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Thank you for your question. The nerve of a tooth is a unique situation in the body. The hollow space inside every healthy tooth contains tissue, a blood supply and a nerve. This live tissue communicates with the rest of your body through a small opening at the root tip. The entire blood supply to the tooth comes in to this enclosed chamber through this tiny opening.
The key for any diseased tissue to heal is the body's ability to bring white blood cells to the area to destroy any bacteria and dead tissue. If a tooth nerve has suffered injury through a bacterial invasion (decay) or trauma, as long as the blood flow to the tooth is healthy, the body attempts to resolve the situation with it's own natural defenses. The problem is, when the nerve is inflamed, it swells up as any tissue would. This inflammation, restricted by the hard chamber it occupies, puts pressure on the tiny opening through which the blood supply comes in and cuts it off. At this point the entire nerve tissue dies. An analogy would be placing a tight tourniquet on your wrist and leaving it there for days. The blood supply would be cut off, and your hand would become irreversibly necrotic, requiring amputation. The same happens to a tooth nerve. You cant bring the dead back to life. Without a blood supply, no repairing of the tissue can be made. A root canal then has to be performed to seal this area off from the rest of the body, preventing a tissue rejection attempt. I hope this answers your question. If you have any concerns that I have not addressed regarding this matte, please let me know and I will get back to you with more information.
Sincerely, XXXXX XXXXX
We use the patient's symptoms and a radiograph to determine the health of the tooth. If a tooth is sensitive to just cold, that indicates a reversable situation. The nerve is inflamed but can be reversed with decay removal and sedative filling placement. If the pain of the cold stimulus lingers on for more than about 15 seconds after the stimulus is removed, then the health is borderline. Any sensitivity to heat is an indication that the nerve has died and decomposed. Methane gas, a byproduct of tissue decay, is present in the nerve space and expands upon the application of heat, putting pressure outside the small opening at the tip of the tooth and causing pain on the nerves outside the tooth.
If the radiograph shows bone loss around the tip of the root, then the nerve is necrotic and the body's natural defenses are detecting the bacteria and necrotic byproducts that start spilling out of the small opening in the tooth. Sometimes, this stage of the process can be painless and can go on for years without the patient being aware that anything is wrong. The white blood calls are busy devouring the bacteria as fast as they spill out of the tooth and can keep the small chronic infection from getting any larger. Eventually, however, the bone loss around the tooth progresses and the corralled infection gradually enlarges and creates and acute situation typically manifesting as an abscess.
Once the root canal is completed, the contents of the nerve chamber cleaned and sealed with a biologically inert material. The white blood cells eliminate the remaining bacteria and the bone loss from the infection gradually is replaced with new bone. The larger the bone loss around the tip of the tooth, the longer it takes to regenerate. We can't bone graft a situation like this. The body regenerates the bone. Presence of this bone loss before performing a root canal has nothing to do with the root canal's success. This is determined by the skill in which the dentist properly cleans, disinfects and seals all the canals in the tooth.
I hope this helps.Please let me know if you need more information.
George McKee DDS
You are most welcome. I am not always online but check this site often. If you have any follow up questions regarding this issue, I will be happy to elaborate.
SIncerely, XXXXX XXXXX DDS
You are most welcome. If you have any further questions regarding this matter, I will be happy to elaborate.
Sincerely, XXXXX XXXXX DDS
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Thanks for the update. Do you know if the bone loss that is evident on the radiograph around #3 is due to periodontal disease or a necrotic dental nerve. These ususally have distinctive bone loss patterns. Did you dentist elaborate on this at all?
A couple of things to mention. Just because the insurance company won't pay for the root canal does not mean that the tooth won't last for years and years if one is done and the periodontal status remains stable. Dental insurance companies are in the business of NOT paying claims. They are profitable business endeavors because they collect more money than they pay out. The thick booklet that comes with your initial insurance premium is a list of all the things they don't cover. Try to persuade your employer to purchase a better dental plan next year.
The other tests that should be performed to be absolutely certain of the diagnosis is:
1. Hot test
2. Electric pulp vitality tester
Your dentist must also see the specific bone loss pattern around the root tips that indicates a dead tooth in addition to the periodontal bone loss. The presence of this alone is indication enough for the need of a root canal.
Thanks for the additional information. I've been battling insurance companies for 28 years. It all comes down to the written contract of the individual plan. The employer gets what they pay for. Cheap dental plans exclude more treatment than expensive ones.
You might have an endodontic/periodontic lesion. That is a situation where an isolated area of bone loss around one root due to the periodontal condition communicates with the bone loss of the root tip. Ask the endodontist if this is the case. If so, the root canal will also improve the periodontal situation in that specific location.
We are doing some amazing things with implants these days. Because there is no periodontal space associated with an implant as there is with a natural tooth, we can "grow" bone around an implant using bone-like crystals and membranes in a surgical procedure. There are very specific situations where this works. A periodontist who keeps up with the latest technology would be knowledgeable on this topic.
I wish you well.