Read some Frequently Asked Questions About Root Canal Therapy.
What is a root canal?
A root canal is the removal of the inflamed, dying, dead or infected material found in the center of the tooth, the cleaning, shaping and tapering of the center of the root, and the sealing of the root to enable the bone and tissue around the root to heal. The pulp or nerve normally contains nerve tissue, blood vessels, and connective tissue. The nerve or pulp is only responsible for the development and formation of the root structure when you are a child. When this pulp or nerve has become infected, root canal therapy is needed.
WHY WOULD I NEED A ROOT CANAL?
Endodontic treatment is necessary when the pulp (nerve) becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, a crack or chip, biting on an un-popped piece of popcorn or any other trauma to a tooth. In addition, a blow to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain, lead to an abscess, or even the loss of the tooth.
Signs of pulp damage may include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, swelling and tenderness nearby the gums and pain on biting and or releasing. Sometimes, there are no symptoms.
How does endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans, shapes and tapers the inside of the root, then fills and seals the space. Endodontic (root canal) treatment is based on a very simple concept: the dental pulp in a mature tooth can be removed when it becomes inflamed or infected and the tooth remains healthy without it.
The pulp itself consists of very small blood vessels and nerve tissue located in the center of each tooth in the root canal. The primary function of the pulp is to lay down hard tooth structure (dentin) during the developmental stage of each tooth. It has a limited blood supply, however, and is highly susceptible to inflammation and infection, which is why it causes problems. Afterwards, you will return to your dentist, who will place a permanent restoration on the tooth to protect and restore it back to full function.
HOW IS ENDODONTIC TREATMENT PERFORMED?
Although the rationale for endodontic treatment is uncomplicated, the treatment itself can, at times, be tedious and complex. As we age, the canals in our teeth tend to narrow or “calcify.” This can make the process of locating and cleaning them somewhat time-consuming. To begin, a local anesthetic is administered and, once the area is completely numb, treatment is initiated.
An opening is made in the biting surface on a back tooth or the tongue side of a front tooth. Through this access-opening, small instruments (files) are inserted to remove the pulp tissue and widen the root canals. This accomplishes two things: first, it eliminates the pulp, which is the source of inflammation or infection and second, it creates a shape inside the tooth that will accept a root canal filling.
The filling material is called gutta-percha, which is a rubber-like material that is biocompatible and has been used successfully for this purpose for many years.
WILL I FEEL PAIN DURING THE PROCEDURE?
With the use of modern techniques, root canal treatment typically involves little or no discomfort. Often there is pain before the treatment and endodontic therapy provides relief within 12 to 36 hours. While there may be a feeling or awareness that the Endodontist is doing something there is usually no pain during the procedure. Many people report that it is similar to having a filing placed.
Will I feel pain after the procedure?
For the first few days after treatment, your tooth may feel sensitive or tender to tapping or touching, especially if there was pain or infection before the procedure. These mild symptoms can last for up to a week after the root filling has been carried out and are not unusual.
If postoperative pain persists or increases in severity, please call our office. We ask you not to chew on the tooth being treated as this may cause pain and or damage the tooth. Discomfort can usually be relieved with over-the-counter medications.
Dr. Lubit will usually give you a written prescription for an antibiotic and a painkiller to either hold as a precaution or to take as instructed. Cleaning the root canal system may cause some inflammation of the surrounding tissues.
What can I expect to feel after my root canal?
The pain to hot and cold that was coming from the tooth that was treated will usually be gone within a few days. Vague facial pain and aching or throbbing coming from the tooth that we treated will usually take a little longer to dissipate as will pain on biting or chewing. It is very common for slight tenderness or soreness to linger after a visit.
WHAT ARE THE BENEFITS OF ENDODONTIC TREATMENT?
Endodontic treatment saves teeth that would otherwise need to be extracted. Although the pulp (nerve) is removed, the treated tooth remains alive, nourished by the surrounding tissues. The pulp or nerve is only responsible for the development and formation of the root structure when you are a child. There is no real substitute for your own tooth in terms of health and investment.
