Root Canal
Treatment
You had a rough night. Your toothache that had been
escalating over
the past week had come to a dreadful
peak. You go to your dentist in the morning and he calmly tells you
that you need a root canal. Terror sets
in. Fortunately, if you ask around, more people have had root canals
than you might think, and more so
than not, you will surprisingly hear “oh, it’s not so bad”. Technology,
materials, and practitioner
experience have improved so much over the years that the myth of a
root canal being a fate worse than
death has been mostly dispelled.
What is a root canal and why
would I need
one?
Your teeth are not just solid pearly whites. They have up to four roots
which hold them into the gum and
bone below. These roots are actually hollow, with a very thin canal
space, about the diameter of a thread.
In this hollow space are the nerves and blood supply of the tooth.
You need these tissues for the growth and
development of the tooth. Typically, this “pulp” is needed only up
to about age 12. If you should have deep
decay (or a deep filling that may need to be placed when this decay
is removed), the pulp can be damaged,
sometimes irreversibly. This is what typically causes a toothache.
When a root canal is performed, the
damaged pulp is removed and replaced with a filling.
Does a root canal hurt?
It shouldn’t. Years ago “novocaine” was used to numb the area for
dental
treatment. Today, most dentists
use lidocaine, xylocaine, or carbocaine as the local anesthetic. Placed
in the appropriate locations, the
procedure will be pain-free. There are also new administering devices
that enable more profound
anesthesia, with less discomfort than ever before.
What should I expect?
You should anticipate being a little bored. Root canals now typically
take only one visit, in less than an
hour, and are no more traumatic than a filling. Typically, after the
root canal is done, there is little
discomfort. Only about five percent of patients need more than a couple
of Tylenol or ibuprofens.
Do root canals work?
Yes. They are probably more successful long term than any other dental
procedure. After the treatment is
done, a crown or cap may be necessary. Keep in mind, that like any
procedure where living tissue is
involved, nothing is one hundred percent successful. However, in the
small chance that there is a recurrent
problem, it can usually be resolved.
Can my regular dentist do a
root canal?
Yes. All dentists are trained to do root canals. However, many dentists
choose to refer their patients to an
endodontist, a root canal specialist, for more complicated cases.
Tell me more....
Simply put, when the nerves inside the tooth (the "pulp") gets
irreversibly
inflamed or infected, you need a root canal. Below is an explanation of
the procedure.
 |
This is a picture of your tooth. The pulp is the
soft tissue
inside
the tooth. It provides the tooth its ability to feel hot and cold, and
allows the tooth the essential blood supply and nutrients necessary
during
the tooth's development. |
| When decay gets real close to or into the pulp,
the tissue
becomes
very inflamed and sometimes infected. This inflammation and infection
inside
the tooth can be very painful. |
|
 |
The inflammation and infection
can also spread to the surrounding
bone and be sometimes more
painful and cause swelling. |
To
treat this,
first the decay
is removed,
an entry is made into the pulp,
and the pulp is removed.. |
 |
|
Finally, the canal spaces are filled,
usually with an inert material called
Gutta Percha, and a crown
is placed. After about 3-6 months,
the bone reforms. |
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After Completion
of Endodontic
Treatment
Endodontic treatment for this tooth has been completed.
The canals
inside
the roots have been cleaned and permanently sealed. However, there is a
temporary filling in the outer surface of the tooth. PLEASE CALL YOUR
DENTIST
FOR AN APPOINTMENT IN ABOUT TWO WEEKS FOR A PERMANENT FILLING OR CROWN.
This is very important for the protection of the tooth against fracture
or reinfection of the root canal. Although the nerves inside the tooth
have been removed, there are still many nerves outside the roots. These
nerves have been inflamed and may continue to be sensitive for a short
time after the root canal treatment. Avoid chewing with this tooth. Two
to four tablets of Ibuprofen (Advil, Motrin, etc.) taken four times a
day
for the next 3-4 days usually helps control the sensitivity. Frequent
rinsing
with hot salt water for the next two days will also help. If the doctor
has prescribed other medications, be sure to take as directed. We will
contact you by mail in six months for a follow-up appointment. We will
take an x-ray to ensure that the tooth and surrounding tissues are
healed.
If you ever have any questions concerning your treatment, please feel
free
to call us. Our doctors are available after hours through our answering
service.
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Non-Healing After
Endodontic
Treatment
Fortunately for everyone, most
root canals
heal
with about a 95% success rate. When they don't heal, we would prefer to
call this "non-healing" rather than "failing". Be aware that this is
not
mere carpentry -- it is a medical procedure and all medical procedures
do not heal 100% of the time, including root canals. Generally
speaking,
the non-healing takes one of two avenues:
1. Pain (mild to severe) with or
without
swelling,
or
2. No symptoms at all, but rather
changes on
the x-ray suggestive of non-healing (i.e.: bone dissolving around the
root
tips).
Typically, the non-healing is
caused by one
two
things:
1. inflammation, or
2. infection .
The inflammation may be from the
tooth being
inflamed
prior to treatment, or the treatment itself may elicit more
inflammation.
Usually time, non-steroidal medication (i.e.: Advil), or steroids
(i.e.:
dexamethazone) can resolve this. Infection can be from three main
causes:
1. the original infection persists, or
2. there is a crack in the tooth, or
3. there is leakage through the top
of the tooth
(i.e.: the filling) that re-infected the root canal filling.
If the non-healing is due to
infection,
usually
time and antibiotics will resolve this. If signs or symptoms persist,
there
are three options:
1. retreat the root canal, or
2. surgically clean the bone that
surrounds the
root tip and seal the tip of the root (apicoectomy), or
3. extract the tooth.
Obviously, every case is different
and careful
evaluation is paramount to resolving any conditions of non-healing.
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Apicoectomy 
When there is non-healing of a
root canal,
many
times it is because of a persistent infection, located typically at the
tip of the root of the offending tooth. When a root canal is done,
usually
the source of this infection is removed by cleaning out the inside of
the
root and sealing it up. However, sometimes this infection persists
outside
the tip of the root, possibly because of irregularities in the root
system.
This necessitates surgically cleaning out the infection around the
outside
of the root and then trimming off the tip of the root to reveal a clean
surface, and then the tip of the root is sealed.
|
Here is a picture of a tooth
that has had a root canal
(pink filling inside of canal
space)
and a crown. There is good
bone around the roots
|
|
|
On a rare occasion, the root canal treatment may
not heal,
either just
after the procedure, or years later. As described above, this infection
can be taken care of by antibiotics, or if necessary, retreatment of
the
root canal or an apicoectomy. |
|
When an apicoectomy is performed,
the area of
recurrent
infection is surgically cleaned out by making a small opening through
the
gums and using a surgical microscope. Then, a filling is placed into
the
tip of the roots associated with this infection.
|
|
|
When healing occurs, the bone fills in
where is was previously infected. |
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