It seems that I cannot get started with Invisalign treatment. Now the issue is with my left lateral incisor that had a filling in it since childhood. I had the filling replaced three times over the years. In June 2020, my previous dentist placed a pulp cap to prevent root canal treatment. He used a caries detector to avoid drilling near the pulp before he placed the filling. The tooth felt okay, and it still feels fine.
My employer switched dental insurance companies for 2021, and I had to find a new dentist. I thought I made a good choice because I wanted to find a dentist who also does Invisalign. But after my new dentist completed the exam and x-rays, he said that my lateral incisor has what looks like decay beneath the filling. He recommends a root canal and crown.
As I mentioned, I have no problems with the tooth. Can my dentist remove the decay and place a new filling? And how do I know that I need root canal treatment? I suspect overtreatment. I just want to move forward with Invisalign. – Thank you. Gavin from TN
Thank you for submitting your question to our office. Although Dr. Finley would need to examine your tooth for an accurate diagnosis, we suggest that you do not allow your new dentist to complete root canal treatment. It seems that your dentist might be recommending treatment you do not need.
Reasons You Might Not Need a Root Canal After All
You may not need root canal treatment or a crown if your dentist is unsure about your x-ray results, if you never had tooth pain, or if a front tooth is affected.
- Faulty x-ray reading – An infected tooth shows up on an x-ray at the tooth root. But your dentist said he sees a spot beneath the filling. Dental materials, including radiolucent glass ionomer base or filling materials, might look like decay beneath a filling.
- Never felt tooth pain – If your tooth is infected, you will usually have a toothache at some point. Although there are exceptions, most people feel some pain. Tooth infection usually causes sensitivity to cold that progresses to a toothache. If a dentist does not treat the infection, the tooth pulp (tissue and nerves inside) will eventually die. And the toothache will end. But you have felt no pain at all, which is unusual for a tooth that needs root canal treatments. Even if you do not feel pain, your dentist should look for signs of infection if he sees an issue on your x-ray.
- Tooth position – A lateral incisor is thin and delicate. Even when a lateral incisor needs root canal treatment, preparing it for a crown removes about 60% of the tooth structure. As a result, your tooth will become weak and at risk of breaking off. A dental crown protects a tooth with root canal treatment. But front teeth often fare better when a cosmetic dentist stabilizes them without a crown after a root canal. In some cases, a tooth is in such poor condition that a dentist may recommend a crown.
Schedule a Root Canal Second Opinion
We recommend that you try to find an accredited cosmetic dentist in your insurance plan. If you cannot, look for a dentist with advanced cosmetic dentistry training. Then, schedule an appointment for a second opinion, and ensure the dentist has a copy of your x-ray before the appointment.
You may need an exam for the dentist to explain the status of your tooth. And if you like the second-opinion dentist, you may want to speak with them about Invisalign treatment.
David Finley, DDS, an accredited fellow of cosmetic dentistry in Monroe, LA, sponsors this post.