Root Canal Treatment
Natural teeth are meant to last a lifetime. Even if one of your teeth should become critically injured or diseased, it can oftentimes be saved through a specialized dental procedure know as endodontic treatment commonly called a root canal. Although this technique has been around for several decades, recent advances in the field of endodontics have made root canal therapy almost a routine procedure.
To help you understand when and why such a procedure might be needed and how a damaged tooth can be saved, we have answered some of the most frequently asked questions about endodontic treatment.
What is endodontic treatment ?
Endodontics is the area of dentistry concerned with the prevention, diagnosis and treatment of disorders of the dental pulp (the tooth’s soft core). Years ago, teeth with diseased or injured pulps were extracted. Today, endodontic treatment gives dentists a safe and effective means of saving teeth.
What is the dental pulp ?
The pulp is a soft tissue that contains the nerves, arteries, veins and lymph vessels of a tooth. It lies within the dentin, the bone-like tissue that supports the enamel. Within the dentin, the pulp extends from the pulp chamber in the crown (the portion of the tooth visible above the gums) down to the tip of the root by way of the root canal. All teeth have only one pulp chamber, but teeth with more than one root with have more than one canal.
What happens to the damaged pulp ?
When the pulp is diseased or injured and unable to repair itself, the pulp dies. The most common cause of pulp death is a fracture or a deep cavity that exposes the pulp to saliva. The bacteria found in saliva causes infection inside the tooth. Left untreated, the infection eventually causes the pulp to die. Pus builds up at the root tip, forming an abscess that can destroy the supporting bone that surrounds the tooth.
Why does the pulp need to be removed ?
If the damaged or diseased pulp is not removed, the tooth and surrounding tissues become infected. Pain and swelling may accompany the infection. Even in the absence of pain, certain by-products of a diseased pulp can injure the bone that anchors your tooth in the jaw. Without endodontic treatment, your tooth will eventually have to be removed.
What does endodontic treatment involve ?
Treatment usually requires from one to three appointments. During these treatments, your dentist or endodontist (a dentist who specializes in disorders of the pulp) removes the diseased pulp. The pulp chamber and root canal(s) of the tooth is then cleaned, shaped, filled and sealed to prevent recontamination of the root canal system.
Here is how your tooth is saved through endodontic treatment :
1. First, the tooth is isolated from the saliva with a rubber dam (a sheet of rubber placed around the tooth). An opening is then made through the crown of the tooth into the pulp chamber. You may be given a local anesthetic prior to this step so that you will be more comfortable during treatment.
2. The pulp is then carefully removed from both the pulp chamber and root canal(s). The root canal(s) is cleaned, enlarged and shaped to a form that can be properly filled.
3. Medication may be put in the pulp chamber and root canal(s) between appointments to help eliminate bacteria and prevent infection.
4. A temporary filling will be placed in an opening in the crown of the tooth to protect the pulp chamber and root canal(s). If the pulp was severely infected, your dentist may leave the tooth open for a few days to drain. You may also be given antibiotics to help the body control infection that has spread beyond the tooth.
5. During the next stage of treatment, the temporary filling is removed. The pulp chamber and root canal(s) are then filled and permanently sealed with a material that prevents bacteria from re-entering the canal.
6. In the final step, a gold or porcelain crown is usually placed over the tooth to restore the tooth’s structure, function and appearance. If an endodontist performs the treatment, he or she will recommend that you return to your family dentist for this final step.
The type of material used for the crown will depend on where the tooth is located in your mouth, the color of the tooth and the amount of natural tooth remaining. A front tooth that affects appearance, for instance, most likely will be restored with a porcelain or a porcelain-fused-to-metal crown. When a back tooth has been badly fractured or decayed, a gold or porcelain-fused-to-metal crown may be used. Your dentist will discuss these options with you.
Why couldn’t you just remove the tooth ?
The choice is yours but there are many disadvantages to losing a tooth. When a tooth is removed and no replaced, the teeth next to the empty space begins to shift from their normal position. This may cause teeth to become crooked or crowded, which then decreases chewing and biting efficiency. Crowded or crooked teeth may be more prone to dental disease because they are harder to keep clean than properly aligned teeth. As a result, other teeth may be lost if the missing tooth is not replaced.
A replacement tooth (an implant or a bridge) is usually more expensive than endodontic treatment and involves more extensive dental procedures on adjacent teeth. Endodontic treatment can safely and comfortably save a tooth that otherwise would have to be removed. In fact, root canal therapy is successful approximately 95% of the time. Remember, a healthy restored tooth is always better than an artificial one.
How long will the restored tooth last ?
Your endodontically treated and restored tooth could last a lifetime, if you continue to care for your teeth and gums. As long as the root(s) of an endodontically treated tooth are properly nourished by the surrounding tissues, you tooth will remain healthy.
