Endodontics (Root Canal)

Endodontics refers to the treatment of the inner portion of the tooth and roots.

What Is A Root Canal?

A tooth has a hollow space in the center of it called the pulp chamber. This hollow space contains the nerve and blood vessels that support the tooth and it continues down the center of each root. Sometimes there are more than one nerve and blood vessel extending down each root. Generally, most teeth have one to five nerve canals and one to three roots.

A root canal is the procedure where the dentist drills into the center of the tooth to expose the damaged nerves and blood vessels. Once the damaged nerves and blood vessels are accessed the dentist removes them with special instruments. All of the damaged tissue must be removed from both the pulp chamber and the canals that extend down the roots for the procedure to be successful.

The inside of the tooth is then disinfected and a warm rubbery material called gutta percha is used to fill the space where the nerve and blood vessels used to reside.

Generally, the tooth is then stuffed with a small amount of cotton and a temporary filling is placed in the opening that the dentist created to access the pulp chamber. After about two weeks you should return to the office to have the temporary filling removed and replaced with a permanent filling or crown buildup and crown. In some instances, a permanent filling or a crown build up may be placed the same day the root canal is done, if the dentist determines that to be an appropriate course of action.

It is normal for a tooth to be a little tender for several days after a root canal. In most cases it is tolerable and rarely requires pain medicine.

What Happens After My Root Canal?

Once the nerve and blood vessels have been removed from your tooth you will no longer have hot or cold sensations on that tooth and the tooth should be pain free once healing has been completed.

On the negative side, the tooth no longer has a nourishing flow of blood going to it. Over time the tooth can dry out or desiccate due to the lack of blood flow. This results in a very brittle tooth that is prone to fracture and splitting. Your dentist will recommend treatment options to you to help insure that your tooth does not split or fracture. The location of the tooth that needed the root canal will affect the recommended treatment. Your front teeth do not bear a lot of force during every day chewing and a root canal on a front tooth that has very little damage to it can usually be restored with a simple filling. A front tooth with a patchwork of different fillings and large decay may still require a crown or possibly even a post inside of the root to secure the new filling and crown.

A root canal on a premolar or molar will always require a crown or similar full coverage restoration to prevent fracture or splitting. Failure to place a crown on a premolar or molar after a root canal commonly leads to the eventual fracture and extraction of the tooth. In fact, this is the most common reason for the loss of a tooth after a successful root canal. Fracture can occur anytime after the root canal procedure. In rare instances people can go years without fracture but this is not the norm and your dentist will encourage you to restore your premolar or molar with a crown. However, ultimately the decision is yours.

What Caused Me To Need A Root Canal?

You need a root canal because the inside of you tooth is dying and cannot be healed. There can be many reasons for this:

Some common causes for root canals:

  • Cracked tooth
  • Infection in the pulp chamber/ abscess
  • Tooth decay that reaches or gets close to the pulp chamber
  • Chipped or broken tooth
  • Blow to the tooth/Trauma
  • Failed previous root canal/ permanent filling never placed
  • Pulp stones or calcifications in the nerve chamber

In some instances no cause can be identified for the death of the nerve in your tooth.

What Symptoms Will I Have If I Need A Root Canal?

In rare instances there are no symptoms. These cases are identified during routine examination of x-rays in which a black halo is seen around the tip of the root of the dead tooth. Also, in some situations, the patient has no symptoms but they notice that a small pimple has formed on the gum tissue adjacent to where the root would be located. This is the area where the pus from the infected tooth is draining.

However, most cases of people needing root canals have unmistakable symptoms. A prolonged throbbing toothache that wakes you up in the middle of the night frequently means you need a root canal. Hot/Cold sensitivity that lingers after the stimulus has been removed could indicate the need for a root canal, but not always. Percussion sensitivity (ie tapping really hard on your tooth) could mean you need a root canal, if it hurts when you tap on it. Spontaneous pain that comes on for no reason could also signal the need for a root canal. If you are having any of these symptoms your dentist will take an x-ray to help determine the need for a root canal. Teeth that need root canals almost always have radiographic evidence that indicate the need for a root canal.

Please contact our office for an evaluation if you experience any of the symptoms above.

Will My Root Canal Be Painful?

A common misconception is that a root canal is a painful procedure. Actually, root canals are similar to having a cavity filled, producing minimal discomfort.

However, a badly infected tooth may require a course of antibiotics for 48-72 hours prior to the start of the root canal. Bad infections can affect the ph in the gum tissues around the tooth and cause the local anesthetic not to work properly. In these rare instances, a root canal could be very painful if the antibiotics are not taken for a few days to reduce the infection. This is the reason root canals have a reputation for being painful. If your dentist determines that you need antibiotics prior to your root canal, make sure you take them.

What If I Don’t Want A Root Canal?

Once it is determined that you need a root canal there are only two choices. Have the root canal performed or have the tooth extracted.

You cannot fix a tooth that needs a root canal with antibiotics, you can only reduce the infection with antibiotics. When it returns full force a few weeks or months later it will come back worse than it was the first time and antibiotics may not work again.

In rare instances a patient will wait too long to seek treatment and their infected tooth develops a full blown abscess. In these extreme cases, a golf ball size swelling will be present around the infected tooth and the person will be in significant discomfort. Over time this swelling can start to travel down the neck and can even enter the persons blood stream. This is a potentially fatal condition if left untreated.

In fact, prior to the discovery of antibiotics, abscessed teeth were frequently among the top five causes of death in the United States.