munkispank,
Hi Jackie,
I am not debating the actual need for a root canal...as long as it is indicated. An asympomatic tooth that has no cold, hot or pressure sensitivity could well be chronically inflammed and as such a root canal is in order.
On the otherhand, if the tooth needs a root canal because there is little left to place a cap may, in fact, have a vital, healty nerve.
The restorative dentist's concern may be that in the event of a crown preparation, there will be nothing left to restore...unless the nerve chamber and/or canal is used to hold an endo post and core.
It the x-ray shows a "spot" or "radiolucency" is suggestive of an abscess then the risk of a barodontalgia is increased because the nerve and blood supply is possibly compromised to that tooth.
Logistically, a root canal immediately prior to travel is problematic. If it is completed in one visit and there is no pain, with a proper temporary filling, the tooth may be no problem. On the otherhand, if the tooth requires multiple visits, is still uncomfortable following the treatment, your trip could be a nightmare.
Have the root canal specialists do an electrical pulp test to determine vitality (live nerve). If the nerve tests alive and within normal limits, it would be my inclination to leave any treatment, be it root canal therapy or crown preparations to be done on your return. The other choice is to do only the root canal and use a solid temporary material within the access opening. DO NOT START THE CAP until you return. It is too easy to swallow or worse, aspirate. No cotton or hollow space should be left under the temporary filling and a hard, permanent cement or filling material should be used to fill in the opening--this won't trap air or come out.
If the tooth tests non-vital, a root canal is the wisest course.
BTW, there are two other clinical entities that mimic an abscessed tooth. In the lower bicuspid area there is and opening in the jaw bone called the Mental Foramen. It often appears at the end of an otherwise normal tooth and appears suspicious. Taking another x-ray from a different angle will usually produce a "shift" in the spot's position and is a clue that the spot is NOT associated with the end of the suspect tooth.
The other spot that can occur is the beginning of a cementoma. It starts as a dark spot and eventually gets light in density. They are benign and commonly appear at the root ends of the lower front teeth but other teeth may display the condition. The tooth will test normal to a vitality test.
Now for the clincher. This is something I cannot recommend but you or your husband may choose to do this. Do your dive trip without opening the tooth. Your are taking a risk and should realize this. However this is a very rare condition. In most cases, you will probably get away with it.
I know from correspondence that there is a skillful dentist on Bonaire capable of providing emergency treatment. I have corresponded with a diver who had to seek his help.
I will try to find out his name.
Remember I'm not recommending this course of action but I also understand the disappointment and financial loss failure to go on the trip may entail.
Good luck,
Laurence Stein DDS
:doctor:
BTW, antibiotics are only indicated if signs of infection are present NOT AS A PROPHYLACTIC treatment. If your husband has no pain, swelling, fever, etc, do not start antibiotics. If your dentist feels it is appropriate he can Rx an appropriate antibiotic and pain killer. They must be kept in the original prescription bottles with his name on them. Putting them into a pill case can get you into deep trouble.
In the event he must start these medications, DO NOT DIVE and see the local dentist. Finish the antibiotic rather than stop when feeling better.
Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)