About Root Canal Treatment
Nothing is as good as a natural tooth! And sometimes your natural tooth may need root canal (endodontic) treatment for it to remain a healthy part of your mouth.
Most patients report that having root canal (endodontic) treatment today is as unremarkable as having a cavity filled.
If you’ve been told you need root canal (endodontic) treatment, you can find the answers to your questions below.
Who performs endodontic treatment ?
All dentists, including your general dentist, received some training in endodontics while in dental school. Often general dentists refer patients needing root canal treatment to endodontists.
What is an “endodontist” ?
Endodontists are dentists who specialize in treating the soft inner tissue of your tooth’s roots. After they complete dental school, they attend another dental school program for two or three more years. This program is called an advanced specialty education program. They study only endodontic treatment and learn advanced techniques so they can give you the very best care.
Endodontists are specialists. In their offices, they perform only endodontic procedures, both routine and complex. They are also experienced at finding the cause of oral and facial pain that is difficult to diagnos.
Why is there a need for endodontic treatment ?
Sometimes the pulp inside your tooth becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a blow to the tooth.
What are the signs of needing endodontic treatment ?
Signs to look for include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. But sometimes, there are no symptoms.
How does endodontic treatment save the tooth ?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it and restore it to full function.
Will I feel pain during or after the procedure ?
While many patients may be in great pain before seeing an endodontist, most report that the pain is relieved by the endodontist and that they are comfortable during the procedure. For the first few days after treatment, the tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. The endodontist will tell you how to care for your tooth at home.
How much will the procedure cost ?
The cost varies depending on how severe the problem is and which tooth is affected. Many dental insurance policies cover endodontic treatment. Generally, treatment and restoration of your natural tooth is the least expensive option. The only alternative is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting.
Will the tooth need any special care or additional treatment ?
You should not chew or bite on the treated tooth until you have had it restored by your general dentist because your tooth could fracture. Otherwise, just practice good oral hygiene – brushing, flossing and regular checkups and cleanings. Endodontically treated teeth can last for many years, even a lifetime.
What causes an endodontically treated tooth to need additional treatment ?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, your endodontist may discover very narrow or curved canals that could not be treated during the initial procedure. Sometimes a treated tooth may need endodontic surgery to be saved.
What is endodontic surgery ?
The most common endodontic surgical procedure is an apicoectomy or root-end resection. It is used to relieve inflammation or infection in the bony area around the end of your tooth that continues after endodontic treatment. The endodontist opens the gum tissue and removes the infected tissue and may remove the very end of the root. A small filling may be placed to seal the root canal.
Endodontists use local anesthetics, like those used when you have a cavity filled. Most patients return to their normal activities the next day. For more on surgery, see Endodontic Surgery.
Endodontics and Endodontists
An endodontist is a dentist who specializes in root canal treatment. Root canal, or endodontic treatment, is a procedure performed to remove damaged tissue from inside the root canals of a tooth. As a specialist, endodontists limit their practice to endodontic procedures. For more information on root canal treatment, see Treating Your Tooth to Endodontics.
Endodontists have advanced surgical and nonsurgical skills that make them uniquely qualified to treat routine as well as complex cases. The care that an endodontist provides is supported by intensive education on how to perform the very best endodontics. After completing dental school, endodontists attend a two- or three-year advanced dental school program that focuses only on endodontic science and procedures. Endodontists also attend continuing education courses after they are in practice, so they are knowledgeable about state-of-the-art research, clinical procedures, and technology.
Your Guide to Cracked Teeth
Today, people are keeping their teeth longer thanks to advances in dental procedures. At the same time, people are also exposing their teeth to many more years of crack-inducing habits and stress. Although cracked teeth are becoming more and more common, these teeth can often be saved if treated promptly.
How do I know if my tooth is cracked ?
Cracked teeth exhibit a variety of symptoms. If your tooth is cracked, you might feel occasional pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks are difficult to diagnose because the pain comes and goes, and cracks rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.
Why does my cracked tooth hurt ?
A crack in a tooth usually affects the soft inner tissue of the tooth called the pulp. The pulp contains blood vessels and nerves. When it is damaged, it causes pain. That is why a cracked tooth hurts—the pulp is damaged. To relieve the pain and save your tooth, the pulp needs to be gently treated.
Why have I been referred to an endodontist ?
Endodontists are dental specialists who diagnose and treat oral and facial pain. They specialize in root canal (endodontic) treatment, including any treatment for the inner soft tissues of the tooth. During dental school, all dentists are educated in treating the dental pulp. In addition to dental school, endodontists receive two or more years of advanced education in this kind of treatment. They study root canal techniques and procedures in greater depth, including the treatment of cracked teeth. For this reason, many dentists choose to refer their patients with cracked teeth to endodontists.
Why does my cracked tooth need to be treated ?
