How can you tell if your tooth needs root canal treatment?

- What are the signs and symptoms? / Solutions.

Links to page: Animations | Slideshows
Nerve exposure slideshow.
Tooth abscess slideshow.
X-ray signs of needing treatment slideshow.
Visible signs of needing treatment slideshow.

Since endodontic therapy is used in resolving so many different types of problems (inflamed nerves, dying or dead nerves, cracked teeth, failed previous treatment), there isn't just a single set of symptoms that appears in every case where it's needed.

It's only after sorting through all of the bits of information they have collected, that your dentist can determine if root canal (or possibly an entirely different dental procedure) seems to be the appropriate solution.

What are the signs that a dentist looks for?

When collecting data, your dentist will be interested in the following:

  1. Symptoms you have noticed. - It's usually the presence of discomfort and/or swelling that signals to a person that their tooth has a problem. Your dentist will quiz you about what you have experienced.
  2. Signs your dentist may uncover. - Some teeth give little indication that there's a problem within their nerve space. These cases are often discovered, unexpectedly, during routine dental examination.

1) Root canal symptoms you (the patient) may notice.

a) Pain.

  • Its intensity can range from very mild to extreme. It may include a throbbing component (feels like it has its own heartbeat). Its character may change (lessen or intensify) as you change your posture (i.e. stand up, bend over, etc...).
  • The pain may only come in response to a stimulus, such as biting pressure or thermal insult (hot foods and beverages). In other instances, its onset may be totally spontaneous.
  • The pain may linger and then fade. In other cases, it may last for hours on end.

Swelling associated with a tooth abscess.

Swelling here usually means that treatment is needed.

b) Gum tenderness or swelling in the area near the tooth.

  • If swelling is present, it can range from very slight (just an area of tenderness) to quite pronounced. In extreme cases, it may extend into your face or neck.
  • When swelling is relatively minor and localized, it's typically positioned at a level that approximates the tip of the problem tooth's root.
  • Instead of major swelling, a pimple-like drain for pus may form on your gums in this same general region. (See this graphic's slideshow for more details.)

c) Symptom frequency.

The signs and symptoms described above can be:

  1. Transient - Varying day-to-day, month-to-month, or anything in between.
  2. Continual and persistent.


2) Signs that may only be obvious to your dentist.

The death of a tooth's nerve tissue isn't always a painful event. It's possible for this process to occur without producing any noticeable symptoms at all.

In other cases, the events that occurred may have been so slight, or taken place so long ago that they're not remembered.

In these types of situations, it may take your dentist's keen eye during their examination to discover evidence that endodontic therapy is needed for your tooth.

a) Identifying problem teeth with x-rays.

Low-grade tooth infections, or infections whose pus can drain, may go totally unnoticed by the patient. In fact, a tooth's need for root canal treatment may remain undiscovered, even for some years.

An x-ray of a tooth needing treatment. A radiolucency is shown.

To a dentist, this is proof positive that treatment is needed.

Why routine dental x-rays can be important.

Dentists often discover these types of problem teeth during routine x-ray evaluations. In the most obvious cases, the x-ray will show a dark spot right at the tip of the tooth's root.

This dark spot, termed a "radiolucency," is an indication that changes have occurred in the bone in this region due to its response to the infection housed within the tooth.

b) Recurring or persistent gum pimples.

An infection located inside a tooth may cause the formation of a pimple-like lesion on a person's gum tissue. Usually its location will approximate the level where the tip of the tooth's root is located.

Dentists call these lesions "fistulous tracts." Their size may wax and wane over time (on a daily, weekly or even monthly basis). And because they function as a drain for pus, they often have a bad taste coming from them.

A patient may be totally unaware that they have this type of lesion and it's their dentist, during their routine examination, who's first to identify it and recognize it as an indication of a problem.

(If you didn't use its link above, this slideshow provides illustrations and further details about these types of lesions.)

c) Individually darkened teeth.

An individually darkened tooth.

The dark color of this tooth suggests that it needs treatment.

As a result of having experienced some type of trauma (like being banged up in an accident), the nerve tissue inside a tooth may begin to deteriorate and ultimately die off.

This process may take place even some years after the original event, frequently without displaying any obvious symptoms (pain or swelling).

As this transformation takes place, the breakdown byproducts produced inside the tooth can cause tooth staining. And as a result, the compromised tooth will turn darker than its neighbors.

This color mismatch is frequently the sole reason why a dentist will initially suspect that a tooth is in need of root canal treatment.

Exposure of a tooth's nerve during dental work.

If nerve exposure occurs, endodontic therapy is usually needed.

d) Exposure of a tooth's nerve.

In some cases, the dental work that a tooth requires will result in the exposure of its nerve. The term "exposure" means that the dentist's work has literally made contact with the tooth's pulp tissue.

An exposure (or the conditions that have lead up to it) can result in pulp tissue degeneration. And for this reason, a dentist may determine that it's best to go ahead and perform root canal treatment now, so to avoid the possibility of a painful, or more difficult to treat, situation later.


What should you do if you notice symptoms?

If you notice any of the signs and symptoms mentioned on this page, you should establish contact with your dentist's office and make arrangements to be evaluated and receive treatment in the time frame they determine is necessary.

Don't make assumptions. Don't delay.

Making a self misdiagnosis about their need for root canal treatment (by way of using website information like this) may deter some people from seeking treatment during that stage when another (simpler, cheaper and easier) repair might have been possible.

That's because some patients won't seek treatment promptly if, in their mind, they think it's already too late, or it will cost too much money or else the idea of having the treatment is too unnerving for them.

Don't make this mistake. If you have a tooth that's displaying symptoms, have your dentist evaluate it sooner rather than later. Doing so may make a big difference in both your treatment and what you experience

Things that might help.

In the case where root canal treatment will be required, there's not a whole lot you can do on your own to relieve your symptoms. Of course, it only makes sense to discontinue those activities that tend to set your tooth off. And, within the guidelines of the product you choose, you may find that OTC pain relievers provide some help.

With some cases, being placed on antibiotics sooner rather than later can be beneficial. And although these are prescription medications, just a phone call to your dentist may be enough to get the ball rolling towards your obtaining them.

Home remedy: Try placing ice on your tooth.

In some cases where endodontic therapy is needed, during that stage when the tooth has started to produce extended periods of constant pain, chilling the tooth (by holding a chip of ice against it) may provide some relief.

This won't work in all cases and, in fact, it may irritate the tooth in some. So, ease into this remedy with testing. But when this solution does work, it can provide much needed relief until you can receive the treatment you require from your dentist.

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