Signs and Symptoms of a Future Root Canal

Why evaluations are needed!

Dear Doctor,
Two months ago I had a tooth prepared for a crown and one week later, I had horrible pain. Ibuprofen helped a little, but after a few weeks the pain was completely gone. Is it possible that the nerve is healing in the tooth and that I do not need the recommended root canal treatment? Also, I am still wearing the temporary crown, will that wear out?

Dear Janet,
You are describing exactly what happens when deep decay in a tooth reaches the “pulp chamber” or root canal in a tooth. It is not uncommon when teeth also have large fillings, and the fillings break down or decay around their edges or margins.

Once the pulp gets infected, i.e. the living tissue inside the tooth dies, including the nerves — that's when the pain as you described it, is “horrible” or what we call acute. Acute pain comes on very quickly, is very intensely painful and then goes away fairly quickly after two or three days, as opposed to chronic pain which lasts a lot longer. Acute pain from a root canal infection can be excruciating. Because it is inflammatory in nature, anti-inflammatory drugs such as ibuprofen are somewhat helpful, but sometimes stronger medication is needed which needs to be prescribed by your dentist or endodontist (root canal specialist).

When all the tissue in the pulp chamber dies, including the nerve, the pain may go away (temporarily), but the infection doesn't.

When all the tissue in the pulp chamber dies, including the nerve, the pain may go away (temporarily), but the infection doesn't. It slowly travels through the end of the root and into the bone — so now you feel it slightly when you bite on the tooth. This secondary pain is transmitted through other nerves that live in the periodontal ligament (peri-around, odont-tooth), the lining membrane which joins the tooth to the bone. If left untreated you may either develop an acute (painful) abscess or a chronic abscess — a more longstanding and silent infection, silent means that you might not feel it at all. So it really is time for a root canal treatment, just as the endodontist suggested. If the nerve has died, the treatment won't hurt and it will certainly save the tooth.

As for your question about a temporary crown, yes it will wear out — it is after all temporary. Once the root canal treatment is completed a permanent crown will protect the tooth. My advice is to go and get the root canal treatment and final crown without delay. Hope this explains what you've been feeling and what you need to do.