Root Canal + Crown vs. Extraction? Which Is Better for a Tinnitus Sufferer?

Hi,

I’ve been living with noise induced tinnitus for over 7 years now. I would say my tinnitus is somewhat moderate severity (can hear it in most low/moderate noise level environments) during this time I’ve had many ups and downs, I try to protect my hearing against further noise exposure etc, but I feel it is manageable overall which I’m grateful for.

Unfortunately after a severe bout of toothache and visit to the dentist, they found an infection on my upper first molar tooth. I was told I would need a root canal with a crown placed at a later date (tooth currently has a large silver filling) or the option of an extraction.

This has really got me concerned because at most I’ve only had fillings in the past which required little drilling (with no change in my tinnitus). If I go ahead with the root canal they will first have to drill out the old metal filling, then get on with the root canal, so a lot of drilling!

If that wasn’t bad enough I’ve got to go back for the prep for placing the crown, I’ve looked online and looks like that would require 15-20 minutes drilling! Despite all this there is still no guarantee the root canal working anyway! So lots of noise and money spent for nothing to show for it...

I think the most sensible option would be to have the molar extracted, but it would leave a hefty gap when I smile, plus I’ve heard removing teeth can be detrimental to the overall structure of the remaining teeth and make them shift overtime? Unfortunately I cannot afford an implant ($3,000-4,000) and not keen going abroad for cheaper dental work.

Anyone had a root canal and crown? Really would appreciate some advice because the appointment is booked for this week and I can’t stop thinking I’m heading straight into a disaster!

Thanks.

 

Why not? Once the tooth is drilled out and the source of infection and decay is removed, the tooth can then safely be rebuilt. Is that not how it works?

 

I’m just thinking a successful root canal treated tooth is dependent of various factors, the main being the job being done properly and not botched, sometimes the infection isn’t cleared properly, all the root canals cannot be found (molar teeth have 3-4 canals etc), leading to further infections, unfortunately there are no guarantees you won’t have further problems down the road.

But despite the outcome of the tooth my major focus is on all the drilling not worsening my tinnitus. Like I say I’ve have fillings the past several years without issue, but the removal of an amalgam filling, root canal and crown placement is an awful amount of drilling... just wanted to know if anyone else as had the same dental work done and what effect it had on their tinnitus?

 

Sometimes a tooth can have very fine fractures which will still allow bacteria to get in, or there could be an additional small canals which most general dentists won’t detect.

 

That's what I would do in this situation.

 

I agree Bill, too much drilling involved, too risky, just got to get my priorities right.

I’ve changed the appointment to extraction instead, if the gap bothers me there is always the option of dental implants in the future.

 

I understand your fear about drilling affecting your ears, but resorting to simply extracting a tooth without exploring all other possibilities seems extreme to me.

I would have thought trying ear plugs first or if occlusion is a problem, perhaps noise cancelling earphones, as some dentists use. Also, explore the possibility of laser dentistry, though I understand it's not always possible in every case.

Extraction can come with its own issues too as can implants, because delicate nerves can be affected. There are people on Tinnitus Talk who have reported issues with tinnitus caused by aggravated or damaged nerves following dental surgery.

I know it's all fraught and I'm not qualified to advise, but ripping teeth out that can be repaired, seems a more judicious approach to me.

 

I agree it may be an extreme option, none of it is ideal, but I’m only trying to mitigate the risk to my tinnitus the best I can.

Ideally I would love to be able to save the tooth (after a course of amoxicillin the pain has vanished but I know the underlying problem is still there) and it have no effect on my tinnitus, but what if it goes wrong? The chance of significantly worsening my tinnitus potentially permanently, a risk of severe debilitating tinnitus for the rest of my days doesn’t seem worth the trade off, there may be no second chances!

Unfortunately from the little I’ve read, laser dentistry is only available for small cavities, my tooth requires the removal of a massive amalgam (metal) filling, root canal and extensive drilling for preparation for a crown to reinforce the tooth, only a traditional drill is possible, and a lot of it.

Another problem and major threat to the tinnitus worsening isn’t just the external noise of the drill, but also the vibration travelling through bone conduction directly to the inner ear, so earplugs and noise cancelling headphones may not resolve the issue. I think the general census to cut down the noise exposure is asking to have intermittent drilling of 5 seconds on, 10 seconds off etc.

All I know is teeth are a bloody massive pain in the backside, and when they go wrong with infection there is a tendency for the problem to keep arising and having to have repeated dental procedures over your lifetime, might be simpler to extract and replace with an artificial implant, I don't know, I keep swapping and changing my mind! Lol.

