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Does a Tooth Sensitive To Cold Mean It Needs a Root Canal?

Updated: Nov 13

A tooth sensitive to cold doesn't always mean that it needs a root canal because vital teeth should feel the cold but intense sensitivity is a bad sign.


Yes, the cold test (endo ice) is a diagnostic tool used to diagnose teeth that do need root canal. However, it can also be used to rule out teeth that do not need endodontic treatment.


Therefore, teeth sensitivity to cold is not an absolute indication for root canal therapy. It really depends on how severe your condition is. Is your sensitivity mild or severe?


Cold beverages in fridge
Cold beverages in fridge

After all, there are more conservative treatments for milder forms of the condition but you won't know what you need until get a consultation with your dentist.


Our purpose here today is to at least prepare you for what you can potentially expect.


When cold sensitivity means root canal

Teeth that are extremely sensitive to cold may potentially need to be treated with a root canal but it needs to be very severe. Below are a list of signs and symptoms of the type of severity that we're looking for.


Completed root canal on x-ray
Completed root canal on x-ray

Signs necessitating root canal:

  • Lingering pain. After drinking or eating cold foods, the discomfort will linger even though you already stopped eating/drinking.

  • Spontaneous pain. It could be minutes or even hours after your meal, the tooth pain will spontaneously return. You can also call this type of pain sporadic in nature.

  • Nighttime pain. You will wake up in the middle of your sleep with a raging toothache.

If you're experiencing any of the above signs, it could be an indication that your cold sensitive tooth may require root canal treatment.


Why a root canal is necessary

Teeth that are sensitive to cold with lingering, spontaneous, and nighttime pain are all symptoms of irreversible pulpitis. In other words, the tooth nerve is unhealthy and it is inflamed beyond repair.


Put another way, the reason your tooth is cold sensitive is due to an unhealthy tooth nerve. The only way to treat nerve related cold sensitivity is with a root canal procedure.


What to expect for root canal procedure:

  1. Anesthetic for numbing the tooth.

  2. Protect the mouth with a rubber dam.

  3. Drill a hole through the enamel and dentin to reach the pulp.

  4. Remove the unhealthy nerve with rotary and hand files.

  5. Disinfect the pulp chamber and canals.

  6. Place a root canal filling to seal it off.

  7. Return to your restorative dentist for a core and crown procedure.


In case you were wondering, a dental filling would be insufficient to treat this condition. That is because fillings don't treat tooth nerve pain.


When cold sensitivity doesn't mean root canal

Teeth that are only mildly sensitive to cold typically do not require a root canal. Mild symptoms can often be managed with more conservative treatment and at home care.


Gum recession causing sensitivity
Gum recession causing sensitivity

Signs it doesn't need a root canal:

  • Short lasting sensitivity. You may feel a sharp zing, discomfort, or pain but it only lasts for 1-3 seconds at most. The sensitivity does not linger.

  • Only sensitive while eating/drinking. The discomfort only occurs during mealtimes, otherwise it remains asymptomatic.

  • Mild discomfort. The pain is a 1-3 on a scale of 10 being the highest for pain.


The above signs are indications that your cold sensitivity are relatively mild in nature, especially when compared to the severe symptoms in the previous section.


Overall, this kind of discomfort isn't severe enough to affect the quality of your life. Sure it may be a little uncomfortable drinking cold beverages but it's not excruciatingly painful.


Causes of mild cold sensitivity

Milder forms of cold sensitivity do not require root canal treatment. These are often caused by conditions which can be treated with other types of treatments.


Potential causes:

  • Receding gums

  • Brushing too hard

  • Teeth grinding or clenching

  • Excessive consumption of cold foods


What does cold sensitivity even mean?

Believe it or not, teeth are supposed to be able to feel the cold because if it weren't able to, the tooth would be considered dead. The fact that it is able to feel the cold is an indication that the tooth nerve is still vital (alive).


However, the type of response to a cold stimuli will often give clues as to the health status of the tooth pulp. The best way to test this is with a cold test on teeth by using endo ice.


endo ice - cold test
endo ice - cold test

Cold test results:

  • Healthy tooth: Feels the cold but it shouldn't linger for more than 2-3 seconds.

  • Unhealthy tooth: Feels the cold but it'll linger for an extended period of time.

  • Dead tooth: Cannot feel the cold at all.


The worst news you can get is a tooth that cannot feel the cold which means it is non-vital.


How to reduce sensitivity to cold

Regardless of whether or not you decide to pursue professional sensitivity treatment, the at home techniques will still need to be utilized.


At home management

Here are some tips which you can use at home to help manage your condition on a daily basis. It predominantly revolves around brushing twice daily with a sensitivity toothpaste.


Tips:

  • Brush with sensitive toothpaste. All sensitive toothpastes have an anti-sensitivity agent within it that can block open dentinal tubules or depolarize the tooth nerve. Either of these effects will help reduce your discomfort to cold stimuli.

  • Minimize cold food consumption. It always helps to eat less cold foods and drink less cold beverages if they aggravate you.

  • Avoid acidic foods. Consumption of acidic foods often do make teeth sensitivity worse in general. This not only includes cold discomfort but also to hot, sour, & spicy.


Professional help

Depending on the cause of your sensitivity to cold, the treatment may vary. Below are a couple of well known procedures that may give some relief.

  • Fluoride varnish. Professionally applied fluoride can help alleviate the sensitivity for at least couple of months.

  • Dental bonding. Teeth bonding is very effective for sensitivity due to exposed root surfaces and receding gums.

  • Gum graft. Seeing a gum specialist who can graft and regrow the gums.

  • Veneer. Placing a thin layer of porcelain laminate over the teeth can block sensitivity.

  • Crown. Extremely sensitive teeth may need a full coverage tooth cap.

  • Root canal. Sensitivity stemming from tooth nerve pain may require root canal therapy. This option is typically reserved for the worse case scenarios.


Verdict

Whether or not your tooth that is sensitive to cold needs a root canal would depend on how severe it is. Mild symptoms may be treated with just at home care while the most severe symptoms would need a root canal.


If you're unable to distinguish which condition you have, you should get a consultation with your dentist to find out. They will give you recommendations as to which option is best for you. Just so that you know, after root canal treatment the tooth will no longer be sensitive to cold.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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