Should You Have Root Canal Treatment on a Wisdom Tooth

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Not many patients will ever be faced with the recommendation of having root canal treatment performed on a wisdom tooth, but it is a situation that can occur from time to time. When it does, it is best to be informed on what exactly a root canal is, how wisdom teeth differ from other teeth, and how root canal treatment for a wisdom tooth is different than it is for others. You can’t decide if getting a root canal on a wisdom tooth is a wise decision until you understand exactly what a root canal is and why it is performed.

What is Root Canal Treatment?

Root Canal Treatment Cartoon

In short, root canal treatment is a procedure in which the dental pulp—the interior tissues of the tooth that contain the nerve and blood vessels—is removed from the tooth. Once the pulp is removed, the interior of the tooth is cleaned and shaped before being filled with an anti-bacterial material. The reason a root canal is performed can vary from one case to another, but the most common reason is that the pulp has a bacterial infection. Commonly known as a “dental abscess,” a bacterial infection of the pulp is one that cannot be cured without removing the pulp altogether. While it’s true that some medications can reduce the pain and swelling associated with an abscessed tooth, the infection (and therefore the symptoms) will always return until the pulp is removed.

What Makes Root Canal Treatment on a Wisdom Tooth Different?

Wisdom teeth are the “wild cards” of the mouth, as they can develop in many different sizes, shapes, orientations, and eruption patterns. Some unfortunate people even have more than the normal four wisdom teeth. Put simply, wisdom teeth certainly look like regular teeth, but their anatomy is quite different. These differences have impacts on the ability to perform root canal treatment successfully.

Wisdom tooth xray

Wisdom teeth often have “fused roots,” which is to say that their roots are not distinct from one another like typical molars. Other wisdom teeth have roots that are widely spaced and flare away from one another. Some wisdom teeth even have roots that bend or turn sharply, resembling a “knot” of roots, if you will. The root structure of wisdom teeth is a major factor in whether or not root canal treatment can be performed successfully.

Root canal treatment is somewhat dependent on the doctor’s ability to access the entire inside space of a root. The straighter the root is, the easier to is to remove the pulp, clean the empty space, and put a filling material back in. Roots that are curved or have sharp angles are not only more difficult to treat, but they are also sometimes impossible to adequately access for root canal treatment. Curved roots, even when accessible, can be harder to disinfect and properly fill. All of these factors make performing root canal treatment on wisdom teeth more challenging.

Nevertheless, there are some instances in which wisdom teeth can benefit from root canal therapy. Sometimes, wisdom teeth erupt normally in the mouth and are upright, just like other molars. In cases where the wisdom tooth is deemed to be functional, there may be compelling reasons to treat it with root canal therapy.

As an example, if you have all 32 of your teeth (which includes wisdom teeth), all of your teeth are straight, and you have enough room to accommodate all 32 teeth, root canal treatment may be possible and advisable should the need arise.

Aside from the configuration of the roots, the most important considerations when it comes to deciding whether or not to perform root canal treatment on wisdom teeth are:

  • Does it have an antagonist? The tooth that a particular tooth bites against is known as its “antagonist.” An antagonist is what makes any given tooth functional, in regard to eating and chewing. Some people are missing some wisdom teeth but can still have others. For instance, if you have your lower right wisdom tooth, but not your upper right, odds are the lower right wisdom tooth is not functional, that is, it serves no purpose when chewing because it has no antagonist. In this, case, extraction is a better treatment choice, since there is no great benefit to saving the tooth with root canal treatment.
  • Is the tooth suitable for a dental crown? Most root canal treated teeth, especially molars, are crowned in order to provide ongoing strength to the tooth. Some wisdom teeth are excessively short or have large amounts of gum tissue around them, making crown delivery more difficult and less predictable. This may compromise the lifespan of the tooth.
  • For lower wisdom teeth, their proximity to a large nerve known as the Intra Alveolar Nerve (IAN) inside the jaw has certain implications. The tips of wisdom teeth roots are often in close proximity to this nerve, making manipulation of the tooth somewhat risky. If the (IAN) is inadvertently damaged, there can be long-lasting negative effects on the mouth.

In many cases, root canal treatment for wisdom teeth is easily performed and the tooth can enjoy a long life. In truth, deciding whether or not to endodontically treat a wisdom tooth boils down to weighing the costs of treatment versus the function or importance of the wisdom tooth in question. If saving the tooth is worthwhile, root canal treatment can be performed, provided the tooth has favorable anatomy and restorability with a dental crown.

Model in Pain

Only by consulting your endodontist can you determine whether you have an abscessed wisdom tooth and if it can be treated with root canal therapy. Wisdom tooth pain can manifest in many different ways, but if yours is erupted and is experiencing significant dull, throbbing pain with extreme sensitivity to chewing and temperature extremes, you should consult your endodontist right away. These are tell-tell signs of a pulpal infection that must be treated soon, whether it be with root canal therapy or not. If you endodontist determines that your wisdom tooth can be saved with root canal treatment, you can expect it to have a long life and provide many years of painless function.

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