I would appreciate it very much if someone could advise me whether I need
a RCT or not.

I have been experiencing problems with no. 15 (molar on upper right end).
I have a large inlay (still intact) and the tooth (inner side) has been
chipping off since 2 years ago.  I have been feeling something
occasionally since maybe January, 1998, and my general dentist then told
me I need a root c{*filter*}and a full crown on the basis that a large inlay
would impose more pressure on the tooth.  (but the space that needs to be
covered feels very small to me).  He sent me to a root c{*filter*}
specialist who told me I don't need a root canal--they did a dry ice
test, which I could feel.
(She told me she'd talk with the dentist and call me, but I never heard
from her, and the school got busy and the tooth wasn't hurting much so I
forgot about it).

The tooth has been hurting on and off and since June but since the
middle of that month the pain has been getting worse, and that's when
I was in New York for a research trip.  I saw 2 dentists (prosthdontists)
there and they both told me I wouldn't need a root c{*filter*}nor a full crown
from what they see.  (I thought I didn't have enough time for a treatment
there).  The tooth seems to look clear on the X-ray.  

Once the pain starts it lasts for a while and chewing does not seem to
cause any pain, though once in a while I can feel a little bit of it.  
The tooth is not sensitive to hot and cold.  I discovered, however, a few
a days ago that brushing triggers pain a big time--sore type pain--which
lasts for hours.  (I tried Colgate, Arm and Hammer and an herbal formular)
Then it sometimes settles down as some kind of dull pain which lasts for a
while.  Hard to describe.  But no throbbing type pain yet.  I have't tried
any pain killers.

Is this a sign that the tooth may be dying?  Or is it just the cement
being washed away?  How long would a molar take to die till it does not feel
the dry ice or something show up on the X-ray?  I am trying to see the
endo person again but that's not till 3 weeks later.  I haven't been able
to see the general dentist either mainly because he's all booked up, etc,
though I have been asking for an appointment since end of June.

In the past I have had a few RTC, apico, a bridge, nerve pain, etc in the
anterior area but never had any RTC in my molar, so I'm very worried.
I'm resentful of the fact that the dentist advised me to get
treatments that were supposedly much more than what I may have needed when
I was trying to get a new inlay 6 months ago.  

I am very distracted and can't concentrate on anything.  Please write me
back regarding what my symptoms seem to call for.  Thank you very much.

Sincerely,

Eunmi

What you need 1st of all is a temporary coverage of that exposed
part of the dentin (tooth-bone). It can easily be made by some GIC
(I usually use Ketac Cem from ESPE). Then wait and see if the off
and on pain goes away totally. If is does; find a dentist who has
been doing adhesive dentistry for some time and have a ceramic
build-up bonded to your tooth.

If the pain still is there; it may have to ba an RTC; but I don't think
so since the endo guy (sorry; endo gal) said it wasn't necessary.
You may have to have a new evaluation though.

A cool dentist would remove that inlay and place a ceramic onlay onto
your tooth if there was no immediate need for a RTC as assesed by
the endo specialist. Would there, however, afterwards be problems
with the nerve a RTC can be made without ahving to remove the
ceramic (if it is properly made). And then just a small filling on top
to cover the entrance made for the RTC. Myself I would had used
Empress and Tetric Ceram. Usualy works fine.

Hans Lennros DDS