Root Canals/Endodontics

image32Removing the pulp tissue of a tooth is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy.  Root canal therapy (RCT) is necessary when the nerve and blood supply to the tooth have been damaged beyond repair.  In healthy teeth the pulp tissue, which includes connective tissue, nerves and blood vessels, nourishes the tooth.  The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha.

Why are Root Canals Needed?

Root canal treatment is needed for two main reasons, the primary of which is infection. An untreated cavity is a common cause of pulpal infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to infect the pulp, which becomes a source of irritation and infection until treated.

The second reason for a root canal is damage to the pulp that can’t be fixed. Examples include trauma or a fractured tooth. Sometimes dental work such as fillings or crowns that are close to the pulp can irritate it enough as well.  Then the tooth might need a root canal. However, when the pulp is inflamed but not infected, it may heal on its own. Dr. Victor will exam the tooth and run several tests to see if this might be the case before doing root canal treatment.

Signs and Symptoms

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:  

  • It hurts when you bite down on it, touch it or push on it
  • It is sensitive to heat
  • It is sensitive to cold for more than a couple of seconds
  • There is swelling near the tooth
  • It is discolored (whether it hurts or not)
  • It is broken

To determine whether your tooth needs root canal treatment, Dr. Victor will perform several tests to see if it is more or less sensitive than a normal tooth.  Dr. Victor will also take an X-ray to determine if there is a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root, which are signs of infection and inflammation. If either of these is present, you are likely to need a root canal procedure.

What can happen if left untreated?

An infection in the pulp can be very painful, and if left untreated it can spread throughout the body.  Typically the first place infected is the bone around the tooth. The localized infection can cause an abscess, which is an area of pus that forms as part of the body’s effort to fight a bacterial infection. If the abscess does not find a path of drainage, it can cause severe swelling, and may even block off the patient’s airway in a process called Ludwig’s angina.  If such swelling occurs, the patient should seek emergency medical treatment immediately.

An untreated infection of the pulp can also allow the bacteria to spread systemically, allowing it to lodge in other areas of the body, including the brain.

In general, any infection, including dental infections, should not be left untreated.

Alternatives to Root Canals

If you ignore an infected or injured tooth, the infection can spread to other parts of your body, and may even be life threatening. Therefore, it is important to remove the source of infection by either treating the tooth via root canal therapy or extracting  the tooth.

In general, it is better to keep your natural teeth if you can.  If a tooth is missing, neighboring teeth can drift out of line and opposing teeth may super-erupt. Remaining teeth also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges.

Other options to consider for the restoration of missing teeth include implants, bridges , and removable partial dentures.

Talk to Dr. Victor to determine the most appropriate treatment for you.

After Root Canal Treatment

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

Immediately after root canal treatment, your tooth may be sore for two to three days, until your body has had a chance to heal from the infection and trauma. The worse the infection and inflammation were, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. Assuming no medical contraindications, you can take over-the-counter pain relievers. A pain reliever that also reduces inflammation is likely to be most helpful. Examples include ibuprofen and aspirin.

After the tooth has been allowed to heal, the temporary filling will be replaced by a permanent one.  In many cases, a root canal treated tooth will need a crown. Since the pulp tissue has been removed during the root canal, the tooth’s nutritional supply has been dramatically decreased, and the tooth will be weaker.  A crown will help to restore the tooth’s strength and protect it from cracking. If a crown is indicated it should be placed soon after having root canal treatment.