Root canal treatment — also called endodontics (“endo” – inside, “dont” – tooth) — is a set of specialized procedures designed to treat problems of the soft pulp (nerve) tissue inside the tooth. While some mistakenly think of it as an unusually painful treatment, in most cases the procedure is no more uncomfortable than getting a filling. It’s actually one of the most effective ways of relieving some kinds of tooth pain.
Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root. All teeth have between one and four root canals.
Many tooth problems involve infections and inflammations that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves, and other soft, connective tissues. When the infection becomes worse, it can begin affecting the roots. Common causes of root canal problems include:
Severe tooth decay. One potential cause of infection is deep tooth decay. Untreated dental cavities eventually allow bacteria to work their way down to the center of the tooth, where they may infect the pulp tissue.
Chipped or cracked tooth. Another path by which bacteria may come into contact with pulp is via chipped or cracked teeth. Any opening in the protective enamel coating has the potential to allow bacteria access to the tooth’s pulp.
Trauma to the tooth. A traumatic injury to a tooth can also compromise the pulp, leading to similar problems.Trauma to the tooth – the kind that might result from a sports injury or automobile accident, for example — is also a major cause of pulp tissue damage. In this case, it’s essential to seek treatment immediately, both to try and save the tooth and to prevent future problems.
Extreme dental work. In some cases, extensive dental work itself may cause damage to the pulp tissue that will need to be treated via a root canal. Having multiple fillings or restorations on the same tooth increases the chances of this type of injury. Occasionally, common procedures like crown preparation or orthodontics may eventually lead to root canal problems.
A diseased inner tooth brings a host of problems including pain and sensitivity as the first indications of a problem. In time, the pain may go away… at least temporarily. Without treatment, however, the infection won’t. Inside, a spreading infection can cause small pockets of pus to develop, which can lead to a dental abscess and may even contribute to systemic problems in other parts of the body. Other
A root canal procedure becomes necessary when this infection or inflammation develops in the pulp tissue of the tooth; it can save the infected tooth, and prevent the chances of needing to perform an extraction.
How do you know when you need a root canal? Sometimes, it’s painfully obvious. If you feel constant and severe pain and pressure in your mouth, or noticeable swelling and extreme sensitivity in your gums, then it’s clear you need an evaluation and treatment right away. Another telltale symptom of pulp tissue damage is a sharp pain when you bite down on food. Lingering pain after eating hot or cold foods is also an indication of potential trouble. If you notice any of these symptoms, you need to have an examination as soon as possible.
If an examination shows that you do need root canal therapy, don’t worry — it’s one of the most routine and effective procedures in the arsenal of dental treatments and can often be accomplished in just one visit. The root canal process generally begins the same way as a filling does, and with no greater discomfort: an anesthetic is administered to numb the tooth and the surrounding area. For many patients, the worst is already over.
Next, a small opening is drilled through the surface of the affected tooth to give access to the inner pulp chamber and root canals. Tiny instruments are used, sometimes with the aid of a microscope, to remove the dead and dying pulp tissue from inside these narrow passageways. The chamber and empty canals are then cleaned and disinfected, while the tiny canals are reshaped. Then the area is prepared to receive a filling of elastic, inert, biocompatible material and a medication designed to prevent infection. Finally, adhesive cement is used to seal the opening in the tooth, preventing future infection, until a permanent seal is made with a crown.
Following root canal treatment, your tooth may feel some sensitivity or tenderness for a few days. Over-the-counter pain relievers like ibuprofen are generally effective in relieving discomfort, but prescription medications may also be given if needed. During this period, it may help to avoid biting hard on the affected tooth. All of these symptoms, however, should be temporary.
To further protect the tooth and restore it to full function, it’s usually necessary to have a crown or other restoration placed on it. Restorations can take many forms, from traditional gold crowns to tooth replicas made of high-tech tooth-colored material. In any case, you will have made an investment in preserving your dental health for years to come.
We’ve all heard the gag: “I’d rather have a root canal…” This comedy line, comparing the procedure to something truly undesirable, may be funny — but putting off needed endodontic treatment is no joke. The idea that a root canal procedure invariably comes with complications and pain is a shopworn myth. It’s certainly true that infection or inflammation in the tooth’s pulp can be excruciatingly painful. But you should remember that having a root canal results in eliminating this acute pain and is not the cause of the pain.
Need another reason not to delay root canal treatment? How about this: A natural tooth that’s saved via root canal treatment and restoration helps you avoid the problems that commonly occur when teeth must be removed. These include unwanted tooth migration or shifting, which can lead to difficulties in chewing; the need for bridgework or dental implants, which may be costly and complicated; and even the eventual loss of bone structure from the area of the missing tooth.
Most of the time, root canal therapy is effective at permanently relieving tooth pain and halting infection of the soft tissues deep inside the teeth and gums. But occasionally, as in any medical procedure, the body may not heal as we expect it to. After a period of time, you may experience pain in the affected tooth again — or, even if you have no symptoms, x-rays may reveal that infection is still present near the tooth’s roots. In that case, you may need root canal retreatment.
