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Endodontics (Root Canal Treatment)
Nothing is as good as a natural tooth! And sometimes your natural tooth may need root canal (endodontic) treatment for it to remain a healthy part of your mouth. Most patients report that having root canal (endodontic) treatment today is as unremarkable as having a cavity filled.
Teeth are held in the jaw by their roots. Inside each tooth is the “pulp" or "nerve” which supplies nourishment and sensation to the tooth. Root canals are very small, thin canals that branch off from the pulp chamber down to the tip of the root. A tooth has at least one but no more than four root canals.
When the pulp or root canal is diseased or injured, it “dies”. If you don’t remove the dead tissues your tooth gets infected and you could lose it. Inflamed or infected pulp (pulpitis) most often causes a toothache. To relieve the pain and prevent further complications, the tooth may be extracted (surgically removed) or saved by root canal treatment.
Root canal treatment is a dental procedure in which the diseased or damaged pulp (core) of a tooth is removed and cleaned out of any infection in the pulp and root canals.The inside areas (the pulp chamber and root canals) are filled and sealed.
What are the signs of needing endodontic treatment?
- Prolonged sensitivity to heat or cold
- Spontaneous pain or throbbing of the tooth
- Pain while biting or chewing
- Tenderness to touch and chewing
- Drainage and tenderness in the lymph nodes as well as nearby bone and gingival tissues.
- Deep cavity
- Cracked, chipped or split tooth
- Discoloration of the tooth
- Gum (periodontal) disease
- Trauma, such as a sudden blow to the mouth
- For many damaged pulps or root canals there are no symptoms. Your dentist may discover a “dead” tooth in an x-ray.
What Makes a Root Canal Necessary?
Regardless of the initial cause, the tooth pulp becomes irritated and infected. Bacteria grows within the tooth pulp, causing pressure and if a cavity forms and is allowed to go untreated for too long, it can penetrate to the root pulp where and infection can occur pain, sometimes accompanied by swelling of the face. Sometimes the deterioration of the pulp happens so gradually that little pain is felt. Regardless of the amount of pain felt, eventually the bacteria can destroy the pulp.
What will happen if you leave the tooth untreated?
- The tooth will not heal by itself
- Pain will worsen
- The infection will cause swelling that may spread to other areas of the face, neck or head
- Bone around the tooth will begin to degenerate
- Swelling with pus will form in the area around the tooth root, called an abscess
- The tooth may fall out
- Possibility of losing the tooth
If a tooth has an abscess it can firstly cause severe pain, but not always. Some abscesses can be surprisingly painless. Nevertheless, the infection at the root tips can spread into the surrounding bone and soft tissues and cause more serious infections there that could cause swelling and pain. Bacteria also enter the blood stream and can infect other parts of the body. Prosthetic hip and knee joints and heart valves are particularly prone to infection. Patients with other health problems could also be at higher risk.
Root canal treatment is performed under local anesthesia. A thin sheet of rubber, called a rubber dam, is placed in the mouth to isolate the tooth. The dentist removes any tooth decay and makes an opening through the natural crown of the tooth into the pulp chamber. Creating this access also relieves the pressure inside the tooth and can dramatically ease pain.
The dentist determines the length of the root canals, usually with a series of x rays. Small wire-like files are then used to clean the entire canal space of diseased pulp tissue and bacteria. The debris is flushed out with large amounts of water (irrigation). The canals are also slightly enlarged and shaped to receive an inert (non-reactive) filling material called gutta percha. However, the tooth is not filled and permanently sealed until it is completely free of active infection. Once the canals are completely clean, they are filled with gutta percha and a sealer cement to prevent bacteria from entering the tooth in the future.
- For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. Because of the infected nature of the abscess there can be some discomfort or swelling. This will be controlled with antibiotics and anti-inflammatories as needed. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist’s instructions carefully.
- Your tooth will feel sensitive to biting pressure. This feeling is a result of the nerve endings in the tissue outside the end of the root where it was cleaned, irrigated and a filler or sealer material was placed.
- Also, you might feel a rough area where access was made by your Endodontist. There is a soft, temporary material in that area, which may appear to wear away to some degree before your next dental visit.
- Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.
Special care after endodontic treatment
Once the root canal treatment has been completed, you should consider the following:
Brittleness a non-vital (endodontically treated) tooth is more brittle than a vital one and is more susceptible to fracture. Placing a suitable final restoration is almost as important as the root treatment itself. If the restoration leaks bacteria can migrate down the side of the root sealer and re-infect the tooth. In most cases, we recommend that your root canal tooth be crowned (gold or porcelain crown) following treatment.
Loss of tooth structure from dental caries (cavities), prior fillings, and endodontic care frequently results in weakening of the tooth. Teeth which are structurally weakened are prone to fracture, which can lead to tooth loss. A special restoration called a post-and-core is commonly needed to reinforce weakened teeth and a good way to insure against a serious fracture is to crown the tooth.
Discoloration you may notice that your endodontically treated tooth (especially a front tooth) has undergone a change in color. Though this discoloration is of no medical concern, you may be interested in having the teeth whitening. Be sure to ask us about Tooth Whitening if we do not decide to place a crown on the tooth.
The biggest advantage of Root Canal Treatment is that the tooth will not need to be extracted in the future. You are saving your tooth as well as money because if the tooth is extracted then you will need to replace it with either an implant or a bridge to maintain the space and restore the chewing function, both of which will cost you more than the Root Canal Treatment .
More than 95% of Root Canal Treatments are successful. However, sometimes a case needs to be redone due to new trauma, deep decay or loose, cracked or broken filling, which may cause infection. Also, in some cases your dentist may discover very narrow or curved canals that could not be treated during the initial procedure. Sometimes, a root canal treated tooth may need a root canal surgery to be saved.
Unfortunately, usually the only alternative is to remove the infected tooth. Often teeth requiring root canal treatments are weakened from the large tooth decay cavity and cannot easily be simply extracted. Many require surgical removal.