Root Canals

What is root canal therapy?

Root canal therapy is designed to correct disorders of the dental pulp -- the soft tissue inside the tooth that contains nerves, blood vessels, and connective tissue. These disorders can cause the pulp to become inflamed or infected. The inflammation and infection can also spread into the surrounding bone at the end of the tooth. The tooth and surrounding area may become very painful and swelling may occur. Once this happens a root canal procedure must be performed in order to save the tooth. The only alternative is having the tooth extracted.

The most common causes of pulpal nerve damage are:

• Physical irritation - generally brought on by aggressive tooth decay (cavity) reaching down to the nerve or through deep fillings, which allows harmful bacteria to reach the nerve resulting in infection and decay.
• Trauma or fracture - a blow to a tooth or the jaw can cause damage to sensitive nerve tissue within the tooth.

What are the symptoms of pulpal nerve damage?

The most common complaint that brings the patient to the dental office is pain or discomfort. Besides pain, signs to look for include prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes the tooth becomes sensitive to chewing or to tapping. A tooth that becomes badly decayed or injured may need treatment.

We will do a series of test to isolate the offending tooth. Occasionally a x-ray will show evidence of an abscess at the end of an infected tooth. Results of these tests will indicate whether of not an endodontic procedure is necessary.

A common belief is that by removing the nerve the tooth becomes "dead". This is not true. The tooth may no longer be vital but is very much alive and functioning because it receives a source of blood supply and nerve supply from the surrounding tissues that hold it in place in your jaw bone. The tooth will have no sense of feeling to hot, cold, or sweets but will be responsive to biting pressure etc. With proper restoration the tooth should last as long as your other teeth and can even be used as a anchor tooth for a partial denture or cemented bridge. The success rates for root canal therapy have been reported to be as high as 95 percent.

Why is root canal therapy necessary?

Without treatment, the infection of the dental pulp will spread to the bone around the tooth, making it not longer able to hold the tooth in place. The infection can spread and affect other vital organs. In patients with diabetes and other immunosuppressive diseases, these infections could become life threatning.

What does the root canal procedure involve?

The thing most patients are concerned with is whether or not the procedure will be painful. With the latest technologies and anesthetics, root canal treatment is no more uncomfortable than having a filling placed. While many patients may be in great pain before seeing the dentist, most report that the pain is relieved by the treatment and they are comfortable during the procedure. For the first few days after treatment, the tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications.

During the root canal procedure, the dentist carefully numbs the tooth, removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space to prevent further infection and discomfort.

With properly performed root canal procedures, teeth can function normally for a lifetime. However, after a root canal, it is essential that the patient return to have a crown or other restoration placed over the endodontically treated tooth to protect it. Often a post and core procedure will be done prior to making the crown to restore the tooth to its original form and function.

Post-Operative Care Following a Root Canal

Once the root canal therapy is completed, there will be changes to adapt to, including:
• Brittleness - a pulp-less tooth is more brittle than a non-treated tooth and great care should be used to avoid fracture and chipping
• Discoloration - a non-vital tooth may become discolored over time, which can be treated with bleaching. In most cases, the discoloration poses no threat to the health of the tooth.
In addition, soft tissue inflammation may be a source of irritation in the weeks following surgery. Consult your dentist, or other oral health specialist, for a treatment approach to help control any post-operative swelling and discomfort.

Root Canal Therapy Verses Extraction

Many people feel that having a tooth extracted and replaced with a bridge or an implant is a good alternative to having root canal treatment. However, this is not true for several reasons.

First, nothing can completely replace your natural tooth. An artificial tooth can sometimes cause the patient to avoid certain foods. Maintaining the natural dentition is important so that the patient can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in his or her diet.

Second, endodontic treatment, along with appropriate restoration, is a cost effective way to treat teeth with damaged pulps and usually is less expensive than extraction and placement of a bridge or an implant. As previously mentioned, endodontic treatment has a very high success rate.

Third, placement of a bridge or an implant will require significantly more time in treatment and may result in further insult to adjacent teeth and supporting tissues. Millions of endodontically treated teeth have been well maintained in patients for many years after the initial treatment. These now healthy teeth are helping patients chew efficiently and help to maintain the natural appearance of their smile.