As you may be aware, the soft inner material of the tooth, or pulp, extends all the way down into the roots. This area of each root, or canal, is filled with nerves, connective tissue, and blood vessels. Even though the pulp provides nutrition for teeth as they emerge, fully developed teeth also derive nutrition from the gums. Therefore, pulp can be safely removed from adult teeth. When you undergo a root canal, or other types of endodontic treatment, your dentist will not need to extract the tooth. In the United States alone, over 24 million teeth are saved via the usage of root canals.
ROOT CANAL TREATMENT: Why is Procedure Performed?
Once the pulp of a tooth becomes infected, it will cut of the blood supply to the tooth. This, in turn, will also prevent the pulp from healing. Pulp infections can also spread to the bone that supports teeth. Unfortunately, you may also develop abscesses, which can lead to a life threatening condition.
In most cases, pulp infections get started when cavities go untreated. Unfortunately, once the enamel and dentin are gone, infection can reach right into the root canals. Typically, antibiotics cannot get inside the tooth in order to clear the pulp of infection. The only way to resolve this situation is to have a root canal.
Unfortunately, cracked teeth may also need root canals. You will also find that extensive fillings, and preparation for crown placement can also damage pulp enough to require its removal. Depending on the situation, your dentist may want to wait before performing a root canal. For example, if the pulp is not infected, but shows sign of inflammation, it may still heal by itself. That said, if the inflammation is painful, you may want to have the root canal done sooner rather than later.
Once a root canal is performed, the tooth should remain healthy and strong for the rest of your life. Unfortunately, if you decide to have the tooth pulled instead, adjacent teeth can get knocked out of line. There will also be an increased risk of damage to other teeth, as there will be an extra burden placed on them each time you chew food.
ROOT CANAL TREATMENT: Patient Concerns to be Addressed
While pulp infections may not hurt at first, eventually you will feel pain under one or more of the following conditions:
- you cannot bite down, touch, or push the tooth
- tooth is sensitive to heat or cold
- gum swelling near the tooth
- Signs of breaking or discoloration
If your dentist suspects you need a root canal he/she will use hot and cold substances to determine if the tooth is more or less sensitive than your other teeth. An electric pulp tester can also be used to see if the pulp is still alive. Typically, this will not be painful, but you may feel a slight tingling sensation. You should let your dentist know if you have a pacemaker, or rely on some type of electronic life support, as the electric pulp tester can interfere with these devices.
While diagnosing endodontic issues, your dentist will also examine the gums and other tissue to look for signs of infection. Depending on the situation, you may also need to have x-rays to look for other indicators. For example, your dentist may find that the ligament which holds the tooth in place is wider than normal. If a dark tip also appears at one or more roots, your dentist will most likely want to do a root canal.
ROOT CANAL TREATMENT: How is Procedure Performed?
Depending on the location of the tooth, and the number of roots it has, you may have to make more than one visit to complete root canal therapy. In addition, if roots are curved, the canals may not always be easy to find. Curved roots can also be punctured, and require additional follow up treatment.
Typically, your dentist will also want to monitor the treated area to ensure that the infection is gone. After your endodontist is certain that the infection is gone, you will have to go back to your regular dentist in order to get a crown and fillings. If you normally use the tooth for chewing, a crown will be required in order to prevent the tooth from breaking or cracking in the future.
ROOT CANAL TREATMENT: Preparation
Before starting the root canal, your dentist will numb the area. He/she will also give you sedation if required. Prior to receiving a root canal, you can also ask about other medications that are designed to help manage anxiety.
ROOT CANAL TREATMENT: Measuring
In order to reach the pulp chamber, the dentist will make a hole on the back or top of the infected tooth. Aside from removing some of the pulp, it will also be necessary to measure the root canals. These measurements are accomplished by using X-rays and an apex locator. The apex locator makes use of electrical resistance to determine the size of the root. Your dentist may elect to use only one or the other of these methods. Without measurements, your dentist will not be able to determine if the entire canal has been cleaned out. It will also be difficult to know how much filling to pack the empty canal with.
ROOT CANAL TREATMENT: Cleaning
In order to remove pulp from the roots, your dentist will use special tools to get into the root. He/she may also want to use a microscope to look inside the root to ensure it is clean. After all of the pulp is removed, your dentist will apply antiseptics to the interior surface of the canal. This will help prevent infection, as well as kill any pathogens that may exist in this area.
When doing a root canal, your dentist will treat all of the roots that are associated with the tooth. Depending on the type of tooth being treated, this can range from one root to three or four. Typically, each tooth will have root numbers based on the following formula:
- 1 canal – top front teeth
- 1 – 2 canals – bottom front teeth, and premolars
- 3 – 4 canals – molars
After your dentist is sure that all of the pulp has been removed, it will be time to put a temporary filling over the entrance hole. After your tooth and gums heal from the root canal, you will need to get a permanent crown. Whiel the temporary filling will protect your tooth for a short period of time, it will not last for very long. Ideally, if you need a crown, you should have it done as soon as possible.
Once the pulp is removed, your tooth will no longer be sensitive to heat and cold. Fortunately, you will still be able to feel pressure and touch. This, in turn, will leave your tooth feeling pretty much like normal.
ROOT CANAL TREATMENT: Pain, or the Lack of It
For the most part, the root canal procedure does not hurt. As with any other procedure, you should let your dentist know if you feel pain. If you have a fear of the shots used to numb your mouth, there are also gels and newer injection systems that will reduce your discomfort. In most cases, if you let your dentist know that something hurts, he/she has reliable methods for getting rid of the pain.
ROOT CANAL TREATMENT: Post-Operative Concerns
After a root canal, the tooth may be sore for two to three days. If the infection and inflammation were extensive, the tooth will tend to take longer to recover. Typically, avoiding chewing on the treated side will help reduce pain faster. In most cases, over-the-counter pain relievers will be all that you need for pain management. You should use one that reduces inflammation as well as block pain signals. For example, ibuprofen tends to work well.
ROOT CANAL TREATMENT: Perils of Disease
While most root canals are performed without problem, some complications can still develop. For example, when the interior of the root is exposed to the air, oxygenation can promote the growth of some bacteria. While the canal is being cleaned, bacteria can be pushed through the hole at the bottom of the tooth that serves as an access point for blood vessels. As with any other infection, this will cause swelling and pain. In most cases, this is treated with antibiotics and painkillers.
If the canal is curved, the dentist may inadvertently make a hole in the side of the root. Even though the pulp removing tools are flexible, they can still cause damage. Unfortunately, if saliva gets in, your dentist will have to fill the hole. In some cases, it may not be possible to save the tooth.
As you may be aware, not all roots and their branches will show up on x-rays. Therefore, infected pulp may be left behind. If you still experience pain, your dentist may have to do another root canal. There will also be situations where your dentist will not be able to reach into complex root branches.
In some cases, files used within the canal can break. Depending on the situation, your dentist may be able to leave the file where it is. Your dentist may also try to remove it from the top of the tooth. Or, your dentist may have to perform an apicoectomy. This procedure involves making a small cut in the gum, and then shaving off the bottom of the root. From there, he/she will be able to remove the broken file.