Nonsurgical endodontic (root canal) treatment to save a tooth with injured pulp from extraction is one of the most common dental procedures performed that can save your natural teeth.
What is root canal treatment?
Root canal treatment is performed by an endodontic specialist (from the Greek meaning “inside the tooth”). Endodontic treatment is aimed at saving the tooth where the pulp of the tooth has become infected. Simply, put, the tooth is made up of three layers – the enamel, the dentin under that, which surrounds the softest part, the pulp. The pulp contains the nerves supplying the tooth with sensation, both pain and temperature. While the nerve supply is required while the tooth develops, once the tooth is fully grown, the tooth can function perfectly well without its nerve supply. Also found in the pulp is the blood supply of the tooth, which provides nourishment.
Why Does the Pulp Need to Be Removed?
Usually, the problem is infection. As a result of trauma or dental decay, bacteria penetrate the hard outer layers of the tooth and get into the pulp, causing infection. This infection may result in a tooth abscess, or further infection to the gums and bone surrounding the teeth.
What Are the Signs That Root Canal Therapy Is Needed?
The most common symptoms of root canal infection are severe tooth pain or jaw pain that cannot be relieved, and prolonged sensitivity to hot or cold food or drinks that persists even after the stimulus is removed. Patients may notice a change in color of the tooth, or swelling and pain in the gums surrounding the tooth. It is rare that there are no symptoms, and your dentist or endodontist picks it up on a routine examination.
What is the Root Canal Procedure?
While there are many jokes about how painful the procedure is, the alluded-to pain is usually the symptoms that brought one to the dentist or endodontist in the first place. The actual root canal procedure is no more painful than having a “filling” or restoration, and, often, although your dental professional will numb up the area with local anesthetic before working, there is little or no sensation because the nerve can be damaged/destroyed by the infective process.
First, the tooth is x-rayed, so that the precise layout of the root canals can be seen (these are the “feet” of the teeth that extend down into the bone below the gum line. Usually your endodontist will place a waterproof piece of plastic or rubber around the tooth to keep it dry and prevent saliva (containing bacteria) from contaminating the area. Depending on the level of decay or damage to the enamel or dentin, a small hole is made through which progressively larger diameter files are passed to scrape out the infected pulp canal. The holes made are rinsed out with water or sodium hypochlorite (dilute bleach) to make sure that all evidence of infection is removed.
Once the canal is thoroughly cleaned out, a rubber-like material, called gutta percha, is used to fill the space and then the tooth sealed with a composite material (filling). If the tooth is so badly damaged from decay that much of the structure has been destroyed, the dentist/endodontist may place small metal posts within the canal, around which s/he will build up the natural form of the tooth. A temporary crown will be placed. In cases like this, a permanent crown will be required, which can be placed at a second appointment. Until the permanent crown is placed you will usually be advised to stay away from chewing on that tooth to prevent that temporary crown from breaking and allowing the pulp to be re-infected.
What can I expect after a root canal procedure?
Following a root canal you should be able to resume normal activity almost immediately. The tooth may feel “different” for a few days after the procedure, especially if there was pain beforehand, and may remain a little uncomfortable –this discomfort can easily be managed with over-the-counter medications. Any cold or hot sensitivity will be immediately gone once endodontic treatment is complete. Any pain or sensitivity worse than that should be reported immediately to your dentist/endodontist, as it may indicate further or renewed infection in that tooth. Root canal treatment, however, is usually very successful, with over 95% of teeth having good outcomes. Please read our Patient Instructions Following a Root Canal.
Complications of a Root Canal
A few people do have complications, but they are rare. The most common complication is further infection, either because some area was missed during the cleanout, or new cracks or fissures develop in the tooth, leading to the re-introduction of bacteria. The sealing materials may degrade or breakdown over time, also allowing new infection in. This usually does not happen immediately, and can often be successfully treated with a second procedure. If the anatomy of the root canal is such that the files cannot be easily passed into them, a root-end resection, or apicoectomy might need to be performed. In this procedure, the endodontist goes through the gums to get to the base of the root, which is removed, along with the infected material.
Is there an alternative to root canal treatment?
The only real alternative to root canal treatment is extraction of the tooth. This can be replaced with a denture, implant or bridge, none of which options is without need for follow-up care. In the long run, they will probably cost more than a root canal treatment.
