Root Canal Therapy


What is endodontic (Root Canal) treatment?

“Endo” is the Greek word for “inside” and “odont” is Greek for “tooth.” Endodontic treatment treats the inside of the tooth.
To understand endodontic treatment, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue and creates the surrounding hard tissues of the tooth during development.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development. However, once a tooth is fully mature it can survive without the pulp, because the tooth continues to be nourished by the tissues surrounding it.

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Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury 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 or lead to an abscess.

What are the signs of needing endodontic treatment?

Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gingival (Gum) tissues. Sometimes, however, there are no symptoms.

How does endodontic treatment save the tooth?

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the canal, a channel inside the root, then fills and seals the space. Shortly afterwards, you will need to return to your general dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.

Endodontic Procedure
Endodontic treatment will usually be performed in one or two visits and involves the following steps:

 

rct11. The endodontist examines, performs diagnostic tests, and takes a digital radiograph of the tooth, and then administers local anesthetic. After the tooth is numb, the endodontist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure.

 

 

rct22. The endodontist makes an opening in the crown of the tooth. Very specialized small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling.

 

 

 

rct33. After the space is cleaned and shaped, the endodontist fills the root canals with a biocompatible material, usually a rubber-like material called “gutta-percha.” The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your general dentist before the tooth is restored.

 

 

rct44. Once treatment is completed with your endodontist, you must return to your general dentist to have a crown or other permanent restoration placed on the tooth to protect and restore it to full function.

 

 

 

rct55. If your tooth lacks sufficient structure to hold the restoration in place, your general dentist or endodontist may place a post inside the tooth. Ask your dentist or endodontist for more details about the specific restoration planned for your tooth.

 

 

 

 

What will I feel during and after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, patients report that they are comfortable during the procedure.

For the first few days after treatment, your 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. Follow your endodontist’s instructions carefully, and contact our office if you have any questions or concerns.

Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.

Will my tooth need any special care or additional treatment after endodontic treatment?
You should not chew or bite on the treated tooth until you have had it restored by your general dentist.  Your unrestored tooth is susceptible to fracture, so you should see your general dentist for a full restoration within 4 to 6 weeks. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not fully heal or pain lingers or continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure can save the tooth.

What causes an endodontically treated tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, your endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure. Also periodontal (gum) disease can be a cause of failure.

Can all teeth be treated endodontically?
Most teeth can be treated endodontically. Occasionally, a tooth cannot be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not indicated, endodontic surgery may be able to save the tooth.

 

As an endodontic patient in your office, what should I expect?
After checking in at the front desk, we will give you a tour of the office and bring you to your treatment room. One of our certified dental assistants will take an x-ray and complete the preliminary exam. After the results are shared with the Doctor, he will come in and greet you, review the x-ray and perform his exam.  Then a diagnosis is made. This will be discussed thoroughly with options addressed, risks discussed, and all questions answered.

If treatment is recommended and you agree to a treatment plan, then we will place topical anesthesia to start numbing your gums before we give the local anesthesia to put the tooth to sleep. Our doctor’s are very good at getting difficult teeth to numb! We will then isolate the tooth with a dental barrier called a rubber dam.  This keeps out bacteria / saliva from the tooth and protects you from swallowing any small instruments we use or from ingesting the medicines we use to cleanse the tooth, (which don’t taste very good). We will then use the drill and our hand instruments or files to clean out inside the tooth (many patients think these are pins). A few x-rays are taken at this step also. We let our medicine sit inside the tooth for several minutes to make sure it has been sterilized and cleaned and then we dry the tooth using small points of paper. Now that the tooth is sterile, clean and dry, we will place our filling material. A few x-rays may be required to check if it is in the perfect spot, and if more filling material is needed, before the tooth is complete and the assistant places the temporary filling on it. One last x-ray, review of the home care instructions and then a good-bye from the doctor and you are done with the root canal treatment.  The next step is to place a crown at your general dentist’s office in about two weeks

Your initial appointment will consist of a consultation where we will diagnose your tooth and determine what needs to be addressed. If treatment is recommended then you will have the option of having the treatment that same day. We take a conservative treatment approach and sometimes our patients are surprised to find they do NOT require root canal treatment. If  however, we determine root canal treatment is required to save your natural tooth, we will then fully discuss with you all the treatment options, risks and benefits. Please assist us by providing the following information at the time of your consultation:

-Your referral slip and any x-rays if applicable
-A list of medications you are presently taking
-If you have  dental insurance, please provide the necessary information to verify your eligibility to  retrieve your benefits. This will save time and allow us to help you process any insurance claims.

Important:

-All patients under the age of 18 years of age must be accompanied by a parent or guardian at the consultation visit.
-Please alert our office prior to your procedure if you have a medical condition that may be of concern (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.)
-Also please note: it is important to have regular meals before your treatment. It is not necessary to be NPO (nothing by mouth), or fasting prior to your appointment.

What is a root canal? 

Root canal therapy is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent tooth loss which then requires dental implants, bridges or dentures to fill this space.

At the center of your tooth is pulp. Pulp is a collection of blood vessels and nerves that helps to build and protect the surrounding tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, or cracks and chips. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.

How is a root canal performed? 

After the diagnosis and the decision is made to perform root canal therapy, the injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in about 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. We use local anesthesia to eliminate discomfort. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.

What happens after treatment?

When your root canal therapy has been completed, a record of your treatment will be sent to your dentist. You should contact their office for a follow-up restoration within a few weeks of completion at our office. Your general dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene.