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Root canal and pain go hand in hand in many people’s minds. Generally our fears and anxiety stem from others telling us their experiences and not from our own. A root canal (also referred to as RCT or root canal therapy) is a dental procedure where the damaged nerve (also called the pulp) of a tooth is removed. Following removal of the nerve, the canals of the tooth are cleaned and sterilized. Following this cleaning process the canals are filled and sealed permanently to avoid future dental infection. If treatment is not undertaken, the dental infection will affect the tooth along with surrounding oral structures (like gums and bone tissues) and a dental abscess can form in the area as the infection looks to escape.

The reason for the removal of the tooth’s nerve is because these nerves (along with associated blood vessels) is responsible with providing hydration and nutrients to our teeth. They also give us the ability to sense hot and cold.

Surveys year after year find that root canal therapy is considered the most feared of all dental procedures. These surveys also found people’s views on root canal therapy is based on what others have told them and not their own individual experiences. This leads to people believing mostly inaccurate stories about root canals. It is the fear of the unknown as I like to call it.

Is Root Canal Painful Or Can It Be Painless?

A root canal is necessary when the nerve of a tooth develops inflammation or becomes infected. This inflammation or dental infection can develop in a number of different ways:

Tooth decay that pushes into the area of the nerve or pulp chamber.

Fracture or chip in the tooth that gives bacteria a pathway to spread into the tooth’s nerve canal.

Trauma. Traumatic injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to a dental abscess.

A tooth causing pain of this type is irreversible. To save the tooth a root canal must be performed.

Signs and symptoms that a root canal is probably necessary can include pain, extended sensitivity to temperature (either hot or cold or both), tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes, bone and surrounding gingival tissues. In some cases, no outward dental symptoms are present at all

A root canal usually requires one or more visits to the dentist and can be performed by either a general dentist or a specialist called an endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. Your dentist will generally make the call on who should perform the root canal. You will be referred to endodontist if any of the following are needed:

-Degree Of Difficulty. Some teeth have anatomy that is slightly abnormal which makes the canals of the tooth harder to access.

-Re treatment of a previous root canal.

-Patient’s preference.

You and your dentist will discuss who is best suited to complete this root canal for you and make the best, informed decision for your dental treatment.

Root Canal Procedure

Is Root Canal Painful marielaina Perrone DDS Las vegasTake an X-ray if one has not already been taken. This will give your dentist a chance to evaluate the anatomy and shape of the tooth’s canals. It can also show the presence of a dental infection.

Anesthetic. Your dentist will use a local anesthetic to numb the surrounding areas to give you pain relief and also allow the procedure to be completed pain free. Some patients do not require any anesthetic but it will make it more comfortable.

Cleaning Of Tooth Canals. Tiny instruments are used to slowly clean out and debride bacteria, decayed nerve tissues, and bacteria from inside the tooth’s canals. Sterile water, peroxide, or sodium hypochlorite are used periodically to flush away the debris and kill any bacteria present.

Filling of Canals. Each canal is filled to the end of the tooth with a rubbery compound called gutta percha and permanently sealed. The process essentially is like a cork to prevent bacteria and fluid from re-entering the tooth, and keep it sterile. Many dentists prefer to wait a week or so before sealing the tooth. This will give the inflammation that has developed a chance to decrease back to normal levels. Others prefer to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed to keep out contaminants like saliva and food until the next appointment.

Following treatment, your tooth may feel sensitive for a few days to a week. This is especially true if there was pain or dental infection before the procedure. This discomfort can be relieved with over the counter or prescription pain medications or an antibiotic may be necessary if an infection was present. Follow directions given to you very carefully and feel free to ask your dentist questions if an issue comes up.

Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your dentist immediately.

Restoration of Tooth. Generally but not always a tooth that needs a root canal often is one that already has a large dental restoration or extensive tooth decay. Even when tooth decay was not a factor, the tooth treated with a root canal is weaker than a “live” tooth. Therefore, a crown, crown and post, or other extensive dental restoration often needs to be placed on the tooth to protect it, prevent it from breaking, and restore it back to full function again. After a completed dental restoration, you will not be able to notice any difference in its function or form or feel. You and your dentist will discuss this need further and make an informed decision together the best course of action for your dental care.

Is A Root Canal Painful Conclusion

A dental root canal is extremely successful with a more than a 95% rate of success. Many teeth with a completed root canal can last a lifetime with no issues.

Most root canals are completed to relieve the pain of toothaches caused by pulpal inflammation or dental infection. With modern advancements in techniques, dental materials, and anesthetics, most patients state that they do not feel any pain once the procedure is underway. Root canal procedures have an undue reputation of being painful. Usually most patients report that the procedure itself is no more painful than having a routine dental restoration placed. The misconception has developed because the majority of the pain stems from the dental infection and pulpal inflammation that has developed. This can be tricky to get good anesthesia but a good dentist will be able to make you comfortable during the procedure.

