I’ve recently had

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I’ve recently had an inlay in the middle of a back upper molar (accounting for about a third of the tooth). Initial pain and sensitivity following inlay fitting has subsided a little with bite adjustment but I am still unable to chew other than really gently without pain. My dentist advises root canal, saying that in drilling out the decay and fitting the inlay the nerves have become irreversibly inflamed as the inlay is now very close to the nerves. He has not mentioned any ‘infection’. Should I be rushing into root canal or is there a chance it will resolve itself with time?

He recommends that following root canal a new inlay be fitted. What I’ve read about root canal so far suggests that its almost always advisable to use a crown to prevent fracture. So I’m a little confused as to why I’m being advised to have an inlay. Advice please!

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Asked on 04/08/2011 12:00 am
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If your tooth is biting hard onto this inlay it will be sensitive due to your bite , make sure it is not this .

IF THE PATIENT progresses past the period of pulpal inflammation mentioned above without root-canal intervention, the tooth usually enters a calming period. What this really means is that the nerves or pulp have completely degenerated past the stage of total pulpal inflammation to became necrotic. In this state, pain provoked or sustained by temperature would have disappeared. Constant throbbing pain, or the continuous dull radiating ache usually associated with pulpal swelling or degeneration, also subsides. The tooth may still feel sensitive to pressure, since the PDL may still be inflamed due to the presence of the adjacent irritating necrotic debris of the pulp. Some teeth may become asymptomatic, especially with the help of antibiotics and bite adjustment. However, the tooth will not respond to temperature changes or electronic pulp testing.
This later stage of pulpal death can be view as the calm before the storm. Because of the bacteria residing in the necrotic pulp, the situation always has the potential to transition toward an endodontic abscess. However, the transition can often take months or even years, depending on a variety of factors. Although many dentists try their best to medicate symptomatic teeth in the hope of avoiding root-canal treatment before restoration, the truth is that many of these teeth tend to feel better because they have slowly arrived at this transitional stage of pulpal death.
The sedative dressing or temporary filling usually acts as a nerve blocker (as eugenol does, for example) and is effective as a topical pain medication. Unfortunately, the medication does little to reverse the degenerative inflammatory process that has already begun; pulpal recovery from acute inflammation usually is more dependent on the degree of tissue damage sustained and whether the damage is in conjunction with a bacterial presence. Radiographic evidence may appear within normal limits. However, if teeth stay in this stage for a sustained period of time, the bone around the root apex may resorb in the effort to limit the antigenic irritation from the dead pulp. Periapical radiolucency is then seen from a periapical film of the tooth. Sometimes, if the cortical bone adjacent to the radiolucency is lost, a fistula may develop from the area of inflammation or infection that can be seen clinically as a stoma. Its formation is usually a pain-free event, but the situation could become painful if the stoma became clogged or impacted.
When a tooth develops an endodontic abscess from the transition period of pulpal death, pressure pain slowly becomes more and more pronounced. The tooth may even become mobile. An infrequent or continuous ache can also arise, not from the swelling of the pulp (which is already dead) but from a swollen periodontal ligament or from a buildup of pressure surrounding the periapical tissues of the tooth. Edema, with a subsequent buildup of pus, usually creates pressure that translates into pain. Swelling or tenderness is usually seen intraorally adjacent to the root apexes. If the infection is not allowed to drain (via a pulpal opening, fistula, or an incision), extraoral swelling and lymph node involvement may develop as the abscess spreads beyond the local confines of the periapical area and into the facial planes. Radiographically, a noticeable radiolucency can usually be seen beneath the abscessed tooth.
From this short discussion of pulpal deterioration, you can see that the process is a continuous and dynamic one. As dentists we are usually presented with a “snapshot” of the state of the pulp in time. This basic understanding of the tooth’s pulp has given me more assurance in my endodontic diagnosis. Although there are always some exceptions, the symptoms that a patient presents with usually must fall into the pulpal timeline discussed above if root-canal treatment is to be helpful or meaningful. In the end, the root-canal treatment only accomplishes the removal of the inflamed, degenerative, or dead pulpal tissues from the tooth—and by doing so removes the source of pulpal pain or limits the potential for future ligamental inflammation and periapical bone destruction.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 23/06/2011 12:00 am
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It is not always possible to give an accurate assessment and diagnosis without examination, testing and sight of the pre treatment X-ray and photograph.
It may be best to have the inlay adjusted again just in case it is simply the way you bite onto it
It is possible that part of the tooth surrounding the inlay may have a fine (invisible ) fracture – this too may cause pain on biting .

The initial (deep) tooth decay which necessitated the creation of the inlay in the first place may be the cause of the problem If your tooth reacts to hot drinks or biting pressure and lasts for several minutes or you have spontaneous pain then it would appear that the nerve is has lost its 'vitality' and root canal treatment may be necessary .If it lasts for a couple of seconds then you may stand a chance of the tooth recovering .Your dentist would best placed to give you the correct diagnosis prior to root canal treatment .
It is often best –subject to clinical judgement – to create a protective crown or overlay (as opposed to an inlay) after root canal treatment .

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 23/06/2011 12:00 am
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It is possible that this tooth will settle down, maybe with further adjustment to the bite
On the assumption however that it does not settle and RCT is carried out then traditionally a crown should be placed to protect the now brittle tooth from fracture but this could be done with a partial coverage crown (or onlay) this onlay (either gold or ceramic) covers the cusps of the tooth rather than in inlay which occupies space between them but does not need to extend over the whole outer surface of the tooth to the gum margin as with a crown.
Please check with your dentist if this is what he means by a new "inlay"

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 23/06/2011 12:00 am