Root Canal Treatment

[Mog]

Yesterday I had to have two upper rear teeth filled. The dentist said she had to drill close to the nerve on one of them and therefore it might need root canal treatment if an abcess appears because of damage to the nerve. I wasn't sure if she was warning me just in case or if their is a high chance of an abcess forming (I know I should have asked more questions but I'd just spent 50 minutes in the chair and was a bit dazed). Has anyone had the same thing and can you tell me what the outcome was - and is root canal treatment as awful as it sounds. I'm also 31 weeks pregnant so don't want any of this to happen in the next few weeks. Would appreciate any info.

Mog, I haven't had this done while pregnant (as far as I can recall) but root canal treatment is just like a really really long filling; you have to have all the local anaesthetic injections, then the dentist removes the nerve from each root (3 if it's a molar, 2 for a pre-molar) and fills the hole where each nerve used to be.

It is quite a long job but the benefit is that if you subsequently get any root problems (like abcesses) they don't hurt because the nerve has gone. If you are lucky it won't need doing at all but even if it does you may well be able to wait until after your baby has arrived!

Mog, I would try and avoid root canal work while you are pregnant. My dentist injected so much anaesthetic into me I was numb from the neck up (no jokes please!) but it still hurt so much I had to be restrained by the nurse. I may just have been very unlucky or maybe my dentist was c**p but I would definitely not recommend it for the later stages of pregnancy.

I've had root canal done once and am having it done again today (ARGH!) because it wasn't done properly the first time. It's not a pleasant experience, but it doesn't hurt. If you can put it off until after you have your baby that's probably a good idea if you're concerned about the anaesthetic. If you are a particularly nervous dental patient I'm sure they can sedate you for the procedure, but honestly it's not that bad. You are in the chair for about an hour (this is for one tooth) so it's a bit uncomfortable keeping your mouth open for that long. Of course there are always people who have horror stories but root canal is a very common and straightforward procedure. Try not to worry, I can certainly think of much worse things - like a tooth abscess for instance!

Thanks for all your replies - although your experience Bugsy sounds terrifying. I had the filling done Friday and so far there hasn't been a problem. I'm really hoping I don't have to have the RCT because I've had so much work done over my two close together pregnancies. This is all the more annoying as I don't know what else I can do in the cleaning department. Has anyone else had to have a lot of dental work at the time of their pregnancies?

I had a root canal done years ago (non-pregnant!) and emergency one done at about 5-6 months pg last time, and I can honestly say there was no difference whatsoever. Both treatments were equally well pain-relieved, equally effective and equally unpleasant, despite one being private and one NHS. However, because I was pregnant the dentist couldn't xray to check her work, which also meant that she wouldn't put a permanent filling on the tooth. Eventually the crown of the tooth collapsed, leaving just the root under the gum. Nice, I think not. And just after I got pg this time the dentist told me that she thinks one of my molars is cracked and may not last the pregnancy, which would probably result in the same procedure: root-canal, temporary filling, crumbling crown. There's an old-wives tale that each pregnancy costs you one tooth. The baby is overdue so there's still time for me to fulfil that saying!

Please get it done! Firstly it does not hurt at all its just like getting a filling and some poking around. I needed this treatment when I was pregnant but my dentist was reluctant to proceed as he wanted to take an xray - so we decided to leave it until after the birth. When I was in labour I started with the most horrific pain in the tooth and all during my labour was complaining about the pain (the midwives thought I was mad) as a result my face ballooned and my head was pounding so badly I was unable to look after the babies. Fortunately my obstetrician could not believe what I looked like and paged the emergency dentist who put me on antibiotics. They both said the xray and treatment would have been fine to do whilst pg. They explained that the infection was fairly dormant until my body was so pre-occupied with giving birth it saw its chance to really get a hold. So my advise to anyone is get it sorted as it definately made me so ill I couldnt enjoy the babies. Sorry if this sounds all so doom and gloom but you don't want anything to spoil this precious time with your new baby. Hope this helps.

mum2twins - thanks for the advice. As the tooth hasn't flared yet and I'm assuming that the dentist was warning me just in case, I'm going to take the route (!) of no treatment until something happens. I've had a tooth infection on another tooth in the past and antibiotics sorted it in 24 hours - not sure if this is the same as an abcess. Since RCT seems to weaken teeth, as wmf found, I'm still not sure why you can't just have a course of antibiotics when the tooth flares up but still leave the root intact. I shall be asking more questions on my next visit to dentist on Christmas eve.

Good idea Mog, just make sure if you get the slightest twinge of a pain - start asking for the antibiotics so you can nip it in the bud. Good luck with your pregnancy and happy christmas.

