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What is a root canal?
A root canal is the
removal of the inflamed, dying, dead or infected material found in the
center of the tooth, the cleaning, shaping and tapering of the center of
the root, and the sealing of the root to enable the bone and tissue around
the root to heal. The pulp or nerve normally contains nerve tissue,
blood vessels, and connective tissue. The nerve or pulp is only
responsible for the development and formation of the root structure when
you are a child. When this pulp or nerve has become infected, root canal
therapy is needed. to
WHY WOULD I NEED A ROOT CANAL?
Endodontic treatment is
necessary when the pulp (nerve) becomes inflamed or infected. The
inflammation or infection can have a variety of causes: deep decay,
repeated dental procedures on the tooth, a crack or chip, biting on an
un-popped piece of popcorn or any other trauma to a tooth. In addition, a
blow 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, lead to an abscess, or even the loss of the tooth.
Signs of pulp damage may
include pain, prolonged sensitivity to heat or cold, discoloration of the
tooth, swelling and tenderness nearby the gums and pain on biting and or
releasing. Sometimes, there are no symptoms.
How does endodontic treatment save the
tooth?
The endodontist removes
the inflamed or infected pulp, carefully cleans, shapes and tapers the
inside of the root, then fills and seals the space. Endodontic (root
canal) treatment is based on a very simple concept: the dental pulp in a
mature tooth can be removed when it becomes inflamed or infected and the
tooth remains healthy without it. The pulp itself consists of very small
blood vessels and nerve tissue located in the center of each tooth in the
root canal. The primary function of the pulp is to lay down hard tooth
structure (dentin) during the developmental stage of each tooth. It has a
limited blood supply, however, and is highly susceptible to inflammation
and infection, which is why it causes problems. Afterwards, you will
return to your dentist, who will place a permanent restoration on the
tooth to protect and restore it back to full function.
HOW IS ENDODONTIC TREATMENT PERFORMED?
Although the rationale
for endodontic treatment is uncomplicated, the treatment itself can, at
times, be tedious and complex. As we age, the canals in our teeth tend to
narrow or “calcify.” This can make the process of locating and cleaning
them somewhat time-consuming. To begin, a local anesthetic is
administered and, once the area is completely numb, treatment is
initiated. An opening is made in the biting surface on a back tooth or the
tongue side of a front tooth. Through this access-opening, small
instruments (files) are inserted to remove the pulp tissue and widen the
root canals. This accomplishes two things: first, it eliminates the pulp,
which is the source of inflammation or infection and second, it creates a
shape inside the tooth that will accept a root canal filling. The filling
material is called gutta-percha, which is a rubber-like material that is
biocompatible and has been used successfully for this purpose for many
years.
WILL I FEEL PAIN DURING THE PROCEDURE?
With the use of modern
techniques, root canal treatment typically involves little or no
discomfort. Often there is pain before the treatment and endodontic
therapy provides relief within 12 to 36 hours. While there may be a
feeling or awareness that the Endodontist is doing something there is
usually no pain during the procedure.
Many people report
that it is similar to having a filing placed.
Will I feel pain after the procedure?
For the first few days
after treatment, your tooth may feel sensitive or tender to tapping or
touching, especially if there was pain or infection before the procedure.
These mild symptoms can last for up to a week after the root filling has
been carried out and are not unusual. If postoperative pain persists or
increases in severity, please call our office. We ask you not to chew on
the tooth being treated as this may cause pain and or damage the tooth.
Discomfort can usually be relieved with over-the-counter medications. Your
Endodontist will usually give you a written prescription for an antibiotic
and a painkiller to either hold as a precaution or to take as instructed.
Cleaning the root canal system may cause some inflammation of the
surrounding tissues
What can I expect to feel after my root canal?
The pain to hot and
cold that was coming from the tooth that was treated will usually be gone
within a few days. Vague facial pain and aching or throbbing coming from
the tooth that we treated will usually take a little longer to dissipate
as will pain on biting or chewing. It is very common for slight tenderness
or soreness to linger after a visit.
WHAT ARE THE BENEFITS OF ENDODONTIC
TREATMENT?
Endodontic treatment
saves teeth that would otherwise need to be extracted. Although the pulp
(nerve) is removed, the treated tooth remains alive, nourished by the
surrounding tissues. The pulp or nerve is only responsible for the
development and formation of the root structure when you are a child.
There is no real substitute for your own tooth in terms of health and
investment.
