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What is root canal treatment?

Underneath each tooth's outer enamel is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, and arteries. Root canals are very small, thin passageways that branch off from the top pulp chamber through the root tip. A tooth can have up to four root canals.

Sometimes, the pulp inside the tooth becomes infected by disease or bacteria, or damaged by a traumatic injury to the tooth. An infected and untreated root canal can allow bacteria in the mouth to enter the bloodstream and cause infections in other parts of the body. In addition to staving off potentially harmful infections in other parts of your body, root canal treatment can generally save your damaged tooth.

Root canal treatments typically affect the root tip or nerve of the tooth and the structures called the pulp chamber, pulp, and root canal. The procedure involves removal of diseased or damaged pulp inside the tooth, the cleaning, disinfection and reshaping of the inner canals beneath the tooth, and preparation of the tooth for later placement of a filling, and in most cases, an artificial crown made of porcelain or gold. The procedure enables you to keep most of your original tooth.

Repairing the root canal is the way to save the entire tooth. The other alternative is to pull the tooth entirely. However, leaving that space empty may create other problems, like making chewing and biting more difficult. Teeth may also shift their position if missing teeth are not there to hold the space. If you decide to have the dentist pull the tooth and replace it with a denture or bridge, the cost will be significantly more than the cost of a root canal.

Please contact us to setup a consulation for a checkup.

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Root canal Frequently Asked Questions (FAQ)

What is Endodontics?

It is a branch of dentistry that deals with the cause, prevention, diagnosis and treatment of diseases of the human dental pulp and the surrounding tissues.

What is the Dental Pulp?

It is what we commonly know as the "nerve" of the tooth. It is a soft connective tissue that is highly vascularized (tiny blood and lymph vessels), and innervated (nerve fibers). It is located inside the dentin of the tooth in the pulp chamber. Its main function is formative, nutritive and sensory.

What is an Endodontist?

A dental specialist in the treatment of diseases and injuries to the dental pulp, root and surrounding tissues of the teeth. Endodontists receive a "certificate in Endodontics" after additional 2-3 years of training in an accredited program after dental school.

What is a Root Canal?

ROOT CANAL is a "lay persons" term for endodontic therapy or root canal therapy. Root canal therapy is necessary when the nerve inside the tooth becomes irreversibly damaged or infected. This is usually due to the entry of bacteria into the center most part of the tooth called the dental pulp ("nerve"). Root canal therapy involves the removal of the entire nerve system, as well as cleaning, shaping and filling 3-dimensionally the canal system with gutta-percha and a dental sealer.

What are reasons for root canal treatment?

Root canal treatment is called for when the soft tissue inside the tooth's canals, also called the pulp, becomes inflamed or infected by bacteria. The most common cause of pulp death is a fractured tooth or a deep cavity, which can expose the pulp to the bacteria found in your saliva. A traumatic injury or blow to the tooth could cause swelling and inflammation of the tissues in and around the tooth, providing an opportunistic path, usually through a crack, for bacteria to collect. Repeated dental procedures on the same tooth could eventually weaken and compromise the original tooth, allowing pathogens to enter the inner canals. An infected pulp can lead to swelling and possibly fever; left untreated, infected pulp could leak harmful toxins from the root ends, leading to an abscess and erosion of the bone beneath the tooth.

Do I need a root canal?

Do you have any of the following symptoms?

• Sensitivity to hot or cold that lingers
  Pain when chewing or biting
  Dull ache
  Spontaneous pain
  Throbbing or pulsing pain
  Pain that wakes you up at night
  A bubble or pimple on your gum that when pressed may release pus or blood (most likely, not painful)
  Pain that persists four to six weeks following a filling or replacement of a filling
  Chronic pain and/or pressure that may extend to the ear, eye or neck
  A tooth that feels loose
  One tooth is distinctly and consistently more sensitive than the other teeth

Your dentist has diagnosed the need for root canal therapy, either by clinical exam or x-ray
If you answered yes to any of the above, you might very well need a root canal.
Please call and schedule for an evaluation.

What is the root canal procedure?

Root canal treatment usually takes one to three visits. Here is what normally occurs during a root canal procedure:

First, your gums are numbed with a topical substance and a local anesthetic is injected into the nearby area to completely numb your teeth, gums, tongue, and skin. For patients with an acute low tolerance for pain or anxiety, nitrous oxide gas may be used.

A small sheet of rubber is placed over the surrounding area of the affected tooth in order to isolate it from surrounding teeth and prevent you from swallowing debris.

A small hole is made in the top of the tooth in order to access the pulp chamber, pulp and root canals. The pulp is removed, the pulp chamber cleaned and the canals are cleared of debris and tissue. In most cases, the canals are first filled with antibiotic medications and temporary filling materials up to the gum line. Depending on the circumstances, the root canal may be left open for a few days in order to drain. In some cases, the canals may be filled right away with a final root canal filling.

