What is an Endodontist?
An Endodontist is a dental specialist dedicated to root canal treatment, relieving oral and facial pain, and saving natural teeth. Many endodontists use a microscope that allows them to see the space within the tooth with great magnification and clarity. This enables them to more thoroughly clean and locate tough-to-find nerve canals within the tooth, and to see cracks that would otherwise go undiagnosed. The microscope is an advanced piece of equipment that far exceeds the capability of dental loupes (binocular-like magnifiers worn by many dentists).
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What is Root Canal Therapy?
Root Canal Therapy is when the Endodontist removes the inflamed or infected pulp (nerve), carefully cleans and shapes the nerve canals of the tooth’s root and then seals the prepared space. Most treatment is performed in one or two appointments ranging from 30-90 minutes each (depending on the number of canals). Once treatment is completed, you may be instructed to return to your dentist for a more permanent restoration. This restoration of the tooth is an important part of treatment because it seals the cleaned canals from the oral environment, protects the tooth and restores it to function.
Why would someone need a root canal?
Root Canal therapy (Endodontic treatment) is necessary when the nerve (pulp) becomes inflamed or infected. The most common reasons for inflammation or infection are deep cavities, repeated dental procedures, cracks or chips. Trauma can also cause inflammation and often shows up as discoloration of the tooth. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
What are the signs and symptoms that Root Canal Therapy is indicated?
Indications for treatment include prolonged sensitivity to heat or cold, spontaneous pain, discoloration of the tooth, and swelling or tenderness of the tooth or adjacent gums. Transient sensitivity to cold may just be due to exposed root surfaces or heavy teeth grinding. If the cold sensation lingers, and radiates up to give you a headache, chances are there has been irreversible damage to the nerve. Sensitivity to heat is usually a clear indication that there is some nerve damage present. Sometimes there are no symptoms, and diagnosis is made from a routine x-ray. Other times root canal treatment is recommended as a result of the bacteria from the decay extending into the nerve (pulp) of the tooth; this is seen by the dentist during their examination of the tooth.
What is the pulp?
The pulp contains blood vessels, nerves, and connective tissue that are responsible for forming the surrounding Dentin and Enamel during tooth development. The pulp receives its nourishment supply from vessels which enter the end of the root. Although the pulp is important during development of the tooth, it is not necessary for function of the tooth. The tooth continues to be nourished by the tissues surrounding it even after the pulp is removed.
Why do Root Canals have such a bad reputation?
The vast majority of root canal procedures proceed painlessly, both during and after each visit! With modern techniques and anesthetics people report that having a root canal treatment is about as unremarkable as having a cavity filled. On the other hand, some people present with what we call a hot tooth. A hot tooth is one in which the nerve is alive, but badly inflamed. The tooth is generally already very painful, especially to hot or cold stimuli. These are the ones that require multiple anesthetic injections to get numb.
Is it normal to feel sore after a root canal?
Yes, it is normal to experience a little soreness after the appointment. This may be due to the injection, the necessity of keeping the mouth open for a long time, or the treatment. The instruments used to remove the pulp from within the tooth can sometimes irritate surrounding tissues causing discomfort for a few days. This is usually minor in most cases. Your temporary filling will be hard enough to bite on within approximately a half-hour, but avoid biting or chewing on the treated tooth if it hurts, especially if there was pain or infection present before the procedure.
What should I do if I am still feeling pain after a root canal?
Over-the-counter analgesics like acetaminophen, aspirin or ibuprofen usually relieve the discomfort. Other medications can be prescribed as well, but they are rarely required. Should the pain last for more than a few days, or if severe pain or swelling occurs, call your Endodontist. Remember, if your tooth hurt before you came in for treatment, it may take a while to heal.
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What should I do if I have a swelling (abscess)?
The first thing you should do is make an appointment with your dentist to evaluate what the cause of the swelling is and to determine if antibiotics are necessary. For minor swellings caused by gum irritations, hot salt water rinses may be indicated. Abscesses (swellings) are usually caused by untreated cavities, cracked teeth, failed root canals or extensive gum disease. There are 3 basic types of abscesses:
- Gingival (gum) abscesses involve only the gum tissue. This is evident as a pus-filled swelling that may have originated from an inflamed periodontal pocket. The dentist will treat this by cleaning out the gum pocket and draining it. Hot rinses and antibiotics may also be needed.
- A Traumatic gum abscess comes from a trauma (such as irritating the area with a toothbrush, or jabbing the gums with something sharp like a crust of bread, chip or bone). Traumatically induced abscesses usually heal on their own with the aid of warm salt water rinses.
- A tooth abscess or root abscess involves pus enclosed in the tissues of the jaw bone at the tip of an infected tooth. Usually this abscess originates from a bacterial infection that has accumulated within the nerve area of the tooth. In some cases, a tooth abscess may perforate bone and start draining into the surrounding tissues creating local facial swelling. Sometimes the lymph glands in the neck will become swollen and tender in response to the infection. Treatment would be root canal and sometimes antibiotics if swelling is significant. If you should have any form of swelling, fever or pain, immediately contact your dentist.
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What happens if I don’t treat a dental abscess?