WHAT CAUSED THE PROBLEM WITH MY TOOTH?
The most common cause of
pulp (nerve) damage is decay or a fracture that exposes the pulp to
bacteria that can cause infection. Other causes of pulp damage include
traumatic injuries, such as a blow to the tooth, a cracked or loose
filling or repeated fillings in a tooth and occasionally gum disease.
What
could cause the pulp to become inflamed or infected?
Decay, trauma, or
extensive restoration of a decayed or cracked tooth may result in pulpal
inflammation or infection. Pulpal inflammation is a common occurrence
following a deep restoration (filling) or preparation for a full crown.
Unfortunately, fillings do not last forever. Over time they can break
down and begin to leak which can promote decay or small cracks in the
underlying tooth structure. For this reason, fillings eventually need to
be replaced or, in some cases, filled teeth may require the support of a
full crown restoration. The very act of replacing a restoration or
preparing a tooth for a crown may result in inflammation and a damaged
pulp. Evidence of this inflammation may be extreme sensitivity to cold,
heat, discoloration of the tooth, spontaneous pain, and pressure from
biting. Endodontic treatment eliminates this sensitivity and allows the
tooth to be healthy and functional.
HOW MANY TREATMENTS ARE NECESSARY?
Root canal or endodontic
therapy is usually completed in two visits. One visit procedures can be
done on certain selected teeth. Some complex or problematical teeth will
sometimes require additional visits
HOW LONG WILL THE TOOTH LAST?
With a timely and proper
restoration and care your tooth may last a lifetime.
What is the success rate for endodontic
treatment?
Success rates are in the
92 to 95% range. Factors that may limit the success are the presence of
lateral canals or irregularities in the root canal system that are
difficult to thoroughly clean, cracks in the tooth that permit
contamination from the outside of the tooth, a root canal tooth that is
not promptly restored by your general dentist, periodontal disease, and a
lack or proper hygiene. These limiting factors are infrequent and the
majority of endodontically treated teeth remain comfortable and functional
for a long time.
How should a tooth feel after endodontic
treatment?
It is a very common
misunderstanding that a tooth is “dead” or without any sensation following
endodontic treatment. The pulp that is removed from within the tooth is,
however, is responsible for only part of the feeling of the tooth. Around
the outside surface of the root area is the source of nutrition that keeps
the tooth alive, the periodontal ligament. The nerves in this area
transmit pressure and pain sensitivity. The periodontal ligament is not
only alive but also somewhat temporarily inflamed from an endodontic
procedure. For this reason, it is normal for a tooth to be pressure
sensitive following endodontic treatment. The severity and duration of
this pressure sensitivity depends on the prior condition of the tooth as
well as the amount of manipulation required during treatment. Sensitivity
to a degree that requires analgesics usually decreases fairly quickly
after your visit. The most common discomfort that continues is an
awareness or low grade pain from tapping or moving the tooth from side to
side.
WHAT DO I DO AFTER ROOT CANAL TREATMENT
IS COMPLETED?
Once treatment is
completed, you will need to return to your dentist for the final
restoration of the tooth. Your own dentist will provide the check-ups and
future care for your dental health
HOW MUCH DOES ROOT Canal TREATMENT COST?
The expense of an
endodontic procedure varies depending on the tooth being treated and how
severe the problem is. Molars with two, three or four canals are more
difficult to treat and the fee is accordingly more. Endodontic treatment
is usually more economic in the long term than alternative treatments,
such as extraction and restoration of the missing tooth with bridges or
implants.
WHAT ARE THE ALTERNATIVES TO ENDODONTIC
TREATMENT?
Extraction is the only
alternative. Unless the extracted tooth is replaced, adjoining teeth will
shift, interfering with biting and chewing. The loss of a tooth can lead
to periodontal disease and eventually the loss of additional teeth.
Replacing a tooth with an artificial one may often require dental
procedures on adjacent healthy teeth.
CAN ALL TEETH BE TREATED ENDODONTICALLY?
Occasionally a tooth
cannot be saved by root canal treatment. Endodontic treatment can only be
performed if the root canals are accessible and can be adequately cleaned
and filled. A tooth must also have sufficient bone support and structure
to allow it to properly function after a root canal.
CAN THE TREATMENT FAIL?