As noted above, the pain from root canals in modern dentistry is mainly from the dental infection that presents to the dentist and the actual procedure should be pain and worry free. The best defense against developing a toothache and the need for a root canal is to see your dentist regularly, maintain proper oral hygiene, and call your dentist at the earliest signs if you have any pains or discomfort.

 




Root canal therapy is a very important tool in a dentist’s list of dental services to save and maintain our teeth. For many, it can be a scary procedure we try to avoid, but with a little educational knowledge, it can take some of the fear away and put your mind at ease. A root canal should not be avoided due to fear, understanding what to expect and why may help you get the dental treatment you need when you need it.

Root Canal Therapy Frequently Asked Questions

What Is Root Canal Therapy?

Root Canal Therapy (also referred to as root canal treatment or endodontic treatment)  is a dental procedure in which the diseased, decayed tooth, or damaged nerve of a tooth is removed and the inside areas (the nerve and canals within the roots) are cleaned, filled and sealed permanently to avoid infection. Without treatment, the surrounding tissues of the tooth (including the gums and bone) will become infected and a dental abscess can form.

A tooth’s nerve and blood vessel provide nutrients and hydration to a tooth as well as sense of temperature. It provides the sensation of hot or cold. The absence of a nerve will affect the strength of a tooth and make it become more brittle and susceptible to fracture if not protected by a crown.

How Do I Know If Root Canal Therapy Is Needed?

Common symptoms related to an infected tooth include tooth sensitivity (to hot or cold temperatures or even both), sensitivity to touch, toothache/sharp pain when chewing, swelling in the area of the tooth, or a bad taste in the mouth. These symptoms need to be evaluated by a dentist immediately to prevent further pain or damage.

What If I Ignore My Symptoms? Will They Just Go Away?

If the symptoms are ignored and treatment is not begun, the inflammation can progress to infection. Infection will continue to invade the tissues and tooth causing the tooth to become more painful and may become a health threat. Once the tooth “dies”, there are only two choices: extract the damaged tooth or perform root canal therapy.

How Is My Tooth Restored After Root Canal Therapy?

Depending on the extent of the damage to the tooth, your dentist can recommend a dental composite restoration to close the tooth or in most cases recommend a dental crown to protect the tooth against future damage. Over time, the tooth with the root canal therapy will dehydrate. This will make the tooth brittle and more susceptible to fracture/breaking. Most often, a crown is placed after root canal treatment is completed to protect the tooth and restore full function.

Is Root Canal Therapy Painful?

Typically, root canal therapy should cause no more discomfort than a simple dental filling). The pain most people associate with root canal therapy is due to the infection that develops. Root canal therapy actually relieves the pain by removing the dental infection and pressure.

What Are The Advantages Of Root Canal Therapy?

Saving the natural tooth with root canal treatment has many advantages:

-Efficient Chewing.

-Maintains Normal Biting Force And Sensation.

-Natural Looking Appearance.

-Protects other teeth from excessive wear or strain.

Root Canal Therapy helps you maintain your natural smile, continue eating the foods you love and limits the need for ongoing dental work. With proper care, most teeth that have had root canal treatment can last as long as other natural teeth and often for a lifetime.

Are There any Risks Or Complications?

Over 90 % of root canal therapy procedures are successful. However, there is a chance of a failed root canal. Sometimes the root canal therapy needs to be redone due to diseased canal offshoots that went unnoticed, the fracture of a filing instrument, or a fracture or perforation in the root. The signs of a root canal therapy failure are marked by a return of pain, pressure, and sensitivity.

Is There An Alternative To Root Canal Therapy?

There are other options. One includes extracting the infected tooth. Then the question becomes how to replace the tooth. A few options are possible and these include a dental bridge and a dental implant. The success rate of root canal therapy is over 90% so it is an excellent option to save your own natural tooth if at all possible.

What Can You Expect After Root Canal Therapy?

Most patients feel some sensitivity for a few days afterward. For many it is easily relieved with an over the counter pain medication (aleve or ibuprofen).

Can Root Canal Therapy Be Avoided?

Some tips include maintaining good dental hygiene, see your dentist and hygienist regularly, eat a well balanced diet, and wear a custom made sports mouthguards to decrease dental trauma. Root canals, unfortunately, are not entirely unavoidable, and may happen even with good hygiene and care.

