Dentist Questions Root Canal

The tooth where I need a root canal isn't bothering me. Why do I need it?

My last checkup showed that I needed a root canal in one of my back molars, but this tooth isn't bothering me at all. If I'm not in pain or have any discomfort, why should I really need this root canal?

31 Answers

Because there is infection present. I have encountered many patients like this who don't want to move forward. The infection can get so bad as to involve the adjacent teeth, that then need root canals, or land patient in hospital. THis has happened to several patients. Not usually the case, but if you had an infection in you skin and it did not hurt, would you ignore it? Just because you cant see it doesn't mean it is not a problem
It's typically due to a large cavity close to the nerve. This is one of the reasons why X-rays are taken to identify problems before you are in pain.
Even if the tooth doesn't hurt, that doesn't mean that it's healthy. There may still be an infection, fracture, or other issues. Root canals may be recommended for teeth that have don't have any symptoms such as a necrotic nerve (dead nerve that no longer has any sensation). It is important to have the recommended treatment completed to prevent further complications later down the road, such as having to extract the tooth.
Have the tooth removed and find another way to replace it. All root canals eventually fail and can cause other health issues as well. If the tooth is non-vital, it needs to be removed.
There can be multiple reasons for recommending root canal treatment. Your dentist must explain that to you.
It is possible to need a root canal even if the tooth is not hurting. A radiograph will show if infection is present by the root. if it is then the nerve tissue is necrotic and needs to be removed hence the root canal. Many times it is based on the extent of decay. Deep decay in close proximity to the pulp chamber (where the nerve resides) is also treated with a root canal.
Silent infections have a tendency to erupt at the most inopportune of times. You don't want to deal with an emergency when you have other things better to do
Root canals occur because bacteria are encroaching, or are invading the center or nerve of the tooth. Not all root canal needs will be painful. Often they are diagnosed by Xray and are not painful. count your blessings, tooth pain is not fun. Talk to your dentist about the need and maybe they can show you on an xray the reasons why you are needing this procedure.
Sooner, it will bother you and the tooth will eventually it might be lost. Get the root canal and have it fully treated with root canal restorative care.
You should get it done as this is an infection in your body and no matter if it's not in acute (painful) or chronic, which is painless, it can lead to the spread of infection in your facial spaces, which is life threatening
First you need to define why that tooth has been diagnosed to get a rot canal! If the reason is that your tooth has mini infection and cyst on the tip of the roots, then if you don't get rot canal done soon, you are exposing yourself to 1. possibility of abscess and a large infection 2. loss of bone and growth of the cyst that might lead to you loosing your tooth.

When you get swelling or pain on a tooth that will need a root canal ,it could be too late to save the tooth and you might need extraction.

I highly recommend to get a consult and define the necessity of root canal and act on it ASAP.
It is not uncommon for a tooth to need a root canal and yet there is no pain. It is often the same way with a lot of other diseases or infections. When there is pain or swelling it can make treatment more difficult.
If your tooth has a deep cavity with decay that got into the nerve of the tooth, you will need a root canal. Often, this occurs slowly and there is no pain involved. If you want a second opinion, please schedule an appointment.
The decay is to the pulp tissue or very close. I assume the doctor saw this on radiograph. It will be only a matter of time when there is enough infection when you will start experiencing pain.
It is possible for a tooth that needs a root canal to be asymptomatic. Pain or discomfort is not the only criteria that determines whether you need a root canal or not. Sometimes the nerve inside the tooth is already dead, or your body's immune system may have walled off an infection, or the tooth, even though it is in an unhealthy state, does not have any particular feeling. Your dentist or endodontist should take appropriate xrays and perform pulp testing in order to determine if your tooth needs a root canal.
As seen in the X Ray, the tooth has an abscess at the tip of the root.  If the infection is not removed it may drain into the bloodstream to other areas.  If the drainage becomes blocked, it will cause swelling and discomfort.  It is your decision.                                                                                                                                                                       

Frank Gusemano DDS
Good Question!

The short answer is the concern for future flare ups and pain. A necrotic or dead tooth is a breeding ground for bacteria and not the good kind. A root canal not treated could remain quiet for some time or could start to hurt when chewing or become tender or sensitive to heat. I understand the hesitation and it does give you the flexibility to choose when to treat the tooth. But a dead or dying tooth will not heal itself so it is only a matter of time until trouble comes to town.

You should ask your current dentist your question to see what response you get. And you deserve to know why the tooth “ needs a root canal”. I routinely show my patients xrays and explain what is going on. There are times if a patient has no pain I may wait but that can only be determined with proper diagnostics.

