When a patient comes into the office for the first time with a toothache, many times they’ll say “Just take it out,” referring to the tooth. This is a good time to step back and re-evaluate.
There are 3 directions we can go in:
1. Do nothing except prescribe medication, specifically an antibiotic and pain medication
In many cases, this is what we do, if the tooth is too symptomatic to work on, i.e. there is an associated swelling.
The Role of Medication
The medication just helps to calm the tooth down….it is not a cure-all.
Medication should just be looked at as a short term ‘fix’ that we use until the tooth is calm and we can actually treat it.
Eventually the patient needs to make a decision about what they will do with the tooth.
Their options are either a root canal or an extraction.
2. Extract the tooth
This is not a good idea unless the prognosis of the tooth is hopeless.
Removing the tooth at the same appointment depends on how symptomatic the tooth is and if there is a swelling involved (as mentioned above). Both of these factors prevent us from freezing (numbing) the tooth so that we can actually remove it.
3. Do a Pulpotomy or a Pulpectomy
What is a Pulpotomy or Pulpectomy?
If the patient comes in to the office in pain, then it’s likely that they have a large cavity.
The decay has gone into the nerve and this is what is causing the pain.
If we’re able to properly freeze the patient then a pulpotomy or pulpectomy is a good procedure to consider doing as it will get the patient out of pain.
A pulpotomy or pulpectomy is when we remove different parts of the vital nerve tissue and blood vessels that exist within the inside of the tooth.
By removing the nerve tissue, we are actually removing the bacteria that have invaded the pulp space.
After this, we place a temporary filling in the tooth and advise the patient that it would be ideal for them to return to complete the root canal procedure.
We hope that the patient chooses to follow up with a root canal and not extract the tooth if it can be saved.
The whole idea behind the emergency treatment of a Pulpotomy or Pulpectomy is two-fold:
1) To get the patient out of pain.
2) It also buys the patient some time to think about what to do with the tooth in question i.e. remove or save it.
Hopefully the patient will choose to save it, if it can in fact be saved.
If they still plan to extract the tooth, at least the emergency procedure has gotten them out of pain.
And if the decision is to extract the tooth, did I mention that a Dental Implant is an ideal way to replace a missing tooth 🙂
Toothaches are no laughing matter. They can be debilitating. For pain-free relief of toothaches and other dental emergencies, give us a call at 905.791.3867. You’ll be glad you did.
About Dr. Robert Axelrad
Dr. Robert Axelrad is a Brampton dentist who owns and manages his own dental practice in Brampton, Ontario. Affectionately known as ‘The Gentle Dentist‘, his patients include children, adults and seniors from Brampton and across Mississauga and the Greater Toronto Area (GTA). Dr. Axelrad recently moved his practice to its current, state-of-the-art dental office at Bestgate Professional Center in in 2002 to accommodate his growing list of happy patients.