The outside of my tooth looks fine. Even my dentist admitted it has no outward signs of wear, cracks, damage, or anything else. However, my dentist referred me to an endodontist for a root canal. The tooth doesn’t hurt, but my dentist said I have a cavity on the inside. I can’t read tooth X-rays, so I couldn’t challenge her findings? Should I see the endodontist anyway? I must mention that my dentist has a hyphenated name, and the endodontist’s last name is the same as the first half of my dentist’s last name. I am suspicious. Thanks. Phil from OH
Phil,
We understand the concern about your referral for a tooth with no signs of decay. Also, since your dentist and the endodontist share part of your dentist’s name, you have additional concerns.
Can Tooth Decay Start Within a Tooth?
A tooth cannot develop decay internally without bacteria entering from the outside. Cavities always start on the surface. When they progress deep enough, infection follows and may require root canal treatment.
If imaging suggests damage beginning inside the tooth, the issue likely isn’t decay.
What Is Internal Resorption?
Internal resorption occurs when the pulp begins to erode the tooth from within. This inflammatory process is rare and not fully understood. Dentists believe some form of irritation must trigger it.
Trauma may contribute, particularly if a tooth is subjected to additional force due to its position. Still, because this diagnosis is uncommon, it deserves careful verification.
Why Get a Second Opinion?
Given the uncertainty, a second opinion from an endodontist offers the safest path forward. That approach allows for an unbiased evaluation before committing to treatment.
To keep the opinion objective:
- Bring copies of your X-rays.
- Don’t mention previous diagnoses or providers.
- Let the specialist assess the case independently.
Another Condition to Consider
External root resorption affects the outside of the tooth and can mimic internal resorption on X-rays. Taking multiple images at different angles often clarifies which condition is present and guides appropriate treatment.
Baton Rouge family dentist Dr. Ryan Perry sponsors this post. Please read about how he strives to provide his patients with the best care possible.