All the best
Dr David Wiseman DDS FAGD
At some point the tooth will display swelling into your cheek. Leaving an active infection does several things, none of which are good. First is that you have an active infection circulating thru your blood stream, if it is an upper tooth this infection can travel upward toward your brain, if it a lower tooth the infection can travel toward your heart. Secondly, the infection is causing loss of bone around that tooth which, at times, can affect the support of a neighboring tooth.
I need more information to be able to answer you correctly, but generally specking a tooth needs a root canal when there is infection within the nerve of the tooth. Pain is possible, not necessary the only indicator to determine treatment for a tooth including root canal treatment.
Without looking at you and an X-ray I can’t be 100% sure about this, but I would assume the doctor saw something on an X-ray that would indicate you have a dead nerve and chronic abscess at the root of your tooth. With it being chronic, these are asymptomatic. The reason for doing the root canal is that they can turn acute and cause a significant amount of pain and swelling. It’s done to prevent those negative outcomes from occurring. I hope this helps.

Sometimes you don’t at that time. If the tooth is asymptomatic it should be monitored every six months or so to see if there are any changes radiographically. If there is a lesion that increases in size or it starts to give symptoms that you notice.... then it’s time.
If your endodontist sees a problem, even if there is no pain, better to take care of it before the pain starts. Just like HIGH BLOOD PRESSURE is the SILENT KILLER, if you don't get it checked, you may not know you have it until you are dead. Likewise, how many women go for their mammograms and pap smears checking for cancer? How many men get their prostates checked out. That spot on the lung, ignore it? If you wait for cancer to cause pain, you are at stage 4 and beyond saving. If the nerve is dead and gangrenous, why wait for it to blow up? Murphy's Law, it will blow up as you board that cruise ship or plane for an overdue vacation, blow up at your wedding...or your kid's wedding, in the middle of a blizzard with a state-of emergency declared with a ban on travel. There is no good time for root canal therapy or a trip to the dentist. Better to plan it and schedule it when it is less inconvenient because it will never be convenient. OH, you can also extract the tooth instead of saving it with a root canal or live with the infection until symptoms arise and hope you can get an appointment.
Pain is a poor indicator of disease. Without a root canal, you risk the loss of this tooth forever.
Unfortunately pain is not a reliable determining factor for dental needs. Just as high blood pressure doesn’t hurt but can lead to disaster- a tooth that is infected may not bother you but can lead to serious complications.
Infected tooth has a chronic infection and can flare up any time. Sooner or later, root canal needs to be done
Even if you are symptom-free. You still need to take care of that tooth. You might have a chronic infection on that tooth that can't be seen without X-ray. That infection will not be resolved unless you do a root canal. It might even get worse.
It is very common to need root canal treatment even if you have absolutely no symptoms. Typically, an infected tooth will be asymptomatic, not hurting at all, but a big event of swelling or pain can pop up at any time. Radiographs or X-rays often will give your dentist clear evidence of disease even if your tooth is not hurting. Go for it, get the root canal and save yourself much trouble later!

Brett E. Gilbert, D.D.S.
There are two reasons why this may be recommended. One is that the cavity is close to the nerve and will cause pain to treat, and if not treated will cause pain in the near future. The next reason is that the nerve is already dead and a periapical infection is present. What I always tell may patients is that although the pain may not be present, the source of the pain still remains. If this is not treated and you are not in pain now you will be in the near future, and having gone through this myself, you will wish you had it treated prior. I hope this helps. Good luck!
This means that this spot it and abscess on the x-ray. Even though the tooth is symptom-free it is important to take care of this because that infection causes bone loss and will keep growing larger as time goes on. Teeth have dental meridians and I believe they can affect our organs in our body even though there are no symptoms.

Best Regards,
Dr. Mark Berkowitz
Not all medical or dental problems obviously reveal themselves to the person who has the issues. Diabetes and high blood pressure are 2 well known examples of silent significant medical issues. Likewise the need for root canal therapy may be obvious to your dentist, but not at all to you. The pulp of a tooth may deteriorate (die) quickly and painfully (the need for treatment is obvious) or slowly and silently (the need for treatment is NOT obvious). X-rays reveal a silent infection that calls for the tooth to receive root canal treatment.
I understand your confusion. Root canals are done for teeth with damaged pulps (nerves and blood vessels deep inside the teeth). Sometimes pulps die silent deaths and never give the tooth any pain. However abscesses (balls of pus) will form at the tips of the roots deep in the bone. The abscess will continue to enlarge at the expense of the bone until it reaches the surface of the bone. Then you will get sudden and severe swelling. A dentist can usually identify abscesses before they reach that crisis level. It would help to ask the dentist who told you that you needed the procedure why you need it.