Root Canal Therapy Conclusion

Many are fearful of the root canal therapy procedure but in reality it is not the horror that many believe it to be. Root canal therapy is an easy way to save your teeth in the event of dental trauma, decay, or dental infection. Knowing what to expect can go a long way to alleviating any fears you may have. It is important to save your natural teeth whenever possible.


With the advancement of modern cosmetic dentistry into all porcelain crowns from traditional porcelain fused to metal crowns (PFM crowns), many have wondered if the

Porcelain Crowns Marielaina Perrone DDS

The Natural Look of Porcelain Crowns

porcelain crowns would be as durable over the long term. Well, recent clinical studies have shown that they are just as strong and also have the ability to maintain their beauty over time as well.

The main differences in porcelain crowns are the type of porcelain used, and how they are fabricated in a dental laboratory. Different porcelain types and strengths are used for different reasons. Remember also, that a lab created porcelain crown, is of higher fabrication quality and fit, than an in office computer milled crown.

Long Term Study – Porcelain Crowns

The researchers at the Medical University at Innsbruck studied a little over 1,300 all porcelain crowns placed between 1987 and 2009. They were tested for predictability and strength and found to have a high,(93.5% probability of survival) success over a 10 year period. The study was published in the International Journal of Prosthodontics). The study included those with root canal teeth, and those who grind their teeth.

A total of 302 patients (120 men and 182 women) participated in the study. They were examined at the university during regularly scheduled visits for dental examination. Patient-specific data about sex, age, tooth sensitivity, smoking, and grinding  were noted, as well as self-reported data regarding their level of

Cosmetic Dentist Marielaina Perrone DDS

satisfaction with their restorations: excellent, good, medium, or none. The porcelain crowns were broken down into areas of mouth as well, into front( anterior), and back( premolar, and molar) regions.
All 1,335 porcelain crowns had been placed at the university between November 1987 and December 2009. Of these porcelain crowns, 451 were observed over a 10-year period, 84 for 15 years, and 24 over 20 years.

Dental examinations were completed by two dentists in the spring of 2010. One dentist had placed the majority of porcelain crowns, whereas the other dentist involved in examinations had placed none of them. California Dental Association/Ryge criteria were used to rate each porcelain crowns as a success, relative failure, or absolute failure.

Any porcelain crowns that had severe enough issues to warrant replacement were considered an absolute failure. If a finishing procedure or polishing was able to fix the issue, the porcelain crown was labeled a relative failure.

Of the 1,300+ porcelain crowns in the study, only 95 porcelain crowns were rated as failures, 79% of which were absolute failure. Most failures occurred in the anterior region, with 65, while 19 occurred in premolars and 11 occurred in molars.

Success rates remained strong over time. The estimated survival rate was 97.3% at five years, 96% at eight years, 94% at 10 years, 85.8% at 15 years, and 78.5% after 20

Porcelain Crowns Marielaina Perrone DDS

The Beauty Of Porcelain Crowns

years. Almost half of all porcelain crown failures happened in the first 8 years..

The most frequent reason for failure was fracture,(cracks) of the ceramic, according to the researchers, followed in order by cracks in the ceramic and decay.

Root canal teeth and patients who grind their teeth, had higher failure rates.

Patient responses to questions about satisfaction were very positive. With 96% rating it as excellent and 4% rating it as good. The surprising thing about this study was that even patients with failures thought that porcelain crowns were an ideal dental restoration and would do it all over again.

Porcelain Crowns Conclusion

Porcelain crowns are a proven part of cosmetic dentistry and with continued advances in dental porcelain (like e.max porcelain crowns) these results will be even better into the future. Porcelain crowns are an ideal restoration due to their color, shape, and light reflecting properties. The study just proves that they are a valuable asset to any dental patient’s smile.

 

Avulsed Tooth is the complete displacement of a tooth from its socket in alveolar bone from trauma.

Dentists generally refer to a tooth that has been knocked out as an avulsed tooth. The accidental loss of a tooth through trauma ( avulsed tooth ) is considered a very serious dental emergency for a permanent tooth (occurs in about 1/10th of the population). For an avulsed primary tooth re-implantation is generally not successful, and is usually left alone. For a permanent tooth if you act quickly enough there is a chance the avulsed tooth can be saved and maintained for many years. Even the best techniques and intentions do not always lead to a successful outcome for an avulsed tooth.

The usual cause of an avulsed tooth is a  force sufficient to break the bond between the tooth and the connection (periodontal ligament ) to the bone. An avulsed tooth has no oxygen or blood flow and will die quickly if not re implanted. The primary goal of quick reimplementation is to maintain the periodontal ligament, so that the tooth is not rejected. The avulsed tooth will always need to be splinted to the other teeth, and usually, but not always, require a root canal. The speed in which the tooth is re implanted, the cleanliness of it, and how hydrated or wet it has been all play key roles in whether or not re-implantation of the avulsed tooth will be successful.