 

Considering there’s no guarantee that root canal will work (for whatever reason), cost of procedure and most importantly the noise exposure due to drilling required (it’s a lot) in all honesty I would opt for extraction.

You can always have a small denture made with one tooth to fill the gap for aesthetics.

I’ve recently had upper second molar restored and it’s very close to the nerve but dentist said there’s a crack in the tooth (root canal would be a waste of money) so if it starts playing up it needs to come out.

So be it! I would rather have tooth missing than live with worse tinnitus.

Good luck!

 

Yes I understand exactly how you feel. I have similar fears to you about dental work. But I also suspect that with an understanding dentist, with the aid of hearing protection, pauses in drilling when requested, these risks can be mitigated.

There is a thread about dental work and tinnitus on Tinnitus Talk, I believe, that may yield more information that may help. The question is, does conductive noise of a drill over 15 or so minutes, permanently damage hearing? I don't know the answer to that, though my feeling is that probably doesn't, but may certainly cause a temporary spike.

I feel your dilemma in weighing up the variables and you're seeking to fully inform yourself. If you're able to hold off on a decision and research further, it'd be helpful because you still sound conflicted and torn. Let us know how you go.

 

Ear plugs and headphones can't help the vibrational sound that occurs through your bones during dental drilling. If anything, they could actually make it worse.

Laser dentistry is great...but you can't laser a root canal!

I'm with @Bill Bauer on this one: I would 100% go for extraction and implant.

 

I agree! But the question I posed in my last post was whether or not conductive sound and vibration, as a result of dental drilling, cause permanent auditory damage.

I have felt conductive sound in the dentist's chair in the past without damage to my hearing. Countless millions of dental patients do so around the world each day, also I'd suggest, without permanent damage.

Are our damaged ears now more susceptible to this kind of drilling? That's the question and it'd be helpful to see some evidence to back up any claims to help the OP with their dilemma.

 

Indeed! [Would love to see fairies dancing on the head of a pin too; sadly, I'm not sure which is less likely]

Best evidence we have is likely here:

https://www.tinnitustalk.com/thread...reatment-cause-or-worsen-your-tinnitus.28020/

 

Yes TT is a good start, but I don't think it should take any dancing fairies to get some real world evidence.

Dental drilling has been going on for an awfully long time and if there was a causal link, it would be reported widely. In fact there should be an epidemic of hearing loss due to conductive drill damage.

Dentists have long reported their own hearing losses due to high frequency drilling noise as an occupational hazard. But conductive damage to the patient, I'm not too sure about. Of course anything is possible when it comes tinnitus. Certainly, it'd be prudent to worry about mechanical damage to delicate nerves.

 

Thanks for all your input @Bill Bauer @Fabrikat @valeri @MattS , much appreciated!

Thanks Fabrikat, You’re absolutely right, I’m really stumped, not knowing what to do for the best?

I’ve taken on board your advice and for the moment have delayed having anything done for now. Fortunately the toothache has disappeared, even though antibiotics haven’t solved the issue completely, the tooth will need work done soon, it’s inevitable.

My general dentist had initially offered to do the root canal but had given me only a 60% success rate of saving the tooth, I’ve made another appointment for a consultation with an endodontist (root canal specialist) for next week and have been told success rates are significantly higher (90+%). I’m going have a good chat with him, considering I would be paying top dollar the least they can do is accommodate my needs. Then if I go ahead with the treatment I would have to go back to my regular dentist to have the crown work done, but I will enquire if this could be done is stages, multiple visits to cut down on drilling time.

I’ll weigh up my options and will keep you all updated.

 

@mick1987

Good luck, and thank you for keeping us posted: your experience may be important for some of us in the future.

 

After the first course of Amoxicillin over 2 weeks ago which completely got rid of the tooth pain, due to the delayed treatment for the tooth (appointment next week for consultation) the pain came back slightly on Friday.

Contacted the dentist and was told to take a second course of amoxicillin until I get the tooth sorted. Unfortunately after only two pills of amoxicillin I developed a widespread rash all over my body, was told by a GP it was highly likely an allergic reaction to amoxicillin and was ordered not to take any more and advised to avoid it in the future!

Really concerned about this since amoxicillin seemed like one of the few antibiotics that was safe for Tinnitus! The tooth pain is manageable for now but don’t know what the hell im going to have to take as an alternative in the future.