A tooth that has
undergone endodontic therapy can occasionally fail. Root canal treatment
is performed because the soft inner tissue of the tooth, called the pulp,
has been damaged. As with any other part of the body, treatments can be
unsuccessful. Sometimes for no known reasons, the hard and soft tissues
surrounding the tooth may simply fail to heal. As with any procedure
dealing with the healing of the body, nothing is 100% successful. In
other cases, a new problem can jeopardize a tooth that was successfully
treated. For example:
* New decay can
expose the root canal filling material to bacteria, causing a new
infection in the tooth.
* A loose, cracked or
broken crown or filling can also expose the tooth to new infection.
WILL I NEED TO RETURN FOR ANY ADDITIONAL
TREATMENT
You must see your general
dentist to restore the tooth that has had a root canal 1 to 2 weeks after
treatment is completed. Your tooth should be examined six months to a
year after treatment to make sure that it has healed properly. While
there is no charge for this you may alternately have your dentist send us
a copy of an x-ray.
WANT TO KNOW MORE?
If you have any further
questions or are worried about treatment, please telephone our practice
and we will be happy to talk with you. If you have an emergency, please
feel free to call.
Why do I need another endodontic
procedure?
As occasionally happens
with any dental or medical procedure, a tooth may not heal as expected
after initial treatment for a variety of reasons:
* Narrow or curved
canals were not treated during the initial procedure.
* Complicated canal
anatomy went undetected in the first procedure.
* The crown or other
restoration was not placed soon enough after the procedure.
* The restoration did
not prevent saliva from contaminating the inside of the tooth.
What are the alternatives to re-treatment?
For some patients
considering re-treatment, endodontic surgery is also an option. This
surgery involves making an incision near the end of the root to allow the
tip of the root to be re-sealed. Endodontic surgery (Apicoectomy) may be
recommended in conjunction with re-treatment or as an alternative. Your
endodontist will discuss your options and recommend appropriate treatment.
In other cases, a new problem can jeopardize a tooth that was successfully
treated. For example:
* New decay can
expose the root canal filling material to bacteria, causing a new
infection in the tooth.
* A loose, cracked or
broken crown or filling can expose the tooth to new infection.
The only other
alternative is extraction (removal) of the tooth. The extracted tooth must
then be replaced with an implant, bridge or removable partial denture to
restore chewing function and to prevent adjacent teeth from shifting.
How much time will it take?
Most root canals
can be done in 2 visits. Visits are usually a week to 10 days apart to
allow for healing and comfort. The amount of time at any one visit will
depend upon how long it takes for you to get numb and the difficulty or
complications associated with your particular tooth. Previous work on your
tooth, obstructions, curved roots and calcified canals can also increase
the complexity and therefore the treatment time. If you have a portable
listening device with headphones (such as an MP3 player, walkman, personal
CD player etc), feel free to bring it with you if you like. Certain root
canals can be completed in one visit, but will require additional time to
accomplish this. This can be discussed during your consultation.
Should I take or stop taking any medications before my visits?
Patients should
take all medications as prescribed by their doctors. If you premedicate
with antibiotics for any dental procedures you should premedicate before
you see us. A review of your medical history will be done to ensure that
our treatment does not interfere with the medications you are already
taking. If you have any questions do not hesitate to contact you
physician and or pharmacist.
Can I eat after my root canal?
You should not eat
for at least 1 hour after each visit nor until the numbness has gone. A
temporary filling will be placed onto the top of your tooth so that food
and debris do not pack into the tooth. It is safer to plan for a soft
meal after your visit, and to avoid chewing on the tooth and side that was
treated until you return to your regular dentist. This will help to
protect your tooth and decrease the chances of a crack or fracture. Hard
foods such as jawbreakers, popcorn, and nuts should be avoided completely.
How long do I wait to see
my regular dentist?
You should see your
referring dentist about 2 weeks after we complete the root canal therapy.
Make an appointment right away as delay could cause you to lose a tooth.
Sometimes decay, cracks, or fracture lines in your tooth is what caused
the tooth to need a root canal. This prior damage along with the
additional drilling necessary for treatment can leave a tooth at great
risk of further fracture if it is not restored promptly and properly. It
is critical to success that your tooth is properly restored by your
general dentist as soon as possible. Your regular dentist will determine
with you the best course of action to restore and protect your tooth. This
can be in the form of a new crown, core and post build up, repair of an
existing crown or other measures to minimize the risk of recontamination
and fracture so that your investment in dental health is successful and
protected.
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