Root Canal Therapy (also called root canal treatment or endodontic treatment) is a dental procedure in which the diseased or damaged nerve (pulp) of a tooth is removed and the inside areas (the nerve or pulp chamber and root canals) are cleaned, filled and sealed permanently to avoid dental 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 the ability to sense temperature. It provides the sensation of hot or cold. The presence or absence of a nerve will affect the routine functioning of a tooth. Over time, the tooth with the root canal dehydrates which makes the tooth brittle and more susceptible to fracture. Most often, a crown is placed following root canal treatment is completed to protect the tooth and restore full function to the patient.
Root canal therapy is considered by many to be the most feared dental procedure. Does that surprise you? Surveys completed by the American Association of Endodontists reveals that most people with a fear of the dentist are based on others’ experience and not on their own.
The inaccurate information they receive about root canal therapy prevents patients from making a properly informed decision regarding their teeth. Many patients will ask that a tooth be extracted rather than experience a root canal procedure simply fearing the unknown.
Root canal treatment is needed when the nerve or pulp tissue becomes inflamed or infected. The inflammation or infection can occur from a number of ways: Decay that extends into the pulp chamber, repeated dental procedures on the tooth, or a fracture or chip in the tooth that allows bacteria to spread into the pulp chamber. Also, a 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.
Root canal therapy is almost always recommended because a tooth is causing pain from a condition that is irreversible. Pulpitis (inflammation of the pulp), an infected pulp, broken teeth, or a slowly dying nerve are all common reasons for root canal therapy.
Root canal therapy is used to alleviate that dental pain. Most people who have root canal therapy admit they did not experience any pain during the appointment and felt better almost immediately afterward.
Signs that a root canal may be necessary include pain, prolonged sensitivity to temperature (hot or cold), tenderness to touch and chewing, darkening or discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes, bone and surrounding gingival tissues. Sometimes, no symptoms are shown at all
Root Canal Therapy generally requires one or more visits to the dentist and can be performed by either a 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. The choice is generally up to the dentist on who will perform the root canal. The reasons the dentist may send you to the endodontist include: degree of difficulty of the tooth involved and need for a microscope, re treatment of a previous root canal, and the patients preference. You and your dentist will discuss who is best suited to complete this treatment for you and make the best decision for your treatment.
The first step is to take an X-ray (if one has not been already taken during the diagnosis) to see the shape of the root canals and determine if there are any indications of dental infection in the surrounding bone tissues. Your dentist or endodontist will then use a local anesthetic to numb the area surrounding the tooth. Anesthesia is not always necessary but generally preferred by patient to make the procedure more comfortable.
Once numb, the pulpal tissue along with bacteria, the decayed nerve tissue and related debris are cleaned out from the inside of the tooth and roots. Tiny instruments called dental files are used to measure the length of the root canal and to shape and clean the inside of each root. Sterile water, peroxide, or sodium hypochlorite are used periodically to flush away the debris and kill bacteria..
Once the tooth is thoroughly cleaned, each root canal is filled to the end with a rubbery compound called gutta percha and sealed . The process essentially is like a cork to prevent bacteria and fluid from re-entering the tooth, and keep it sterile. Some dentists like to wait a week before sealing the tooth. This will give the inflammation a chance to settle down back to normal. Some 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.
The final step may involve a more extensive restoration of the tooth. Generally a tooth that needs a root canal often is one that has a large filling or extensive decay. Even when decay was not a factor, the root canaled tooth is weaker than a “live” tooth. Therefore, a crown, crown and post, or other 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 restoration, you will not notice any difference in its function or form. You and your dentist will discuss this need further and decide together the best course of action for you.
Root canal therapy is highly successful and has more than a 95% success rate. Many teeth repaired with a root canal can last a lifetime.
Most root canals are performed to relieve the pain of toothaches caused by pulpal inflammation or infection. With modern techniques, materials, and anesthetics, most patients report that they do not feel any pain once the procedure is underway. Root canal procedures have the reputation of being painful. Usually most patients report that the procedure itself is no more painful than having a routine filling placed.
For a few days following treatment, your 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 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 questions if an issue arises.
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.
As noted above, the pain from root canals in modern dentistry is from the infection that presents to the dentist and the actual procedure should be pain and worry free. Best defense against developing a toothache 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.
Xray of completed root canal