Will I need a root canal? Diagnosing dental pain.

Written by: Dr Adi Moran
Edited by: Lisa Heffernan

To understand dental pain, let’s take a look at the anatomy of the tooth. The crown is essentially what you see, but inside the tooth, there are nerves and blood vessels that make up what we call the pulp of the tooth. In a healthy tooth, the pulp is sealed off by the crown, so no infection from the mouth can enter. However, if we have decay, a fracture line or very deep restoration work has been done on the tooth, infection can find its way inside the tooth, leading to inflammation and pain.

If irritation in the pulp remains for a long time or the pulp tissue dies, infection can seep through the pulp to the bone, causing inflammation and pain right at the root canal. Pain can derive from both the irritated nerves in the pulp of the tooth or from the bone below. Dr Adi Moran, endodontist in London tells us how we can diagnose a toothache and when we need root canal treatment.

Can you prevent dental pain?

Unfortunately, you cannot always prevent dental pain. That being said, there is a lot that you can do to prevent pain, cavities and tooth decay. The most important thing is to keep good oral hygiene and to visit your dentist regularly for check-ups. You should also make regular appointments to clean your teeth to minimise dental problems in the future. Anyone with sensitive teeth should use a desensitising toothpaste.

How does an endodontist diagnose a toothache?

Diagnosing dental pain is a form of art. Many factors need to be taken into consideration and a lot of information gathered to form a diagnosis or differential diagnosis. It’s important not only to use a radiograph and an X-ray, but to hear what the patient feels and how they describe their pain. The dental history of the tooth is very important. A clinical examination of the tooth must be carried out and the radiographs examined, sometimes CT scans to give a 3D picture of the tooth may be necessary.

The endodontist may test the tooth with cold temperatures, knock on the tooth and press on the gums to assess where the pain radiates from and to assess the health of the gums and tooth. They will look for any swelling, sensitivity and how healthy the connection is between the gums and the tooth. Diagnosis is very multifactorial. After the end of the consultation, the patient should not only have a clear diagnosis but should fully understand what needs to be done and the treatment options that are available to them.

How do I know if I need root canal treatment?

Not all conditions requiring root canal treatment are painful, so some patients will require root canal treatment even if they are completely pain-free. If nerves in the tooth are inflamed, but only to such an extent where the tooth can heal itself, then a person may experience sensitivity when consuming anything sweet, hot or cold, but they won’t experience spontaneous bouts of sharp pain.

More on root canal treatment

A root canal will be needed if the nerves in the tooth are severely inflamed and pain is felt in the tooth even without eating or drinking. The pain can be provoked with anything hot or cold that will cause severe throbbing pain. The pain may be localised or anywhere on the same side of the face as the problem tooth, by the ear, eye or jaw.

Any pain radiating from below the tooth, comes from the bone itself and may indicate that an abscess is present, the tooth tissue has died or the inflammation has progressed into the bone. This pain will feel dull and constant and will be much easier to locate, as opposed to the pain that radiates solely from the nerves or the pulp of the tooth.

Who performs a root canal treatment?

Your dentist should be able to perform a root canal treatment, however, randomised controlled trials do show that specialists have a higher success rate when performing root canal treatment. If you are having root canal re-treatment or there was a complication with your initial root canal, then you should definitely be seeking a specialist for treatment. Dr Moran recommends having root canal treatment in a clinic where the dentist has access to a dental operating microscope with high power magnification. The anatomy of the root canal is very complex and for a root canal to be carried out to the highest quality, the best tools to examine the root canal and perform treatment are vital. It’s also important that the patient completely understands the process and feels at ease before the procedure is carried out.

If you’re in need of a dental check or would like more information, visit Dr Adi Moran on the Top Doctors website.

Dr Adi Moran

By Dr Adi Moran

Dr Adi Moran is an expert endodontist based in London with an outstanding academic background. He practices at Harley Street Dental Studio and at Endocare Richmond. Originally qualifying from Semmelweis University, Budapest, Dr Moran completed a specialty programme in Endodontics at the Hebrew University, Hadassah, where he was one of the few interns regularly asked to lecture before being certified as a specialist. He now practices at Endocare, a centre of excellence for diagnosing and treating dental pain and providing root canal surgery.

Dr Moran held an official academic title of an ‘associate clinical teacher’ at the department of Endodontics, the University of Warwick for five years, teaching and instructing MSc courses and being involved in research. He routinely lectures to general dental practitioners, and is a guest lecturer at the department of Endodontics, Hadassah where he has been a clinical instructor to undergraduate dental students for a number of years. Additionally he is a key opinion leader for Kerr Endodontics.

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