There are several reasons why your root canal treatment may not have succeeded at first. The “canals” themselves are slender, forked passageways deep inside the tooth that enclose nerves and blood vessels: the tooth’s soft “pulp.” They can be so narrow and intricate that some may have gone undetected, or failed to respond to treatment the first time. Or, the canals might have become re-contaminated via a number of routes: a delayed or ineffective crown restoration, new tooth decay, advancing gum disease, or a cracked or fractured tooth. Any of these conditions could result in reinfection.
If initial root canal (endodontic) therapy has failed, the first thing to do is evaluate your options. Besides retreatment, the alternatives may include endodontic surgery or extraction (removal) of the tooth. However, a missing tooth should be replaced by a dental implant, a bridge or a partial denture as soon as possible — and none of these are simple or inexpensive options. That’s part of the reason we prefer to help you retain your natural teeth whenever possible.
If endodontic retreatment is appropriate for you, the procedure is similar to a routine root canal, with a few added measures. After you are anesthetized (usually with a numbing shot), any restorations presently on your tooth — crowns, for example — will be altered to provide access to the root canal filling material. This is usually accomplished by making a small opening into the inner part of the tooth, removing filling material or obstructions, and cleaning the pulp chambers with tiny instruments.
A microscope and light are used to search carefully for additional canals or unusual structures. If the treatment process becomes extremely complex, it may be finished in a subsequent visit. Finally, when all the canals have been cleaned and disinfected, they will be filled with inert material and sealed. Then a temporary filling will be placed in the tooth. A permanent restoration will need to be placed at a later time.
Medicine and dentistry are as much art as science, and neither one can guarantee that any procedure will be 100% successful. While endodontic retreatment can be more complex than initial root canal therapy, it offers a good chance of success in many instances. And, since the field of endodontics is constantly evolving, it may be possible to use new techniques that weren’t available when your first root canal procedure was done.
Dentists take seriously our responsibility to help you understand the risks, benefits, and alternatives for treating root canal problems. When we recommend retreatment, it’s because we feel it is the best way for you to preserve your natural teeth — and we want you to be able to enjoy them for many years to come.
Occasionally, root canal treatment proves unsuccessful at resolving an infection in the tissues near a tooth’s roots. That’s when a minor surgical procedure called an apicoectomy may be recommended. Because this procedure is often performed with the aid of a microscope and other small specialized tools, it’s considered a type of endodontic microsurgery. Probably the most common type of root canal surgery, an apicoectomy involves removing a small portion of the apex (tip) of the tooth’s root, along with any surrounding hard or soft tissue that may be infected.
What would cause you to need an apicoectomy? There could be several reasons, including a canal that is blocked or inaccessible, an anatomical irregularity, or a fracture or crack in the tooth’s roots. The procedure is normally only recommended after one or more root canal treatments have been attempted, and have failed. Since this type of problem generally occurs near the apex of the root, the procedure is often an effective way to treat a persistent infection.
Before an apicoectomy procedure, diagnostic images (such as X-rays) of the affected tooth and surrounding bone, a careful review of your medical history including medications you take (both prescription and non-prescription), and other factors are reviewed. If an apicoectomy is recommended, the reasons for it will be explained to you.
Root canal surgery is usually performed under local anesthesia such as a numbing shot, so you won’t feel any pain. To begin the procedure, a small incision is made in the gum, and the infection at the end of the tooth’s roots is exposed. The infected tissue is then removed, along with a few millimeters of the root tip itself. A dye may be used to help make cracks or fractures easy to see; if we discover that the tooth is fractured, it may be better to extract (remove) it at this time instead of completing the apicoectomy.
Next, a microscope and light are used to examine the tiny canals. They will be cleaned with an ultrasonic instrument, then filled with an inert material and sealed up with a small filling. To finish the procedure, a small bone graft may be placed at the affected site, and then the gum tissue covering the tooth’s root will be sutured (sewn) closed. X-rays may also be taken as the procedure nears completion. Afterward, instructions on postoperative care will be given, and you’ll go home. Most apicoectomies take about 30 to 90 minutes to complete.
Following the procedure, you may experience some swelling and soreness in the area that was treated. Over-the-counter non-steroidal anti-inflammatory medications (such as ibuprofen) are usually all that’s needed to control any discomfort. You can probably return to normal activities the following day, but you may want to avoid eating hard or crunchy foods or brushing vigorously for a few days afterward. If your sutures aren’t self-dissolving, you will be asked to return in about a week to have them removed.
Although apicoectomy is typically a safe and effective procedure, there are slight risks with any type of minor surgery. That’s why apicoectomies are not recommended unless further root canal treatment won’t be effective. An alternative treatment in most cases would be the extraction of the tooth. However, our goal as dentists is to help you preserve your natural teeth for as long as possible.
While there are excellent methods of tooth replacement (such as dental implants), these involve further and more complex treatments, and they can be costly. An apicoectomy is generally a permanent and cost-effective solution which can help the tooth last for the rest of your life.