensitive a few weeks later, even though dentist does the cold test and says nerve is healthy

The other one I don't regret at all having done root canal even with the cold test also having said not needed, because when doing the root canal it hurt a lot to clean the nerve, even with heavy anesthesia dose, nerve was very inflammed. but this one isn't so bad. It handles the cold well for a few seconds (whereas the other hurt immediately to anything cold touching it), but not as good as all other teeth, to the point that I have to be careful while eating or drinking anything cold. It also seems to get very slightly hurt after cold stimulus sometimes.

So should I do root canal? And is there a chance of the tooth starting to hurt a lot, like the nerve getting more wonky with time? Because I don't mind if it's just gonna stay like this, I only care about progressing to severe pain, like getting it in the middle of the night with no urgent dentist open and painkillers not working. my last toothache traumatized me a lot...

 

[Dr M]

I would not recommend doing a root canal at this stage. Try and treat the cold sensitivity first. A lot of times, the tooth in question might have thin enamel, leading to exposed areas of dentin, which results in the cold sensitivity.
Try and apply some Sensodyne toothpaste on the affected tooth. Brush like you normally do first, and then apply the toothpaste with your finger on the tooth, and then leave it on. Don't rinse your mouth. This usually does not take the symptoms away completely, but it makes it a lot less sensitive.
If the sensitivity becomes more severe, then I would look at options such as a root canal.

 

[JcMac]

I would not recommend doing a root canal at this stage. Try and treat the cold sensitivity first. A lot of times, the tooth in question might have thin enamel, leading to exposed areas of dentin, which results in the cold sensitivity.
Try and apply some Sensodyne toothpaste on the affected tooth. Brush like you normally do first, and then apply the toothpaste with your finger on the tooth, and then leave it on. Don't rinse your mouth. This usually does not take the symptoms away completely, but it makes it a lot less sensitive.
If the sensitivity becomes more severe, then I would look at options such as a root canal.

Thanks for the reply Dr. Can I also ask you one more thing: it's that I fear these sensitive "wonky nerve" teeth more than actual tooth decay, because for tooth decay, if I ever get a "hot tooth", I know of something that takes away the pain completely - holding ice cold water in the mouth. According to google, it works because the bacteria creating the infection release gases which create pressure in the tooth, which is what causes the pain, and the cold temperature of the cold water decreases pressure, therefore relieving pain. And I also know from personal experience that this works.

These tooth pains are sometimes so severe that no analgesics work, so even if that happens and the pain starts at night when I can't see an emergency dentist, I got the cold water to save me. Yes, it's boring to always need to be replacing it, but it works.

But with sensitive "wonky nerve" teeth there's no bacterial infection, just inflammation, so I'm not sure the cold water would relieve the pain, in case of it progressing to severe pain from irreversible pulpitis.

Do you know if the cold water also relieves the pain in these cases?

Or what about clove oil? This is also something that I know it works wonders for a hot tooth (after all it's almost 100% eugenol, a strong anesthetic), but I'm not sure it would work for these cases, because there's no hole/cavity for the oil to slip through.

In short, believe it or not I don't fear an infected tooth nearly as much because I know of these two very effective ways to relieve the severe pain if analgesics fail (which they often do), but I'm not sure they work for non-infectious irreversible pulpitis as well.

I've asked 2 irl dentists and they didn't know.

 

[Dr M]

It depends on the cause of the sensitivity. If the teeth has exposed dentin, then cold water will not take away the discomfort. In fact, it might increase the pain. Inside dentin, you have small tubules that contain fluid. Once your enamel layer disappears, these tubules become open, causing the movement of the fluid, that stimulates a nerve response. What Sensodyne does, and some other enamel/dentin sealants, is that it seals these tubules, preventing the movement of fluid and thereby decreasing the pain sensation you feel.
But like I said, it depends on the overall cause of the sensitivity.

 

[JcMac]

It depends on the cause of the sensitivity. If the teeth has exposed dentin, then cold water will not take away the discomfort. In fact, it might increase the pain. Inside dentin, you have small tubules that contain fluid. Once your enamel layer disappears, these tubules become open, causing the movement of the fluid, that stimulates a nerve response. What Sensodyne does, and some other enamel/dentin sealants, is that it seals these tubules, preventing the movement of fluid and thereby decreasing the pain sensation you feel.
But like I said, it depends on the overall cause of the sensitivity.

The cause of the sensitivity here would be non-infectious irreversible pulpitis. Imagine that the nerve gets "wonky" over time, for whatever reason (be it enamel erosion, extensive fillings, etc), and it degenerates into 10/10 pain from irreversible pulpitis one day. No infection whatsoever, just high inflammation from a disfuncional nerve. Will the cold water relieve such pain, as it usually does with a normal tooth infection (cavity reaching the nerve/pulp)?

I fear that it won't, because with tooth infection the pain is caused by large amounts of bacteria releasing large amounts of gas in a tiny space, leading to huge pressure and therefore pain. The cold temperature from the cold water decreases pressure, very effectively relieving pain (even when these infected tooth are also sensitive to cold, because usually they're only sensitive at the beginning of the stimulus, if you "insist" with the cold they get "used" to it, at least ime and of everyone who swears by cold water.)

But with non-infectious irreversible pulpitis there's no bacterial infection, so if the pain isn't coming from high amounts bacteria-released gas in a tiny space, only from high inflammation, then I'm not sure it would get effectively relieved by cold water.

Or by the clove oil, this time for the reason that there's no cavity in the tooth to let oil slip through into the pulp/nerve.