As mentioned earlier, cracks in teeth often affect the inner tissue of the tooth, the pulp. The pulp contains blood vessels, nerves and connective tissue. When a tooth is cracked, chewing can cause movement of the separate pieces of the tooth. This movement irritates the pulp and often causes pain. The tooth may also become sensitive to temperature extremes. In time, the pulp may become so irritated that your tooth may hurt by itself, even when you are not chewing, or eating or drinking something hot or cold. When the pulp becomes irritated, it needs to be treated in order to save the tooth.
How will my cracked tooth be treated ?
The treatment of your cracked tooth depends on the type and severity of the crack. There are five common types of cracks.
Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment.
The second type of crack involves the cusp. The cusp is the pointed part of the chewing surface of your tooth. If a cusp becomes weakened, a fracture can result. Part of the cusp may break off or may need to be removed by your dentist. But this type of crack, a fractured cusp, rarely affects the pulp. Because the pulp is not affected, it is very unlikely that you would need root canal treatment. Your tooth can usually be restored by your dentist with a crown or other restoration.
If your crack is diagnosed as a cracked tooth, then the crack probably extends from the chewing surface of the tooth vertically towards the root. Sometimes it extends below the gum line and into the root. A cracked tooth is not separated into two distinct segments, but the soft inner tissue of the tooth is usually damaged anyway. If this happens, you will probably need root canal treatment to remove the damaged tissues and save the tooth. It is particularly important to diagnose this type of crack early. In its earlier stages, a cracked tooth can still be saved.
If you have a split tooth, on the other hand, it can never be saved intact. A split tooth is often the result of an untreated cracked tooth that splits into two distinct segments. With endodontic (root canal) treatment, however, a portion of the tooth can sometimes be saved.
Vertical root fractures are cracks that begin in the root and extend toward the chewing surface. They show very few signs and symptoms and therefore may go unnoticed for some time. You may discover that you have a vertical root fracture when the bone and gum surrounding the root become inflamed and infected. Treatment usually involves extraction of the tooth, but sometimes endodontic surgery can save a portion of the tooth.
After treatment for a cracked tooth, will my tooth completely heal ?
Unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.
Despite the possibility for the tooth to worsen, the treatment you receive is important. It will relieve your pain and reduce the chances that the crack will worsen. Most cracked teeth continue to function for years after treatment. Your dentist or endodontist will be able to tell you more about your particular diagnosis and treatment recommendations.
If you have a tooth that has had endodontic (root canal) treatment, it can last as long as your other natural teeth. In some cases, however, complete healing may not occur. There may be new problems months or even years after the initial treatment. When this happens, it is sometimes possible for your endodontist may be able to perform the treatment again with more successful results. This process is called retreatment.
Who performs endodontic retreatment ?
All dentists are educated in endodontic treatment. Retreatment, however, can be more challenging than the initial treatment. For this reason, many dentists refer their patients in need of retreatment to endodontists.
What is an endodontist ?
Endodontists are dental specialists who diagnose and treat oral and facial pain. They specialize in endodontic (root canal) treatment, including any treatment for the soft inner tissues of the tooth, the pulp. In addition to dental school, endodontists receive another two or more years of advanced education. They study root canal techniques and procedures in greater depth, including the area of retreatment.
Why does my tooth need retreatment ?
Occasionally, healing may not occur as expected after an initial root canal procedure. This can happen for a variety of reasons—new decay, a broken or cracked crown, or canals that were not detected during the first procedure. By performing the procedure a second time, endodontists can often save your tooth.
What happens during endodontic retreatment ?
First, your endodontist will remove the restoration or crown and the filling materials inside your tooth to reclean the canals and take a closer look at the inside of your tooth. Examination of the inside of your tooth may determine what caused the first treatment to fail.
Next, your endodontist will fill and seal the canals with a rubbery material called gutta-percha, and then place a temporary filling in the tooth.
The entire root canal procedure may require just one or perhaps several trips to your endodontist’s office. Talk to your endodontist for information on your retreatment.
After retreatment, your family dentist should place a new crown or other restoration on your tooth. Returning to your dentist is very important because the crown will restore your tooth and help protect it from more damage.
Is retreatment the best treatment option for me ?
The decision to retreat should be made by you, your dentist and your endodontist. While retreated teeth can last a lifetime, there is no guarantee that treatment will be more successful the second time. The treatment option for any particular patient must be chosen on an individual basis.
How much will retreatment cost ?
The cost of retreatment varies depending on the complexity of the procedure. It will probably cost more than the initial procedure, because your restoration and root filling materials must be removed before the second treatment can begin. Also, your endodontist may need to spend more time searching for problems that may have caused the initial treatment to fail.
