dental

[airedaleaot]

I had a root canal on my right lower molar two years ago. Over the last six weeks a transient pain has gradually come back. Seen the dentist again who x-rayed it again and compared the one from two years ago, apparently they are both exactly the same. He is recommending that I have the tooth crowned as it was only filled before. I am thinking that this would just be covering a tooth that is already hurting. He seems reluctant to repeat the root canal as it looks so good on x-ray. He also says he cant guarantee getting rid of the pain as it may have a crack in the root that is undetectable. Help, what do people think?

[J9PUR]

I'm sorry that there is not enough information there to advise you, and no-one can diagnose the problem on line, but I will happily give you my thoughts....
Firstly, the diagnosis of the recurrent pain is uncertain, and there are a number of possibilities. It may be due to:
a) Failure of the root canal treatment. This may be due to the root canal system having accesssory canals that are not accessible for instrumentation, or it may be due to residual bacteria within the canal system. Just because the two radiographs 'look the same' this does not mean that there is not a problem, only that there is nothing visible. This is a situation that is extremely common, and we then have to make a diagnosis from the symptoms described, physical examination and other investigations .Re-root canal treatment may improve the prognosis, though I undertand your dentist's hesitency if all 'looks well'
b) Root fracture or root perforation. Without seeing the radiographs, I cannot advise
c) Cusp fracture in the tooth. You most likely have a large restoration (filling) within the tooth, surrounded by thin shells of tooth. These shells of tooth can become brittle and infractions (hair-line fractures) of the tooth can occur and the tooth become painful under loading. This usually presents as tenderness on biting. Placing a crown on the tooth would reinforce the tooth from further fracture, and a crown is usually the long-term restoration of choice
d) Periodontal (gum-related) problems of the tooth.

It sounds as you and your dentist have a dilemma, and there is no easy solution without a definative diagnosis. Sometimes in these situations, we have to go with the most LIKELY diagnosis and treat as neccessary. There are only 4 main treatments available to you long-term: do nothing, re-root treat, crown or extract. I would re-discuss with your dentist as only he has the information needed to help you make a decision. Sorry I can't help further.