If the canals are not permanently sealed, the temporary filling is removed and the pulp chamber and canal(s) are filled with a rubber-like material to prevent recontamination. If the tooth is still weak, a metal post may be inserted above the canal filling to reinforce the tooth.

Once filled, the area is permanently sealed, an impression of the tooth is made so an artificial crown can be made for placement over the affected tooth. In some cases, a temporary crown is placed over the tooth until the permanent gold or porcelain crown is made and cemented in, usually by your dentist.

What is Gutta-Percha?

Gutta-percha is the purified coagulated exudate from a tree, commonly called the "mazer wood" tree, of the Malaysian archipelagos. The substance is similar to that of the rubber tree, which is then processed to obtain the dental compound. This is the only ADA approved material to be used as a filling in root canals.

What Happens at an Endodontic Consultation?

Your doctor will review your past dental and medical history. A dental x-ray will be taken even if you have one from your referring dentist. Different x-ray angles are necessary to reveal possible problems such as decay or an abscess. Also, a series of test, such as hot, cold, biting and percussion (tapping) can be performed on several teeth. Through these tests the dentist will attempt to reproduce your symptoms that will enable him/her to make a proper diagnosis and decide if you do, or do not, need a root canal.

How Does the Dental Pulp Become Damaged or Infected?

The reason is bacterial contamination. Bacteria are a normal host present in the mouth and saliva, but when it gets inside the tooth and enters the pulp (through decay, or a fracture in the tooth, broken down old filling, or a gap between your tooth and an existing crown), then it becomes pathologic. The time frame for this to occur can vary significantly. Sometimes it is very fast and usually painful, but also, it could be a very slow process in which the patient is unaware and no pain is manifested until it is significantly advanced.

Is the Root Canal Procedure Painful?

Usually not. With modern technology and local anesthetics, the procedure is usually much faster and more painless than it has ever been. A similar anesthetic, as the one used in the general dentist office, will be used for a root canal. The main difference is the quantity. A deeper level of anesthesia is necessary for this procedure to be painless. In many occasions, it can be a completely pain-free procedure. Painkillers are usually recommended for a few days after treatment, in order to control normal post-treatment discomfort.

How Much Time Will A Root Canal Take?

Root canals can be done in one, two or multiple appointments, depending on the tooth, how many roots there are, the current conditions of the tooth, the accessibility to area, the canals, and time available. Each visit or appointment can take from under 1 hour, to over 2 hours.

What is an Abscess?

An abscess is a localized collection of pus (infection) within a tissue or a confined space.

Does Every Abscessed Tooth Hurt?

No. Some abscessed teeth can be pain free, those are most commonly found and diagnosed accidentally by a dentist, usually through a dental x-ray and exam. Whenever possible, the recommended treatment is a root canal.

What Happens When an Infected Dental Pulp is not Treated?

The infection will continue its progress, extending from the confines of the dental pulp and involving the surrounding tissues, such as the root, the bone, the gums etc. A progressing infection could easily involve facial spaces and the patient would then start observing swelling of the face. Such condition could become life threatening if left unattended.

What is a Cellulitis?

Cellulitis is a painful inflammatory process that spreads through the connective tissue and is characterized by swelling and edema. It is usually associated with a bacterial infection.

Will My Tooth Discolor After Root Canal Treatment?

No, with all the new materials and modern technology used during the procedure, your tooth should not discolor after the treatment. If you have a tooth that has had a root canal and it has discolored, it is best to have your dentist take a look. It may be that germs (bacteria) have penetrated underneath the old filling, and it is time for a new one.

What Follow-Up Care is Involved in a Root Canal Procedure?

Avoid chewing on the tooth. It will most likely feel very tender and sensitive to pressure or touch. There should not be any discomfort upon drinking hot or cold fluids. Follow any instructions given by your dentist in reference to drugs such as painkillers and anti-inflammatories. Any of these, or the combination of them, usually provide excellent results to alleviate the normal post-treatment discomfort. If your pain does not respond to the initial medicine, then you should call your dentist. Sometimes, there will be a need for stronger painkillers and/or antibiotics. Finally, once your tooth is pain free, you must see your general dentist who will complete the necessary dental reconstruction of the crown. This last item is very important and should happen as soon as possible after completion of the root canal.

Do I Need to Take Antibiotics Every Time a Root Canal is Done?

