What is a Root Canal?

Root canal therapy (also called endodontic therapy) corrects disorders of the pulp or nerve of the tooth. From the outside the tooth looks like a hard, solid substance. In fact, it is a complex system of specialized tissues. Generally speaking the tooth is made up of three parts. The crown is the part of the tooth you see in the mouth and is used to chew your food. The root is the part of the tooth that sits in the bone below the gum. It is about twice as long as the crown and anchors the tooth in the bone socket. The pulp tissue is located inside the root of the tooth which is a hollow structure. This soft tissue is composed of nerves, blood vessels, and connective tissue. The pulp provides nourishment for the tooth and is what makes the tooth vital or alive. It is commonly called "the nerve."

With the latest technologies and anesthetics, root canal treatment is no more uncomfortable than having a filling placed. 

Root canal therapy or endodontic treatment becomes necessary when the pulp tissue becomes inflamed or infected. It involves removing of the damaged pulp tissue and replacing it with an inert material called gutta percha.

When is Root Canal Treatment Needed?

A root canal becomes necessary if the pulp tissue or nerve inside the tooth becomes inflamed or infected. This can be caused from several things. The most common cause is tooth decay progressing down into the tooth that allows harmful bacteria to reach the soft tissue. Other causes are trauma or an accidental blow to the tooth, multiple fillings over the years, or a broken down tooth needing a crown (cap). All these things can cause the pulp to become inflamed or infected. The inflammation and infection can also spread into the surrounding bone at the end of the tooth. The tooth and surrounding area may become very painful and swelling may occur. Once this happens a root canal procedure must be performed in order to save the tooth. The only alternative is having the tooth extracted.

Who Performs a Root Canal?

All dentists, including your general dentist, received some training in endodontics while in dental school. Often general dentists refer patients to an endodontist who specializes in root canal treatment. 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 diagnose.

What Patients Should Expect

The thing most patients are concerned with is whether or not the procedure will be painful. With the latest technologies and anesthetics, root canal treatment is no more uncomfortable than having a filling placed. While many patients may be in great pain before seeing an endodontist, most report that the pain is relieved by the treatment and 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.

During the root canal procedure, the endodontist or general dentist carefully numbs the tooth, removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space to prevent further infection and discomfort.

With properly performed root canal procedures, teeth can function normally for a lifetime. However, after a root canal, it is essential that the patient return to his or her general dentist or prosthodontist to have a crown or other restoration placed over the endodontically treated tooth to protect it. Often a post and core procedure will be done prior to making the crown to restore the tooth to its original form and function.

Key Indicators of the Need for Root Canal Treatment

The most common complaint that brings the patient to the dental office is pain or discomfort. Besides pain, signs to look for include prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes the tooth becomes sensitive to chewing or to tapping. A tooth that becomes badly decayed or injured may need treatment.

Besides pain, signs to look for include prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. 
 

Your dentist will do a series of test to isolate the offending tooth. Occasionally a x-ray will show evidence of an abscess at the end of an infected tooth. Results of these tests will indicate whether of not an endodontic procedure is necessary.

A common belief is that by removing the nerve the tooth becomes "dead". This is not true. The tooth may no longer be vital but is very much alive and functioning because it receives a source of blood supply and nerve supply from the surrounding tissues that hold it in place in your jaw bone. The tooth will have no sense of feeling to hot, cold, or sweets but will be responsive to biting pressure etc. With proper restoration the tooth should last as long as your other teeth and can even be used as a anchor tooth for a partial denture or cemented bridge. The success rates for root canal therapy have been reported to be as high as 95 percent.

Root Canal Therapy Verses Extraction

Many people feel that having a tooth extracted and replaced with a bridge or an implant is a good alternative to having root canal treatment. However, this is not true for several reasons.

First, nothing can completely replace your natural tooth. An artificial tooth can sometimes cause the patient to avoid certain foods. Maintaining the natural dentition is important so that the patient can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in his or her diet.

Second, endodontic treatment, along with appropriate restoration, is a cost effective way to treat teeth with damaged pulps and usually is less expensive than extraction and placement of a bridge or an implant. As previously mentioned, endodontic treatment has a very high success rate.

Third, placement of a bridge or an implant will require significantly more time in treatment and may result in further insult to adjacent teeth and supporting tissues. Millions of endodontically treated teeth have been well maintained in patients for many years after the initial treatment. These now healthy teeth are helping patients chew efficiently and help to maintain the natural appearance of their smile.