 

I have taken a course of a cephalosporin antibiotic called cefalexin. I don't know if it's prescribed for tooth infections, but it has never caused any problems for my ears. Perhaps that's one you could explore.

 

Thanks for the suggestion, Fabrikat. I’ll look up the name and keep it in mind.

 

You really should attend to that tooth ASAP, having a lingering infection is not good for you, dental infections when spread can do a lot of damage.

 

Yes Valeri, I agree 100% with you. It was due to all the toing and froing on whether or not to have the tooth treated for a root canal vs extraction.

After the latest debacle with the second course of antibiotics, reoccurring pain etc I’ve finally made up my mind and just having the tooth extracted next week instead.

 

Very smart decision, good luck with everything!

 

So, how did the extraction go?

 

Hi, apologies for not coming back sooner for the write up, tbh I put it off, got lazy, it then completely slipped my mind! (Just to note, long read ahead, please excuse any mistakes and/or poor grammar, it isn’t a strength of mine! Lol).

So back in December after much deliberation I decided to throw caution to the wind and try to save the tooth, so I had the root canal done! I was extremely nervous to say the least. I explained my concerns about the drilling noise to my endodontist and he agreed to perform the drilling with the recommended 5 seconds on, 10 seconds off method. Honestly, the drilling wasn’t even that bad! (Didn’t wear earplugs due to the occlusion effect). He removed the old amalgam filling using the ‘chunking method’ where the filling was drilled into sections then removed with a hand tool, this was done within only a few minutes which surprised me! What I wasn’t prepared for however was the use of ultrasonic tools!

Apparently many endodonists (who specialise in root canal treatment) nowadays use ‘ultrasonic tool tips’ that clear away dentine to expose the the root canals (increases accuracy and minimises destruction of dentine from traditional drilling) also to irrigate (swish around) the sodium hypochlorite in the tooth roots to increase sanitisation and clearance of the infection etc, which ultimately increases the success rate outcome.

This was most concerning to me due of everything I read about ultrasonic tools worsening Tinnitus, but I was in the chair and would have to pay £££’s for the appointment regardless so I let him get on with it. Like the drilling, the ultrasonic tool was tolerable, the high pitched ‘squeaking’ wasn’t too loud. However, I was still concerned by the possible vibration directly to the cochlear, even if I didn’t perceive it as loud, it could still be damaging, but again he minimised the use of the ultrasonic due to my concerns. This did have slight implications in the end because after finishing the treatment, a whole two and a half hours later, he told me part of one of the root canal files had snapped off at the bottom of the root during cleaning and he would of attempted to remove it, but he would of had to use the ultrasonic tool to do this and knew I didn’t like it so left it in there! But he said it shouldn’t have any detrimental effect on the outcome of the tooth itself, it just become an expensive part of the filling! Lol. At the end he build the tooth back up and told me the go back to my regular dentist to get a crown fitted at a later date to reinforce the tooth.

Anyway, overall even though the root canal treatment was tediously long (2.5 hours with my mouth open) my tinnitus was unchanged for around 2 to 3 days after... BUT only after those few days I had quite a bad tinnitus spike which last 2 to 3 weeks! At the time I was convinced I had messed up bad and was full of regret of the use of ultrasonic tools had possibly worsened my tinnitus quite significantly, fortunately after those tormenting 2-3 weeks the spike subsided to baseline. I’m unsure if it was connected to the dental treatment due to the 2 day delay or admittedly due suffering with long lasting spikes in the past due to ongoing chronic sinus infections/congestion issues etc, I honestly don’t know the cause? I was just totally relieved my the spike subsided back to normal!

It’s now a few months on and I haven’t had any more trouble with the tooth (touch wood!), but I’m yet to get the crown fitted unfortunately. Really hesitant knowing there will be longer drilling required, and the spike scare shortly after the root canal has me a little worried... but I’m fully aware running the risk of the tooth cracking if I don’t get the tooth crowned, so we shall see...

On another rather dramatic dental note my regular dentist and I had been having discussions for quite awhile now regarding my abnormal dental bite, dentist thinks I should be thinking about correcting a class 3 malocclusion (quite a severe underbite/cross bite) I’ve had living with since puberty. They have referred me to an orthodontist/maxillofacial surgeon to see about the possibility of having braces fitted and both my upper and lower jaws broken and aligned properly! After which I would wake up from major surgery with my jaw wired shut, high on morphine and other high pain medications... lol yeah!...and there is me thinking a root canal and crown fitted is risky! Sigh... I hate how tinnitus dictates my life so much!