A dental abscess is an infection that should be taken very seriously and treated immediately. If the abscess is ignored, not only can it result in a large swelling, fever and intense pain, but it can have serious consequences, including:
- Tooth loss (due to loss of surrounding bone from the infection)
- Sinus Infection (when the infection from the upper back teeth spread into the neighboring sinuses)
- Bacterial Endocarditis (when the bacteria from the abscess spreads to the heart via the blood vessels)
- Brain Abscess (when the infection from the abscess reaches the brain through blood vessels)
- Osteomyelitis (which is a local or generalized infection of bone and bone marrow, usually caused by the bacteria from the abscess)
- Cellulitis (when treatment is delayed, the infection can spread through the tissues and cause facial swelling, fever and can eventually spread to the bone and the soft tissues of the floor of the mouth)
- Ludwig’s angina (a very serious infection which affects the lower jaw and parts of the face. This infection can grow to block the airways, resulting in suffocation and possibly death)
Couldn’t I just have my tooth removed instead of having a root canal?
You could, but then adjoining teeth may shift and interfere with biting and chewing if you remove the tooth and fail to replace it. You may also consider placing an implant or fill in a missing space with a ‘dummy tooth’ as part of a fixed or removable bridge. A fixed bridge may require removing adjacent, healthy tooth structure, and may be expensive and require even more dental treatment. If you can save your own tooth with any degree of long term predictability, then that would always be the first choice.
What happens during root canal treatment?
An examination, including radiographs, will be performed. A local anesthetic will be given, if necessary. A sheet of latex, called a “rubber dam,” will be placed around the tooth to isolate it and keep it clean and dry during treatment. Complete treatment consists of the following five basic steps:
- Step 1. An opening is made to access the affected nerve tissue (pulp).
- Step 2. The pulp is removed from within the canals of the roots. Tiny instruments (“files”) are used to clean the root canals and shape them to a form that will ensure they will be well sealed. If the root canal is not completed in one visit, then a temporary filling would be placed to seal the opening and protect the tooth between visits.
- Step 3. The root canals are filled and sealed with a material that prevents bacteria from re-entering. The opening in the crown of the tooth is sealed with a temporary filling. Radiographs (x-rays) are made before, during and after treatment.
- Step 4. Your dentist will later remove the temporary filling (ideally within 4 weeks of treatment), and replace it with a more permanent material, to be followed with a permanent restoration or crown.
- Step 5. The root canal, permanent filling, and/or crown are evaluated for healing at periodic intervals called recall appointments.
How long should my tooth last after having a root canal?
The answer depends, in part, to how compromised your tooth was to begin with. If there is a lot of good, solid tooth structure to work with, and if your tooth was properly restored with a permanent restoration, then regular brushing and flossing, proper diet and periodic dental checkups should give your tooth an excellent chance for long term success.
How long can I wait after root canal therapy before I have to get a final restoration?
When your root canal treatment is complete, a temporary filling is placed. You should then see your general dentist for the permanent crown or restoration. Ideally, the tooth should be permanently restored within a few weeks to prevent the tooth from developing a fracture and to prevent the temporary filling from loosening and leaking, which in turn could cause the root canal treatment to fail, necessitating re-treatment.
Does every root canal require a crown (a dental restoration) that surrounds the prepared tooth structure?
Not every root canal requires a crown, however many of them do in order to lend the tooth the proper strength and support. Often times there is not enough tooth structure remaining after a large cavity or fracture to survive without one. Additionally, the tooth can become more brittle after root canal therapy, and would then become more susceptible to fracture, especially if one is a heavy grinder.
What is an Apicoectomy?
Your teeth are held in place by roots that extend into your bone. The tip or end of each root is called the apex. Nerves and blood vessels enter the tooth through the apex. They travel through a canal inside the root, and into the pulp (nerve) chamber. This chamber is inside the crown (the part of the tooth you can see in the mouth). During root canal treatment, the canals are cleaned. Inflamed or infected tissue is removed. An apicoectomy may be needed when an infection develops or won’t go away after root canal treatment or retreatment. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches. This can possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root. An apicoectomy is sometimes called endodontic microsurgery because it is often done using an operating microscope. Most apicoectomies take 30 to 90 minutes. The length will depend on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.
What is an apicoectomy used for?
If a root canal procedure has been done in the past and it becomes infected again, it’s often because of a problem near the apex of the root. In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect other canals that were not adequately treated. In this case, they may be able to clear up the infection by doing a second root canal procedure. This will avoid the need for an apicoectomy. Your dentist can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure and retreatment has not been successful or is not possible. For example, retreatment is often not a good option when a tooth has a crown or is part of a bridge. Retreatment of the root canal would require cutting through the crown or bridge. That might destroy or weaken the crown or bridge. An apicoectomy is often considered in a situation like this. An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.
What does it mean when I get that white pimple-like bump (fistula) on my gum?
Sometimes after a root canal a pimple develops in the gum area, approximately where the tip of the tooth’s root would be. This pimple will often go away and then come back. This is called a fistula. The fistula is a sign that there is an infection and your body is draining it out through the pimple. There is usually no pain in this situation. If you have symptoms, such as pain or a fistula, contact your dentist. He or she will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.
Why do some root canals fail?
Although only about 5% of root canals fail, there are many possible explanations to explain why this might happen. There may be one or more extra canals that the dentist was unable to locate or fully clean out. This trapped nerve tissue can cause abscesses or ongoing bouts of pain and may lead to failure. A fractured root may cause failure of a root canal. Teeth with dead nerves are always brittle. Fractured roots are generally impossible to repair and this means the loss of the tooth. And in some cases there may be a hypersensitivity to the materials used to fill the canals, although this is a very rare occurrence since the gutta percha used to fill the canal is quite inert and is generally very well tolerated.
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