Root Canal Therapy

Teeth are living parts of the body. The pulp chamber and canals carry blood vessels and nerves, from the apex (the tip of the root imbedded in the bone) into the crown of the tooth. Trauma, (a hard bump to the tooth) or decay, are the most common reasons for the nerve within the tooth to “die”. When the nerve dies, bacteria work their way through the entire length of the tooth from the apex. When the bacteria exits the tooth, the body’s defenses kill the bacteria, creating pus. If the pus can quickly find a route to the surface (a fistula), there is little or no pain. If it can’t, the patient feels a deep, throbbing pain that is usually quite intense.

When a dentist performs a root canal, he is trying to remove the dead nerve tissue and disinfect the interior of the tooth. Most of the time the procedure is successful. Many times it is not. Dentin is composed of small tubules. A bicuspid tooth has 2-3 miles of dentinal tubules. It has been shown that the bacteria can live in these tubules and continue to produce toxins that can get to other parts of the body. The root canal can appear to be successful, because there is no longer any pain, yet be the breeding ground for a countless number of bacteria.

Should root canals no longer be performed? Should you get your existing root canal teeth removed? My personal belief is this: If you are currently in good health and have no pain associated with your present root canal teeth; leave them alone. A patient who tells me, “the tooth has never felt right since the root canal,” should consider its extraction. If you want/need a root canal and are in good health, mark the date of the root canal on a calendar for reference. Go ahead and get the root canal but keep a close eye on your general health. If you notice a worsening of your health, you may want to reconsider the root canal tooth. If you are already in poor health or have a chronic illness, a root canal should probably be avoided, and a bridge or implant maybe a better choice for you. Personally, I would not have a root canal.

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function. However the tooth is now dead and dentistry is the only health profession that believes one can keep a dead portion of the body attached without consequences.

Having a root canal done on a tooth is the 'standard of care' to save a dead tooth that otherwise would have to be removed. 

Root canal treatment is often successful and is expected to last a lifetime, however on occasion, a tooth will have to be retreated or extracted due to new infections or old ones that never quite heal leaving an area on the Xray that still shows up or the tooth simply may never feel 'right'.

Signs and symptoms for possible root canal therapy:

  • An abscess (or pimple) on the gums.
  • Sensitivity to hot and cold.
  • Severe toothache pain.
  • Sometimes no symptoms are present.
  • Swelling and/or tenderness.

Reasons for root canal therapy:

  • Decay has reached the tooth pulp (the living tissue inside the tooth).
  • Infection or abscess have developed inside the tooth or at the root tip.
  • Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment.  Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

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