WHAT CAUSED THE PROBLEM WITH MY TOOTH?
The most common cause of pulp (nerve) damage is decay or a fracture that exposes the pulp to bacteria that can cause infection. Other causes of pulp damage include traumatic injuries, such as a blow to the tooth, a cracked or loose filling or repeated fillings in a tooth and occasionally gum disease.
What could cause the pulp to become inflamed or infected?
Decay, trauma, or extensive restoration of a decayed or cracked tooth may result in pulpal inflammation or infection. Pulpal inflammation is a common occurrence following a deep restoration (filling) or preparation for a full crown. Unfortunately, fillings do not last forever.
Over time they can break down and begin to leak which can promote decay or small cracks in the underlying tooth structure. For this reason, fillings eventually need to be replaced or, in some cases, filled teeth may require the support of a full crown restoration.
The very act of replacing a restoration or preparing a tooth for a crown may result in inflammation and a damaged pulp. Evidence of this inflammation may be extreme sensitivity to cold, heat, discoloration of the tooth, spontaneous pain, and pressure from biting. Endodontic treatment eliminates this sensitivity and allows the tooth to be healthy and functional.
HOW MANY TREATMENTS ARE NECESSARY?
Root canal or endodontic therapy is usually completed in two visits. One visit procedures can be done on certain selected teeth. Some complex or problematical teeth will sometimes require additional visits.
HOW LONG WILL THE TOOTH LAST?
With a timely and proper restoration and care your tooth may last a lifetime.
What is the success rate for endodontic treatment?
Success rates are in the 92 to 95% range. Factors that may limit the success are the presence of lateral canals or irregularities in the root canal system that are difficult to thoroughly clean, cracks in the tooth that permit contamination from the outside of the tooth, a root canal tooth that is not promptly restored by your general dentist, periodontal disease, and a lack or proper hygiene.
These limiting factors are infrequent and the majority of endodontically treated teeth remain comfortable and functional for a long time.
How should a tooth feel after endodontic treatment?
It is a very common misunderstanding that a tooth is “dead” or without any sensation following endodontic treatment. The pulp that is removed from within the tooth is, however, is responsible for only part of the feeling of the tooth. Around the outside surface of the root area is the source of nutrition that keeps the tooth alive, the periodontal ligament.
The nerves in this area transmit pressure and pain sensitivity. The periodontal ligament is not only alive but also somewhat temporarily inflamed from an endodontic procedure.
For this reason, it is normal for a tooth to be pressure sensitive following endodontic treatment. The severity and duration of this pressure sensitivity depends on the prior condition of the tooth as well as the amount of manipulation required during treatment. Sensitivity to a degree that requires analgesics usually decreases fairly quickly after your visit.
The most common discomfort that continues is an awareness or low grade pain from tapping or moving the tooth from side to side.
WHAT DO I DO AFTER ROOT CANAL TREATMENT IS COMPLETED?
Once treatment is completed, you will need to return to your dentist for the final restoration of the tooth. Your own dentist will provide the check-ups and future care for your dental health.
HOW MUCH DOES ROOT Canal TREATMENT COST?
The expense of an endodontic procedure varies depending on the tooth being treated and how severe the problem is. Molars with two, three or four canals are more difficult to treat and the fee is accordingly more. Endodontic treatment is usually more economic in the long term than alternative treatments, such as extraction and restoration of the missing tooth with bridges or implants.
WHAT ARE THE ALTERNATIVES TO ENDODONTIC TREATMENT?
Extraction is the only alternative. Unless the extracted tooth is replaced, adjoining teeth will shift, interfering with biting and chewing. The loss of a tooth can lead to periodontal disease and eventually the loss of additional teeth. Replacing a tooth with an artificial one may often require dental procedures on adjacent healthy teeth.
CAN ALL TEETH BE TREATED ENDODONTICALLY?
Occasionally a tooth cannot be saved by root canal treatment. Endodontic treatment can only be performed if the root canals are accessible and can be adequately cleaned and filled. A tooth must also have sufficient bone support and structure to allow it to properly function after a root canal.
