Thread by @Gautaamm

#thread on the life cycle of a #toothache:

I am often asked the following questions:

1) Why should I see you when I don’t have pain?

2) Why should I get this cavity filled when it’s not hurting?

3) Why do I need a root canal when the tooth is not hurting?

4) Why does my tooth hurt so bad?

5) My tooth was hurting a lot but now it’s ok. Why do I need a root canal? Can’t you do a filling?

6) Won’t just taking antibiotics clean out this infection you are speaking about?

7) Why can’t you finish the root canal in one visit?

8) Why do u need this tooth taken out? Can’t you do a root canal?

I am a big believer in preventive medicine. As such it’s my job to educate the general public about all things teeth.

This is another thread towards that goal!

Here is the life cycle of a tooth ache as it happens!

I will try to explain each stage!

1) Virgin tooth: No caries aka cavity. The red area inside the molar shown here is the new nerve/pulp.

The part of the nerve in the roots is called the root canal.

The two mountains are the guns around the tooth!

Treatment needed: NONE

2) Small cavity: No pain.

This is detected by a skills dentist in a check up. The ones between teeth show up on X-rays.

This is why you should see a dentist once or twice a year for check up/X-rays/cleaning!

Treatment needed: Small filling!

3) Moderate to deep cavity:

Slight occasional pain. Cold sensitivity but only on point of contact of food/liquid.

This is now close to the nerve. Typically needs a filling but MAY need a root canal.

No dentist can predict either way till the caries is removed.

Patients

often choose to delay treatment as it’s not hurting so “why get root canal done now when it’s not hurting”

The next few tweets explain this is the best time to get a root canal done (If there is any such time 😂) if you need one!

If it’s a large one but no root canal is done,

A crown/cap is recommended to protect the tooth from fracture!

This may need a root canal down the road and can be done by drilling through the crown, again by a skilled dentist with the right armamentarium.

4) Cavity into the nerve:

This is when I see most patients!

There is usually acute pain, severe sensitivity to cold liquids which lingers on even when you have swallowed it. Often the patient is woken up from their sleep because of the pain.

Treatment needed: Root Canal

The nerve is now infected but alive. So the bacteria are confined to the pulp within the tooth.

As such the root canal can be done in one visits.

That is an individual choice of the dentist and situation on the given day!

I do most of mine in 2 visits for optimum outcome.

The cavity is usually so large that even after the root canal and permanent filling, a crown/cap is needed to prevent it from fracturing.

A root canal is needed over a filling because the bacteria have invaded the nerve and if we do merely a filling, the same is not eliminated.

This can lead to severe spread of the infection beyond the tooth, pain/swelling and often leading to a prolonged root canal with discomfort because of the severity of infection.

Like an infected appendix HAS to be removed, the nerve has to be removed.

ROOT CANALS DO NOT HURT!

Antibiotics won’t reach the site of the infection INSIDE the tooth and hence don’t work long term.

This stage If left untreated causes tremendous pain, hot sensitivity, lack of sleep etc.

The sooner the tooth is taken care of, the milder the post operative experience.

Like any surgery, it is normal to have some post op discomfort.

I don’t know who created this unrealistic expectation that there is no discomfort post treatment!

I have not met a single surgeon who has never had his patients experience post op discomfort.

So why dentists?

Sometimes the patient will call us with a very peculiar story:

“Doc my tooth hurts like crazy but the pain goes away if I chew on ice or drink cold water!”

What’s happening is that the nerve is semi dead semi alive and that generates a lot of gases causing pressure build up

INSIDE the tooth. Imagine a pressure cooker with no outlet valve on a gas.

That pressure is tremendous. But if I pour cold water on top of it, it reduces the pressure.

The same way cold liquid or ice temporarily reduces the pressure and gives relief.

In my experience, the

relief that the patient gets when I merely open up the tooth is tremendous and the patient literally deflated like a balloon prickled by a sharp needle!

These patients are also the most appreciative and will always say

“Solid jadu kelit tumhi Doctor”

“You were magical”

5) No Pain plateau:

Some how if the patient is able to pass this stage, the tooth is now totally dead!

The pain is gone and the patient is actually able to live their life without any issues!

This is the worst stage!

Reason 1: The bacteria are destroyed nerve and tooth.

Reason 2: If left untreated this infection can spread past the root into the jaw bone!

These root canals are always done in 2/3 visits to ensure the bacteria and their toxic chemicals are totally eliminated.

In all multi visit rot canals a therapeutic medicine called

Calcium Hydroxide is placed inside the nerve space and a temporary filling placed.

Once the nerve is dead, typically antibiotics might be recommended/needed.

6: Deep cavity with periapical infection:

As seen in the picture, the infection has now spread to the jaw bone beyond the end of the root.

The patient typically will call and express inability to chew any food from that side.

Often they will say “The tooth will taller”

Again the blood supply to his region is destroyed and hence merely taking antibiotics won’t work.

The root cause are the bacteria inside the tooth and the infected area around the end of the root and hence only a root canal will eliminate the infection.

These root canals are

ALWAYS done in 2 visits.

There might be a small swelling on the gums on the cheek side inside the mouth. Often this pops and the pain subsides.

In left untreated this can lead to a swollen face which is a serious condition.

Now the tooth needs urgent attention!

If left untreated this can land the patient in the hospital for IV antibiotics and surgical drainage.

All his can be avoided if the tooth is treated in time!

7) Broken tooth at the gum level:

If the cavity totally destroys the part of the tooth above the gun line, it has to be extracted!

Merely doing a root canal is not sufficient! The tooth had to be restored to its full form and function. Typically with a crown.

There are multiple replacement options which I will discuss in a separate thread. But this is the life cycle of a tooth ache!

From NO PAIN to NO TOOTH!

Nowhere else is the saying “A stitch in time saves Nine” more applicable!

Hope this thread will shed some light on it!