Root Canal Treatment

What is a root canal?

What is your response when you hear the words Root Canal? If it sends waves of anxiety over your body, you are not alone. Most people have a predetermined idea of what a root canal entails, but don’t actually know what it is or does for your teeth. A “root canal” is a common term for a branch of dentistry called Endodontics. Endodontics deals with diseases of the tooth’s pulp. The pulp is a cavern found inside the center of the tooth and also extends down the canals (root canals) inside the root of each tooth. The pulp consists mainly of blood vessels and nerve tissue giving the tooth its nutrition and sensation. If the pulp becomes diseased or irritated beyond repair, it can be removed without destroying the tooth. Even though the inside of the tooth is hollow and dead after pulp removal, the outer tissues of the teeth continue to function as normal. Tooth extraction can be avoided and the tooth can be restored to normal function after root canal therapy.

In summary, removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy. Many people refer to pulp removal as “having a root canal” and is a very common and usually painless treatment.

Why Would You Need Root Canal Treatment?

Root canal treatment is needed for two main reasons

1. Infection

An untreated cavity is a common cause of pulp infection. The decay destroys the enamel and dentin of the tooth until it reaches the pulp. Bacteria then infects the pulp. Because antibiotics can’t get to infections inside teeth, the resulting inflammation reduces the blood supply to the tooth. The reduced blood supply keeps the pulp from healing and will eventually lead to tooth death.

2. Damage that can’t be fixed

The second reason for a root canal is damage to the pulp that can’t be fixed. A fracture in a tooth can damage the pulp. So can a less severe blow to the tooth (trauma), even if there’s no visible damage. Multiple fillings or other restorations on the same tooth also can damage the pulp.

When the pulp is inflamed but not infected, it may heal on its own. We may want to see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection and result in the need for Root Canal Therapy.

An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha.

If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges.

Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, and restored with a filling or crown, it often will last the rest of your life.

Signs and Symptoms

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:

• It hurts when you bite down on it, touch it or push on it
• It is sensitive to heat
• It is sensitive to cold for more than a couple of seconds
• There is swelling near the tooth
• It is discolored (whether it hurts or not)
• It is broken

To determine whether your tooth needs root canal treatment, our dentist will place hot or cold substances against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms.

We will also take an X-ray of the tooth and the bone around the tooth. The X-ray may show a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root. If either of these is present, our dentists will probably recommend a root canal procedure.

Length of Treatment

Root canal treatment can be done in one or more visits, but it really depends on your specific situation. An uncomplicated root canal treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved root canals that are difficult to find. If you have an infection, we will probably see you several times until we make sure that the infection is gone.

procedure for the effected tooth. Teeth that have had root canal therapy become more brittle due to loss of blood supply and are more prone to fracture. After a root canal, you are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future.

Measuring and Cleaning the Root Canals

Measuring

1. First, we will numb the area around the tooth.
2. Next, a small protective sheet called a dental dam will be placed over the tooth to keep the area free of saliva. Then we will make a hole in the top or back of your tooth to get to the pulp chamber so we can remove some of the diseased pulp.
3. Then the root canals have to be measured. We need to know how long the canals are to make sure the entire canal is cleaned. We also need to know how much filling material to put in the cleaned canals. To measure the root canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, we will place a file into the canal and then take an X-ray. An apex locator measures a root canal based on its resistance to a small electric current. Many dentists use both methods.

Cleaning

After the canals have been measured, we will use special tools to clean out all of the diseased pulp. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within a tooth must be cleaned. Teeth have different numbers of canals:

Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is placed over the tooth. The top of the tooth should then be covered with a permanent filling or crown. The temporary filling you receive is not meant to last.

In most cases, the tooth will need a crown. A crown will help to restore the tooth’s strength and protect it from cracking. If a crown is indicated it should be placed soon after having root canal treatment.

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

After Root Canal Treatment

Your tooth may be sore for two to three days after the procedure. The worse the infection and inflammation you had, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. You can take over-the-counter pain relievers. A pain reliever that also reduces inflammation is likely to be most helpful. Examples include ibuprofen and aspirin.

Possible Complications

As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.

1. Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.
2. Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.
3. A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. If saliva can get into the hole, it will have to be filled. Sometimes, the tooth has to be removed.
4. Finding root canals can be difficult. If all of the canals aren’t found and cleaned out, the tooth can stay infected. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist’s tools can’t reach.
5. The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if the canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small cut (incision) is made in the gum so the dentist can get at the bottom of the tooth’s root. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

Pain, or the Lack of It

In most cases, you will not have any pain during a root canal procedure. Your dentist will numb your tooth and the surrounding area. Let your dentist know if you are feeling any pain during the root canal. Some people fear the numbing shot more than the root canal treatment itself. Today, numbing gels and modern injection systems have made injections virtually painless. If it does hurt when you are getting an injection, let your dentist know right away. He or she can change the way the injection is given to avoid causing pain.