CAN THE TREATMENT FAIL?
A tooth that has undergone endodontic therapy can occasionally fail. Root canal treatment is performed because the soft inner tissue of the tooth, called the pulp, has been damaged. As with any other part of the body, treatments can be unsuccessful. Sometimes for no known reasons, the hard and soft tissues surrounding the tooth may simply fail to heal.
As with any procedure dealing with the healing of the body, nothing is 100% successful. In other cases, a new problem can jeopardize a tooth that was successfully treated.
* New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
* A loose, cracked or broken crown or filling can also expose the tooth to new infection.
WILL I NEED TO RETURN FOR ANY ADDITIONAL TREATMENT?
You must see your general dentist to restore the tooth that has had a root canal 1 to 2 weeks after treatment is completed. Your tooth should be examined six months to a year after treatment to make sure that it has healed properly. While there is no charge for this you may alternately have your dentist send us a copy of an x-ray.
WANT TO KNOW MORE?
If you have any further questions or are worried about treatment, please telephone our practice and we will be happy to talk with you. If you have an emergency, please feel free to call.
Why do I need another endodontic procedure?
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
* Narrow or curved canals were not treated during the initial procedure.
* Complicated canal anatomy went undetected in the first procedure.
* The crown or other restoration was not placed soon enough after the procedure.
* The restoration did not prevent saliva from contaminating the inside of the tooth.
What are the alternatives to re-treatment?
For some patients considering re-treatment, endodontic surgery is also an option. This surgery involves making an incision near the end of the root to allow the tip of the root to be re-sealed. Endodontic surgery (Apicoectomy) may be recommended in conjunction with re-treatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment. In other cases, a new problem can jeopardize a tooth that was successfully treated.
* New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
* A loose, cracked or broken crown or filling can expose the tooth to new infection.
The only other alternative is extraction (removal) of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting.
How much time will it take?
Most root canals can be done in 2 visits. Visits are usually a week to 10 days apart to allow for healing and comfort. The amount of time at any one visit will depend upon how long it takes for you to get numb and the difficulty or complications associated with your particular tooth.
Previous work on your tooth, obstructions, curved roots and calcified canals can also increase the complexity and therefore the treatment time. If you have a portable listening device with headphones (such as an MP3 player, walkman, personal CD player etc), feel free to bring it with you if you like.
Certain root canals can be completed in one visit, but will require additional time to accomplish this. This can be discussed during your consultation.
Should I take or stop taking any medications before my visits?
Patients should take all medications as prescribed by their doctors. If you premedicate with antibiotics for any dental procedures you should premedicate before you see us.
A review of your medical history will be done to ensure that our treatment does not interfere with the medications you are already taking. If you have any questions do not hesitate to contact you physician and or pharmacist.
Can I eat after my root canal?
You should not eat for at least 1 hour after each visit nor until the numbness has gone. A temporary filling will be placed onto the top of your tooth so that food and debris do not pack into the tooth. It is safer to plan for a soft meal after your visit, and to avoid chewing on the tooth and side that was treated until you return to your regular dentist.
This will help to protect your tooth and decrease the chances of a crack or fracture. Hard foods such as jawbreakers, popcorn, and nuts should be avoided completely.
How long do I wait to see my regular dentist?
You should see your referring dentist about 2 weeks after we complete the root canal therapy. Make an appointment right away as delay could cause you to lose a tooth. Sometimes decay, cracks, or fracture lines in your tooth is what caused the tooth to need a root canal.
This prior damage along with the additional drilling necessary for treatment can leave a tooth at great risk of further fracture if it is not restored promptly and properly. It is critical to success that your tooth is properly restored by your general dentist as soon as possible.
Your regular dentist will determine with you the best course of action to restore and protect your tooth. This can be in the form of a new crown, core and post build up, repair of an existing crown or other measures to minimize the risk of re-contamination and fracture so that your investment in dental health is successful and protected.