Unfortunately, with 4 weeks to go to the birth of second baby, my tooth has become painful although it is not like the pain I had on a tooth infection a few years ago in that this time it is intermittent and is relieved by paracetemol. Suppose I will have to visit the dentist but can anyone tell me how I know the difference between a tooth infection (is this the same as an abcess?) and just sensitivity in the tooth which the dentist warned might happen as the filling is close to the nerve. Also when I've had antibiotics in the past for tooth infection the problem hasn't recurred. Would it be possible to treat intermittent tooth infections with antibiotics and not go down the path of root canal treatment as this seems to weaken teeth?

Dear Mog

not had time to read whole thread as Ds has temp tonight. Very briefly, an abscess and dental infection are more or less the same thing. If you get throbbing or dull ache and especially if woken with pain you may need RCT from your dentist. Post-op sensitivity is more with cold temperature etc. If you get a dull ache with a cup of tea or other hot drink you should see your dentist, shouldn't really just take painkillers and ignore the cause of it. Will come back later..

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Mog there are broadly two types of dental abscess - periodontal , ie pertaining to the gum,(this includes the swelling you can get around an impacted wisdom tooth, and periapical abscesses.(at the tip of the tooth root with the source being a dead or dying nerve inside the tooth). When people talk about having an abscess they usually mean the latter, and that's what you might have.

Periodontal abscesses can self heal , with good oral hygiene, the use of mouthwash such as corsodyl, and in severe cases, antibiotics. Unless the affected tooth is very mobile or impacted the tooth itself can stay put without needing treatment.

Periapical abscesses on the other hand won't go away without treatment (ie a root filling if you want to save the tooth, an extraction if you don't)However not all abscesses are painful so the pain may come and go. Lack of pain does not necessarily mean lack of abscess but it does mean you could delay treatment .

You could indeed get antibiotics for it in this late stage if simple painkillers didn't keep the pain at bay. However there is no real reason not to get a root filling while pregnant (other than the not wanting any additional hassle of any kind when pregnant!)
Root fillings are often done in two stages , with the root canal getting cleaned out at the first stage, and a medicated dressing being placed in the tooth with a temporary filling on top. Often this can be done in just a few minutes .This gets rid of the pain in most cases; the final stage of properly shaping the inside of the canals and placing the root filling is carried out at a later visit ( in your case in a few weeks , after your baby is born)

Corsodyl won't help a periapical abscess, nor will xtlitol.

Hope this helps.

Looking forward to hearing your news in the birth announcements thread sometime soon

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Thanks for all your replies. I'm still not clear though - if it is an abcess in the root and is cleared up by antibiotics why can I not leave it at that? I'm not being a wimp, it's just that it seems that once RCT happens the tooth quite often breaks and is lost anyway. On a lower molar where I had an infection (dentist didn't say what kind) I had a course of antibiotics and everything's been o.k.
Don't they also need to do x-rays during RCT, so are these o.k. in late pregnancy?

Am in a rushMog, hope this makes sense.
If you have a periapical abscess ( tooth, not gum related) antibiotics will get rid of the symptoms for a bit but won't actually "clear it up". You will still have a tooth with a dead or dying pulp which will need definative treatment at some point.
As for teeth breaking after RCT, it's the tooth becoming "dead" that makes it brittle not having a root filling done.
As Robinw's story shows you may not actually need a root filling anyway - might indeed be a gum not tooth thing.
No evidence to show xrays in pregnancy are harmful( I had dental xrays when pregnant) but as a rule they are avoided on the unscientific "just in case " principle.
How is your tooth today?

Lovely, another one on teeth, will have a read and give you a 'tenth opinion'.

Jasper, I love it when you blind em with science!

Another thing to add is on the second visit after the nerve has been removed, when you go back for the amalgam filling, you shouldn't need an injection as the nerve will have been removed at the first visit.

Hopefully you won't need it doing, fingers crossed.

Although I've had a couple of painful bouts of toothache on eating and talking too much, I bought some corsodyl mouthwash today and it seems to have greatly eased things (might just be coincidence). I'm hoping this might indicate that it is a gum rather than tooth infection although I've been really good with oral hygiene this pregnancy. I did wonder if I might be too zealous with flossing and this may have irritated things, also probably a bit run down this close to giving birth.
Jasper, we're so lucky to have you on this site with all the clear explanations you give. I wish you were my dentist. Maybe it's just me, but understanding what is happening takes away alot of the fear of dental work

Lordy, I wish my own patients were as nice to me as you lot
(just kidding)

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Oh dear. After thinking things had settled down, toothache returned lunchtime so went to the dentist. She wanted to take the nerve out there and then, but I couldn't face it this close to birth. She advised against the antibiotic route (my last dentist didn't even mention that there was another route and was quite happy to give antibiotics) but I really want to try this first before major work. She's given me amoxycillin and metronidazole, the latter I've read on another thread isn't suitable for pregnancy - anyone have any info on this as the pharmicist thought it was o.k. too. Here's hoping I'm as lucky as robinw's husband.

Mog, rule of thumb...pharmacists are nearly always right!
Metronidazole is safe in pregnancy although its use is discouraged in the first trimester for the usual no evidence but just in case reasons.
Hope your toothache gets better soon.