Not always, today we are very conservative in determining the need for an antibiotic. It is usually determined by the dentist on an individual basis, per case, per tooth. Usually, if there are systemic signs and symptoms such as swelling, fever, generalized sense of malaise (ill feeling), and/or lymph node tenderness, then an antibiotic will be prescribed. The common toothache even when it is associated with a minor localized infection or abscess will not automatically require an antibiotic. Since a high number of cases will respond favorably to the dental treatment, antibiotics are not prescribed on a preventive basis.

Will I Feel Anything After Root Canal Treatment?

In most cases the quantity and quality of pain will subside dramatically within the first 24-48 hours. Any sensitivity to cold, hot or even breathing air "in" will be gone after the first visit. Nevertheless, you will experience mild to moderate pain that will last for several days after treatment. This pain is usually relieved by taking over the counter medications such as aspirin, Advil, Motrin, or Aleve. Tylenol has been proven not to be as effective as aspirin, etc., because it does not have the anti-inflammatory component as these other medications. The most common complaint is tenderness to touch, bite, tapping or chewing on the tooth. It is recommended to refrain from any of the above until your tooth is permanently restored. You should realistically give yourself 2-4 weeks to fully recover.

Since Treatment Was Done, My Tooth No Longer Hurts. May I Start Chewing On It?

It is not recommended to start chewing on the tooth immediately after the root canal treatment. Most times it will be very tender, but even if it is not painful to chew, you should avoid chewing on it until the crown of the tooth is properly restored (repaired) by your regular dentist. The sooner you see your regular dentist, the sooner to you will be able to re-start normal function on the tooth.

How Long Should I Wait to See My Regular Dentist After the Root Canal is Performed?

Unless otherwise directed, you should see your regular dentist as soon as your treated tooth feels comfortable (about 2-4 weeks). It is very important to see your regular dentist at that time to have a permanent restoration (typically a crown) placed in order to protect the remaining tooth structure. Until the permanent restoration is in place, do not chew on the treated tooth.

What Happens if I Wait Longer Than Recommended to Get the Crown of the Tooth Permanently Repaired?

If the remaining tooth structure is not properly and permanently covered and protected, your tooth could fracture and not be salvageable at all. The bacteria in saliva, as well as food debris, can go between the temporary filling and the tooth surface and contaminate the root canal treatment. This may cause treatment failure. If a re-infection occurs, often, another root canal treatment will need to be done (endodontic retreatment). If the damage is very extensive, extraction should be considered.

What are the Benefits of Root Canal Therapy Versus Extraction?

The single most important benefit of root canal therapy is that you keep your tooth. Extraction may lead to other dental problems. For instance, drifting of teeth, bite problems, TMJ pain, and the need to treat adjacent teeth that do not otherwise need dental treatment in order to restore the missing tooth.

How Successful are Root Canals?

Root canal treatment has a high degree of success if done properly by a trained skilled professional. The success of root canal therapy is equally dependent upon the technical skill of the doctor, as well as the follow through of the patient, to have the tooth immediately restored.

What Should I Do if a Medicated Dressing was Placed Under My Filling and it is Still Sensitive to Heat and/or Cold?

Sensitivity to hot and/or cold, which persists, usually indicates that the nerve of the tooth is irreversibly inflamed. The indicated treatment is Root Canal Therapy. Immediate attention by your dentist or endodontist is necessary to prevent severe pain and abscess.

Why is a Rubber Dam Used During Root Canal Treatment?

The purpose of a rubber dam is to protect the patient from swallowing the small instruments used during root canal treatment and to keep the tooth clean and dry during the procedure. It is for medical/legal reasons that a rubber dam is used for patient safety.

What is Endodontic Retreatment?

Retreatment is a term used to describe a procedure when a root canal has to be redone. The reason for retreatment is because germs or bacteria in the mouth have re-entered the tooth, usually due to decay. A patient may experience pain to biting or swelling. Sometimes, a patient may have no symptoms and your dentist sees something on the x-ray that shows a root canal has not healed and advises a patient to see a root canal specialist for an evaluation.

How Long Will I Be Numb After Root Canal Treatment?

The numbness will last for several hours after your treatment. It is best to avoid chewing until the local anesthesia has completely disappeared to prevent accidentally biting your lip, cheek, or tongue. It is okay to drink or to use a straw to have liquids after treatment.

Will I Be Able to Return to Work After Root Canal Treatment?

Yes. Most patients return to work after root canal treatment. They may keep a light schedule and plan to get rest during the days that follow treatment.

Why Do I Still Feel My Tooth if I Had Root Canal Therapy? I Thought My Tooth Was Dead.

A tooth that has had a root canal is not "dead". It is still considered a "live" or vital part of your body. There are nerve endings that are present in the jawbone underneath the tooth, as well as nerves that attach from the jawbone to the tooth. This is why there is still feeling in a tooth that has had root canal therapy.