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

- What are the signs and symptoms? (pain, swelling) / Tests your dentist performs. / What should you do if you notice problems?

Page Graphics | Animations.
Link to nerve exposure slideshow.
Link to tooth abscess slideshow.

How is a diagnosis made?

To make an accurate diagnosis about your tooth's need for endodontic therapy (root canal), your dentist will need to evaluate information collected from a number of different sources.

And while there are some obvious signs that nearly everyone is familiar with. There are also a number of less apparent ones that quite possibly only your dentist will notice.

Here are the types of issues and events that they'll need to evaluate.

  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 noticed by your dentist. - Some teeth give little indication that there's a problem within their nerve space. But to the trained eye, these subtle hints can be an obvious sign that a problem likely exists.
  3. Additional testing. - Once a dentist has identified a suspect tooth, they'll then perform additional testing that can help to confirm their suspicions.

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

a) Pain.

Teeth that will ultimately require endodontic therapy don't always cause pain. But if yours does, you may experience one or more of the following.

  • The level of discomfort can range from just slight 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 (stand up, bend over, etc...).
  • It may only come in response to a stimulus such as chewing or biting pressure, or pressing or tapping on the tooth. In other instances, its onset may be totally spontaneous.
  • It can be triggered by thermal insult (like exposure to hot or cold foods and beverages). Sometimes heat will bother the culprit tooth and cold liquids or ice will settle it down.
  • The pain may linger, possibly for some minutes, before finally fading. In other cases, once it has set in it may last for hours on end.
  • The discomfort may be severe enough that it wakes you from sound sleep.
  • Sometimes a person can tell which side of their mouth hurts but not which tooth, or even if it's an upper or lower one.

Swelling associated with a tooth abscess.

This slideshow explains "gumboils."

b) Gum tenderness or swelling.

Swelling doesn't occur in every case but when it does:

  • It can range from just very slight (a normal-looking area that has some mild tenderness) to quite pronounced (a lump that you can actually feel or region that has noticeable fullness).
  • When relatively minor and localized, the area of swelling is usually at a level that approximates the tip of the problem tooth's root. (See slideshow.)
  • It's possible that due to swelling the tooth may feel slightly elevated (seems as though it's "taller" than its neighboring teeth).
  • With acute flare-ups, the swelling may extend into your face and/or neck.
  • Instead of pronounced swelling, a pimple-like drain for pus may form on your gums (a "gumboil"). (See slideshow for more details and pictures.)

How to distinguish the likely cause of your swelling.

The following "rules of thumb" would be true for cases where the area of tenderness and swelling is fairly small and localized.

1) When caused by gum-disease issues, it's usually located in the region right where the tooth and gum meet.

2) When caused by a tooth's infected nerve tissue, it's usually centered some distance away, in the region of that tooth's root tip. (See picture above and our sideshow.)

c) Frequency.

The pain and swelling signs and symptoms described above may be:

  1. Transient - Meaning they come and go on a day-to-day or month-to-month basis, or any frequency rate in between.
  2. Persistent and continual. - While not always especially noticeable or intense, the symptoms never totally disappear.

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 (and even common) for this process to occur without producing any noticeable symptoms at all.

In other cases, the events surrounding the nerve's death may have been so mild, or taken place so long ago, that they're not remembered.

With either situation, 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 those whose pus finds a way to drain off may go totally unnoticed by the patient. And, in fact, in these situations 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.

That's why routine dental x-rays can be so 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 type of indication is termed a "radiolucency" and it's a sign that changes have occurred in the bone in this region due to its response to the infection going on within the tooth.

b) Recurring or persistent gum pimples.

As mentioned above, an infection housed inside a tooth may cause the formation of a pimple-like lesion on a person's gum tissue. Its location will usually approximate the level where the tip of the tooth's root is located.

Dentists term these lesions "fistulous tracts."

  • Their size may wax and wane over time (on a daily, weekly or even monthly basis).
  • Since they function as a drain for pus, they frequently have a bad taste coming from them.

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

In cases where the infection inside the tooth remains relatively low-grade, the lesion may remain small and not have much taste coming from it. If so, it's possible for a person to be totally unaware that it's there.

Often it's their dentist, during their routine examination, who is the first to identify it and recognize it as an indication of a problem.

c) Individually darkened teeth.

An individually darkened tooth.

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

A shift in a tooth's color can indicate that changes, possibly pathological, have taken place within its nerve space.

This type of color mismatch is frequently the sole reason why a dentist will initially suspect that a tooth needs root canal therapy.

This section's slideshow explains why the staining occurs. When it does the tooth typically takes on a dark yellow, gray or even black tint.

  • This phenomenon is fairly common with teeth that have experienced some type of trauma (like being banged up in an accident).
  • It may take place even some years after the original event occurred.
  • The process may not create any noticeable symptoms (pain or swelling).

Exposure of a tooth's nerve during dental work.

If nerve exposure occurs, endodontic therapy is usually needed.

d) Exposure of the 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 led 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.

3) Other tests your dentist may perform.

Once your dentist has suspicions about the health of one of your teeth, they'll likely perform additional testing to get a better idea of its status. They include:

a) Percussion testing.

Because it's so simple, the first evaluation your dentist will probably perform is a percussion test. It simply involves tapping on your tooth using the butt end of one of their dental instruments.

Teeth that require attention frequently respond to this test with pain (see above). Although, healthy but irritated teeth may respond in the same way.

Don't worry. Your dentist will start off by just tapping lightly. Then, if they haven't yet gotten a response, tap increasingly harder.

b) X-ray evaluation.

Your dentist will want one or more current x-rays of the suspect tooth, usually with each taken at a slightly different angle (so what isn't obvious on one may be on another).

The films may reveal conclusive evidence of the need for treatment (see "radiolucencies" above). But even if they don't, they can provide subtle hints that help the dentist identify which tooth has a problem.

c) Thermal testing.

Subjecting a tooth to hot and cold extremes can reveal a lot about the health status of its nerve.

In many cases where there is a problem, application of a hot stimulus will cause tooth pain that lingers, whereas a cold one will provide pain relief. (See this page's "home remedy" section below.)

d) Electric pulp testing.

A pulp tester transmits low-levels of electrical current to a tooth.

The general idea is that a healthy nerve will respond with a tingling sensation. A dead nerve will have no response (although there are reasons why a healthy tooth might not respond either).

What should you do if you notice things going on with your tooth?

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 a time frame they determine is necessary.

Don't make assumptions and don't delay.

Making a self misdiagnosis about the 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 people won't seek treatment promptly if, in their mind, they think it's already too late, 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 what you experience, what type of treatment you require and its total cost.

Things that might help.

In the case where root canal treatment is needed, there's not, unfortunately, a whole lot you can do on your own to relieve your symptoms.

  • It only makes sense to discontinue any activities that tend to set your tooth off (biting on it, exposing it to hot or cold foods and beverages, etc...).
  • Within the guidelines of the product you choose, you may find that using an OTC pain reliever provides some degree of relief.
  • Sometimes being placed on an antibiotic (and sooner rather than later, see above) can be a big help in limiting what you have to endure. And although a prescription is required, just a phone call to your dentist may be enough to get the ball rolling towards your obtaining one.
  • Since dentists know that emergencies do happen, they've probably made some type of plans for when they occur. Even if it's after hours, you should call your dentist's office to see if there is a message describing what type of assistance they might have to offer.

Home remedy: Try placing ice on your tooth.

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

This won't work in all cases and, in fact, it may irritate your 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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