Family Dentistry

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.  "Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.  A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory – to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.
Sometimes no symptoms are present; however, signs to look for include

• Severe toothache pain upon chewing or application of pressure
• Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
• Discoloration (a darkening) of the tooth
• Swelling and tenderness in the nearby gums
• A persistent or recurring pimple on the gums

Root Canal Therapy (Endodontic treatment) is necessary when the nerve (pulp) becomes inflamed ot infected.  The most common reasons for inflammation or infection are deep cavities, repeated dental procedures, cracks or chips.  Trauma can also cause inflammation and often shows up as discoloration of the tooth.  If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

An Endodontist is a dental specialist dedicated to root canal treatment.  Many endodontists use a microscope that allows them to see the space within the tooth with great magnification and clarity.  This enables them to more thoroughly clean and locate hard-to-find nerve canals within the tooth, and to see cracks that would otherwise go undiagnosed. 

The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentin and Enamel during tooth development.  The pulp receives its nourishment supply from vessels which enter the end of the root.  Although the pulp is important during development of the tooth, it is not necessary for the function of the tooth.  The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.

The vast majority of root canal procedures proceed painlessly, both during and after each visit!  With modern techniques and anesthetics people report that having a root canal treatment is about the same as having a cavity filled.  On the other hand, some people present with what we call a hot tooth.  A hot tooth is one in which the nerve is alive, but badly inflamed.  The tooth is generally already very painful, especially to hot or cold stimuli.  These are the ones that require multiple anesthetic injections to get numb.

Yes, it is normal to experience a little discomfort after the appointment.  This may be due to the injection, the necessity of keeping the mouth open for a long time, or the treatment.  Your temporary filling will be hard enough to bite on within approximately a half-hour, but avoid biting or chewing on the treated tooth if it hurts especially if there was pain or infection present befoe the procedure. 

An examination, including radiographs, will be performed.  A local anesthetic will be fiven, if nedessary.  A sheet of latex, called a "rubber dam" will be placed around the tooth to isolate it and keep it claen and dry during the procedure.  Complete treatment consists of the following five basic steps:  Step 1. An opening is made to acess the affected nerve tissue (pulp).  Step 2.  The pulp is removed from within the canals of the roots.  Tiny files are used to clean the root canals and shape them to a form that will insure they will be well sealed.  if the root canal is not completed in one visit, then a temporary filling would be placed to seal the opening and protect the tooth between visits.  Step 3.  The root canals are filled and sealed with a material that prevents bacteria from re-entering.  The opening in the crown of the tooth is se3aled with a temporary filling.  X-Rays are taken before, during and after treatment.  Step 4.  Your dentist will later remove the temporary filling (ideally within 4 weeks of treatment, and replace it with a more permanent restoration or crown.  Step 5.  The root canal, permanent filling, and/or crown are evaluated for healing at periodic intervals called recall appointments.                                                        

You could, but then adjoining teeth my shift and interfere with biting and chewing if you remove the tooth and fail to replace it.  You may also consider placing an implant or fill in a missing space with a "dummy tooth" as part of a fixed ro removable bridge.  A fixed bridge may require removing adjacent, healthy tooth structure, and may be expensive and require even more dental treatment.  If you can save your own tooth with any degree of long term predictability, then that would always be the first choice.

When your root canal treatment is complete, a temporary filling is placed.  You should then see your general dentist for the permanent crown or restoration.  Ideally, the tooth should be permanently restored within a few weeks to prevent the tooth from developing a fracture and to prevent the temporary filling from loosening and leaking, which in turn could cause the root canal treatment to fail, necessitating re-treatment.

Not every root canal requires a crown, however many of them do in order to give the tooth proper strength and support.  Often times there is not enough tooth structure remaining after a large cavity or fracture to survive without one.  Additionally, the tooth can become more brittle after a root canal, and would then become more susceptible to fracture, especially if one is a heavy grinder.

Although only about 5% of root canals fail, there are many possible explanations to explain why this might happen.  There may be one or more extra canals that the dentist was umable to locate or fully clean out.  This trapped nerve tissue can cause abscessed or ongoing bouts of pain and may lead to failure.  A fractured root may cause failure of a root canal.  Teeth with dead nerves are always brittle.  Fractured roots are generally impossible to repair and this means the loss of the tooth.  And in some cases there may be a hypersensitivity to the materials used to fill the canals, although this is a very rare occurance since the gutta percha used to fill the canal is quite inert and is generally very well tolerated.