The only alternatives to retreatment are having the tooth extracted or having it retreated surgically, if the root cannot be accessed through the crown. If the tooth is extracted, it must be replaced with a bridge, implant or removable partial denture. This will restore chewing function and prevent adjacent teeth from shifting. Generally, nonsurgical retreatment and restoration of your natural tooth is the least expensive option. Your dentist will be happy to discuss the various treatment options and their costs with you.
Why do I need endodontic surgery ?
Before understanding endodontic surgery, it is important to understand nonsurgical endodontic treatment. Nonsurgical endodontic treatment is more commonly known as root canal treatment. It is necessary when the soft inner tissue of the tooth, the pulp, becomes inflamed or infected. Endodontic treatment involves removal of the damaged pulp. The canals are then cleaned, filled and sealed to preserve the tooth.
Sometimes endodontic treatment alone cannot save your tooth, and your dentist or endodontist may recommend endodontic surgery. Endodontic surgery includes any surgical procedures used to remove infection from your root canals and surrounding areas. Surgery can also be used in diagnosing problems that do not appear on your x-ray, such as root fractures, or in treating problems in the surrounding bone.
Who performs endodontic surgery ?
All dentists are trained in endodontic treatment. Because endodontic surgery can often be more challenging than routine treatment, many dentists refer patients needing surgery to endodontists.
Endodontists are dental specialists who diagnose and treat oral pain. They specialize in endodontic (root canal) treatment, including any treatment for the inner tissues of the tooth. In addition to dental school, endodontists receive two or more years of advanced education. They study root canal techniques and procedures in greater depth, including the area of endodontic surgery.
What is an apicoectomy ?
An apicoectomy is the most common endodontic surgical procedure. This procedure is used to remove infection or inflammation from the bony area around the end of your tooth. The endodontist starts by opening the gum tissue near the tooth. This allows him or her to see the underlying bone.
Next, your endodontist will remove any inflamed or infected tissue. The very end of the root is also removed.
After the inflamed or infected tissue is removed, a small filling may be placed in the root-end to seal the root canal. A few stitches are placed in the gum to help the tissue heal properly. Within a few months, the bone heals around the end of the root.
Are there other types of endodontic surgery ?
There are several other types of surgery that are performed, depending upon the situation. Your endodontist will be happy to discuss the specific type of surgery that you might need.
Will endodontic surgery hurt ?
Your endodontist will provide you with local anesthetics that will make the procedure comfortable. You may feel some discomfort or experience slight swelling after the procedure, but this is normal for any surgical procedure. If necessary, your endodontist will recommend appropriate pain medication to alleviate your discomfort.
What do I do after the surgery ?
Your endodontist will give you specific postoperative instructions to follow. If you have questions or if you have pain that does not respond to medication, call your endodontist.
Can I drive myself home ?
Patients who have had endodontic surgery are usually able to drive themselves home. But it is a good idea to talk to your endodontist about this prior to your appointment to decide if other transportation arrangements will be necessary.
When can I return to my normal activities ?
Most patients return to their normal daily activities one or two days after their surgery. Your endodontist will discuss your expected recovery time with you.
Does insurance cover endodontic surgery ?
Many insurance plans do cover endodontic surgery. Each insurance plan is different, however. You should consult with your employer or insurance company prior to treatment.
What are the chances that the surgery will be successful ?
Your dentist and endodontist have suggested endodontic surgery because they believe it is the best option for you. Your endodontist will discuss your chances for a successful surgery so you can make an informed decision. Keep in mind that there are no guarantees with any surgical procedure.
What are the alternatives if I choose not to have surgery ?
Most often, the only alternative to surgery is extraction of the tooth. You must then replace the extracted tooth with an implant, bridge or removable partial denture. These will restore chewing function and prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option. No matter how effective modern tooth replacements are, nothing is as good as your natural tooth.
Saving a Knocked-Out Tooth
Approximately one to three million permanent teeth are accidentally knocked out each year. Both adults and children are at risk.
With proper emergency action, a tooth that has been entirely knocked out of its socket often can be successfully replanted and last for years. Because of this, it is important to be prepared and know what to do if this happens to you or someone with you. The key is to act quickly, yet calmly, and follow these simple steps.
Pick up the tooth by the crown (the chewing surface) not the root.
The tooth should be handled carefully – touch only the crown – to minimize injury to the root.
Clean tooth with water.
If dirty, gently rinse the tooth with water, remembering not to handle the root surface.
Do not use soap or chemicals.
Do not scrub the tooth.
Do not dry the tooth.
Do not wrap it in a tissue or cloth.
Reposition tooth in socket immediately, if possible.
The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.
Keep tooth moist at all times.
The tooth must not be left outside the mouth to dry. If it cannot be replaced on the socket, put it in one of the following:
Emergency tooth preservation kit
Mouth (next to cheek)
If none of these is practical, use water (with pinch of salt if possible).
See a dentist as soon as possible.
Bring the tooth to a dentist or endodontist as soon as possible – ideally within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.