“Dude, this is a totally deep hole.”

-Bill Preston, Bill & Ted’s Bogus Journey  (1991)                                

Root canal treatment (Removing a dead or dying nerve form a tooth) is something we try and avoid unless we have no choice. But this case certainly made me sweat!

The (new) patient had come in for an exam a few weeks ago, and as part of his examination we took some X-rays. One of the things we found was this:

That’s a pretty deep cavity….

Both teeth are damaged here, but the one to the left has a big cavity. (Yellow dot) That’s getting worryingly close to the nerve. If the decay reaches the nerve it dies, and we have to do root canal. This is definitely filed under “urgent”.

Incidentally this tooth wasn’t causing any pain or discomfort at all. Sometimes people adopt a “If it’s not painful all must be well” attitude. Well, that’s a sure-fire way of ensuring you’ll get to do plenty of root canals! Luckily this gentleman had decided to attend before we got to that point.

So having very, very carefully cleaned out all the decay, we were left with this:

Too close to the nerve for comfort…

If you look at the area I circled, it’s slighty reddish/pink there. That’s the nerve. We haven’t hit it, but we’re so close it’s showing through the tooth. the problem with being so close is that some bacteria may already be in there.

So what to do? Well we could root canal treat it immediately, with all the work and expense that entails. But the patient had no pain and there was no sign of infection, tenderness or anything else that would worry us. So lets try and keep that nerve alive:

Anti-bacterial layer applied over the deep area.

We applied a small layer of strongly antibacterial material over the deep area near the nerve. Hopefully that’ll kill any stray bugs in the area. As a bonus it encourages the nerve to move away from the damage. (Hurrah!)  Finally we finish the filling.

Filling placed, and hopefully all will be fine.

There’s no absolute guarantee this will work; we could be too late and the nerve may die regardless. There’s no 100% guarantee when you’re dealing with the human body I’m afraid! Fundamentally, this is basic dentistry. It doesn’t involve any ultra-hi-tech equipment or approach, it just needs time spent on it. If you rush this, you’ll end up in the nerve, and then you’re doing a root canal for sure.

Obviously it would be better if we’d seen this a year or two earlier while the decay was still further away from that nerve. It illustrates yet again the importance of getting a regular dental check-up. If you wait until you’ve a problem you’re probably too late

Written by Dr. Karl Cassidy.
Haven’t had a dental check-up in a while, and would prefer not to do root canals?(!)  If you’re looking for a dentist in Dublin, we’re always happy to see  new patients. You can book an appointment online or call our reception team at 01-6655900. And as always, you can email us at info@shelbourneclinic.ie – during office hours we always aim to respond to queries within 30 minutes.