February 2019 – Root Exposure and Thermal Sensitivity: Is Endo the Solution?

Root Exposure and Thermal Sensitivity: Is Endo the Solution?

A 48 year old female patient was originally referred to me in 2016 regarding sensitivity associated with the maxillary anterior teeth. The teeth were virgin and unrestored but the patient’s current complaint was described as a sharp intermittent shooting thermal sensitivity pain caused by heat and cold air. The pain was relieved by NSAIDs. There have been no recent restorations of these teeth and the patient had not had recent Perio or scaling procedures. Pain was described as minimal. in 2016 I noted that there was some recession developing along the labial gingival margin associated with these maxillary anterior teeth. Because symptoms were minimal, a decision was made not to treat any of these teeth because of the limited reversible pulpitis nature of the symptoms.

The patient was seen for years of subsequently in 2019 for similar symptoms which had increased in severity. Examination of the area revealed continued significant gingival recession with root exposure. Symptoms were severe enough that the patient was having difficulty eating hot and cold foods and now considered the problem to require some sort of treatment.

Pulp tests revealed elevated responses to cold and heat.  Percussion and palpation were normal . Periapical radiography revealed no abnormal findings. A diagnosis of reversible pulpitis secondary to gingival recession and root exposure was made.
I explained to the patient that while Endodontic treatment could be performed on these teeth and entirely eliminate the patient’s thermal symptoms, this was quite a drastic treatment and required access of a perfectly Virgin tooth. I suggested that she return to the referring dentists office for discussion regarding other possible treatment methods such as topical desensitization with chemicals or with a laser. We also needed to address the source of the gingival recession to ensure that it did not progress further and therefore referral to a Periodontist was also recommended .

In such cases it is very easy to solve the problem of thermal sensitivity by merely devitalizing the pulp, thereby addressing the patient’s current concern. However while we are addressing a symptom, we do not address the cause of this problem, which appears to be the recession and the etiology of what is causing the root to be exposed. This is an excellent example of a situation in which Endodontics is used to treat symptoms but does ultimately did not address the source of the patients problem.