Instructions for an Avulsed Tooth

If a tooth has avulsed due to trauma it must be re implanted in its socket within 60 minutes (or sooner if possible) of the accident for the best chance of a positive result (i.e. tooth remains in position). It is important to keep the root surface of the avulsed tooth moist. This is the reason for the need for speed when re implanting the tooth.

An avulsed tooth, whose structure is maintained without any major fracture, must be re-implanted in its socket within an hour after the accident for best chances for it to remain in position. The best option is to attempt re-implantation within the first few minutes at the site where the accident occurred. The avulsed tooth should be attempted to be cleaned and placed back into the socket ( hole in jaw ) by an adult. This can be either the person who lost his or her tooth or by an adult if a child has suffered the trauma. If the avulsed tooth goes back into its socket where it was originally then it would be considered to be a successful re-implantation.

smileIf the avulsed tooth is dirty, it is vitally important that it is cleaned, the best way is with the patient’s own saliva by putting it in their mouth. Once the avulsed tooth is cleaned in this manner the patient should spit out any blood and dirt in mouth. While spitting, you probably will remove the blood clot forming in the avulsed tooth socket. This will allow an easier re-implantation of the avulsed tooth into the socket. the tooth can also be rinsed with cold water or milk. When the avulsed tooth is as clean as you can get it, it should be placed back in the socket as soon as possible. The quicker it is done, the better the chance for success. There are also “tooth saver” kits made to hold and keep the avulsed tooth wet for transport to a dentist.

If the avulsed tooth cannot be repositioned in its socket for any reason, then it should be brought to the dentist as soon as possible. There are a few ways to accomplish this:

1) The avulsed tooth should be rinsed and cleaned as explained above. The person who had the accident must then keep the avulsed tooth in their mouth. They should keep the avulsed tooth under the tongue or between the cheek and back teeth or lip and front teeth. If the trauma happened to a young child the previous advice should be disregarded as they can swallow the tooth. In such a case, the avulsed tooth should be rinsed and placed in milk, or in water with salt. Go to your dentist as soon as possible.

2) After cleaning with saliva, the avulsed tooth can be put in a solution of water and salt. A half a teaspoon of salt should be mixed in a cup of water. It is best to use bottled water if it is  available, but tap water can also be used in a pinch.

3) The avulsed tooth can also be placed in fresh room temperature milk. The patient and avulsed tooth in solution should be brought to the dentist as soon as possibleSave-a-tooth avulsed tooth kit

4) There is a commercial product available for the storage of an avulsed tooth. It is called Save-A-Tooth. This is a small container containing fluid to help preserve the avulsed tooth  for easy transport and re-implantation.

Exceptions to the Rule

The instructions above are recommended for adult teeth only. If a primary tooth (also called baby tooth) has avulsed following an accident, the re-implantation will not really work.

-If the adult avulsed tooth is broken or has visible fractures following the trauma, and or its root remained in the socket, the re-implantation will not be successful. This is because the tooth will not reattach to its root, and a fractured tooth will continue to break down.

Prognosis of Avulsed Tooth following Re-Implantation

It should be remembered that even if you follow all of these recommendations precisely, the tooth in question may eventually need to be extracted. If the instructions are followed correctly, chances are better that the tooth may remain in position.  An immediate splinting to the other teeth is optimal to take stress off the tooth and allow for healing. It may eventually need root canal treatment and possibly a crown to restore the avulsed tooth to its full form and function.

The re implanted  tooth can also seem to be fine for a few months or even a few years before it eventually becomes a problem.

At the Dentist Office

Putting the avulsed tooth back in its socket sometimes can be quite easy. And sometimes it can be very complicated, such as when the tooth or bone is fractured or broken. Your dentist may use water to flush debris from the socket. Then they will attempt to slide the avulsed tooth back into place. As mentioned earlier, it is most important to re implant the tooth as soon as possible. Ideally, this should occur within the hour of the accident.

The best course to take will depend upon how long the tooth was out of the mouth and amount of trauma. In either case, the dentist will splint the avulsed tooth to the teeth on either side with a soft wire and/or a resin material. This will be used to maintain the tooth in place for days-weeks.

If the bone around the tooth was not fractured, the root usually will reattach firmly to the bone in about three to four weeks. More extensive damage to the area may need 6-8 weeks of healing time.

Your dentist should examine the tooth again in three to six months to ensure the tooth is doing fine with no evidence of infection occurring. If there are no signs of infection, the next visit will be at your yearly dental examination. The dentist will then continue to monitor the tooth for the next 2-3 years to ensure that the tooth re implanted successfully.