Typically, it is necessary for us to take an x-ray image(radiograph) and evaluate your symptoms when you're in desperate need of care. Symptoms associated with teeth like prolonged sensitivity to hot/cold and keeping you awake at night indicate a more serious condition with the tooth that is most likely irreversible. Symptoms such as slight sensitivity to temperature changes or biting usually indicate a more reversible problem.
So what do we need to do when your tooth is irreversibly damaged and waking you up at night? Without going into great detail, the two options are simply to have a root canal performed to save the tooth or have the tooth extracted. Since we are dentists, we love saving teeth but if a tooth needs to be removed due to extensive decay, we have plenty of replacement options if you would like to fill that space. If a reversible problem is present, a simple replacement filling or even bite adjustment may completely rid you of any sensitivity. Also, I can ensure you that our office will go to great lengths to keep you comfortable no matter the treatment of choice. We offer exceptional sedation options and are known for "catering to cowards."