How do I know if I need a filling or a root canal?

Deciding on a filling vs. root canal treatment involves a dentist determining if the tooth's pulp is infected and needs to be removed.

Recurring tooth pain is never normal. When a tooth hurts, it means something is wrong and dental treatment is needed as soon as possible.

The most common cause of tooth pain is a cavity. Although tooth enamel is the hardest substance in the body, it is still vulnerable to erosion by oral bacteria. Cavities form if a portion of a tooth becomes demineralized by lack of brushing and failure to receive regular dental cleanings. Demineralization of tooth enamel is exactly that — loss of minerals essential to enamel health. Demineralized enamel will weaken, dissolve, and eventually form a hole in the tooth.

When a cavity is deep enough to reach the nerves in the tooth’s inner pulp, these nerves will react to cold, heat, pressure, and sugary foods by triggering pain and sensitivity. In addition, a tooth with a cavity may slowly turn dark yellow or brown as the cavity enlarges and the enamel decays.

If enough bacteria reach a tooth’s pulp, the pulp could become infected. In this case, a dentist will need to remove the infected pulp to prevent extracting the tooth. This process is known as a root canal.

Can I get a filling instead of a root canal?

Whether you need a filling or a root canal often depends on the severity of the cavity. Neglecting to get a cavity filled only increases the risk of a pulp infection. Composed of capillaries and nerves, dental pulp keeps a tooth “alive” and functioning normally. If your dentist determines the cavity has reached the pulp and allowed an infection to occur, you will likely need a root canal to save the tooth.

Signs of infected tooth pulp include:

  • Darkening of the tooth
  • Gum inflammation and soreness around the tooth
  • A pimple-like abscess around the tooth that may leak fluid
  • Difficulty sleeping due to severe, throbbing pain
  • Pain radiating into your ears, lower or upper jaw (depending on which tooth is infected), and head
  • Swelling of the gums

Whenever possible, dentists will always try to save an infected tooth with a root canal. The loss of a tooth not only causes the nearby teeth to shift position, but also promotes gum shrinkage and possible loss of jaw bone density.

Filling vs. root canal: 2 basic differences

1. Materials used

Made of silver amalgam, composite resin, gold, or other hard, enamel-like material, a filling is placed inside a cavity to prevent the cavity from growing any larger. Fillings conform tightly to the shape of the cavity so that bacteria can’t infiltrate the filling and further decay the tooth.

Root canals involve a dentist removing a tooth’s infected pulp and replacing it with dental putty called gutta-percha, a substance made from a Malaysian tree. Teeth undergoing a root canal are much weaker than healthy teeth or teeth with fillings. Consequently, dental crowns are necessary to reinforce teeth without their natural pulp.

2. Number of visits

The process of filling a cavity typically takes less than an hour after the dentist has cleaned and prepared the cavity.

A root canal may require two or more visits. During the first procedure, the dentist removes the pulp, cleans the cavity, and places a temporary crown over the tooth. During the second visit, the gutta-percha is inserted in the root cavity and a permanent dental crown is then placed on the tooth.

In cases of root canal treatment where infection is severe, a dentist may need to prescribe antibiotics to control the infection before performing the actual root canal.

Root canal vs. extraction

When a dentist says a tooth can be repaired with a filling, that means the tooth is healthy enough to be saved. Root canals are the last resort for saving a tooth before it must be extracted.

In some cases, a root canal may fail, and the next course of action is likely to be removal of the tooth.

What happens if you don’t get a root canal?

Choosing not to abide by a dentist’s recommendation to have a root canal could result in one or more of the following:

  • Continuation of pain and swelling severe enough to interfere with sleep and daily activities
  • Worsening infection that could spread into your bloodstream and cause sepsis or even a heart attack
  • Losing part of your jaw to an untreated pulp infection

If you don’t want a root canal, the best thing to do is to simply have the tooth extracted to avoid potentially serious health problems.

How do you know if you really need a root canal?

Not all tooth pain indicates a cavity. For example, tooth sensitivity occurs when the inner layer of a tooth (dentin) becomes exposed. Tooth sensitivity is usually due to overbrushing, age-related gum recession, or the simple wearing away of dental enamel.

Feeling sharp pain only when biting down could indicate a cracked tooth instead of a cavity. Other reasons for tooth pain not involving a cavity include abscesses, sinusitis, or temporomandibular jaw disorder.

If you have a toothache or it hurts when you bite down on a tooth, make an appointment with a certified pain-free dentist as soon as possible. A dentist will examine the tooth and take x-rays to determine if a root canal, a filling, or other dental procedure can prevent extraction of the tooth. With advanced endodontic tools and effective numbing agents available today, root canals and fillings are much more comfortable procedures than they were years ago.

Visit our directory to find a certified pain-free dentist in your area today!

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