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Root Canals


Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has at least one but up to five root canals.

Root canal treatment, or endodontic treatment, is needed when the nerve of the tooth has died or is severely inflamed. The process involves cutting a hole through the top or back of the tooth and removing the nerve and blood vessels in the tooth. The canal is then thoroughly cleaned and filled with an inert filling material called gutta percha. If the tooth is in the front of your mouth, it may require only a small filling to seal up the hole. If it is a posterior tooth or an anterior tooth that has broken or decay has broken down the tooth, then a crown will be necessary to prevent fracture of the tooth in the future.

What is a root canal?

Underneath your tooth's outer enamel and within the dentin is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries, and lymph vessels.

How do I know if I need a root canal?

Symptoms of a dead or dying nerve in a tooth are usually pain to cold, hot, or biting pressure. Cold sensitivity that lingers for a while can be a symptom that the nerve is inflamed and may die.

A nerve can die for many reasons, a few are:

  • Trauma - Such as getting hit in the mouth
  • Decay - Caries that has gone deep into the tooth and into the nerve chamber
  • Multiple or Large Restorations - Sometimes after a tooth has been restored multiple times it traumatizes the nerve
  • Cracked Teeth - A crack in a tooth that extends into the nerve canal may require root canal treatment or extraction if it is severe enough.
  • Internal Resorption - This can happen due to trauma of the tooth or for no known reason and causes the tooth root to resorb from the inside out.

Can a root canal fail?

Although the success rates for root canal treatment are high, occasionally a root canal can fail. This is often due to leakage of the restoration on the top of the tooth. A missed canal can also cause failure. You will likely notice pain to chewing if this occurs. If this occurs retreatment is an option. If the tooth is not treatable with another root canal, then extraction is the only option. Replacement can be made with a dental implant, bridge, or a removable denture.

Why do I feel pain?

When the pulp becomes infected due to a deep cavity or fracture that allows bacteria to seep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it, and applying hot or cold foods and drinks.

Why do I need root canal therapy?

Because the tooth will not heal by itself. Without treatment, the infection will spread, bone around the tooth will begin to degenerate, and the tooth may fall out. Pain usually worsens until one is forced to seek emergency dental attention. The only alternative is usually extraction of the tooth, which can cause surrounding teeth to shift crookedly, resulting in a bad bite. Though an extraction is cheaper, the space left behind will require an implant or bridge, which can be more expensive than root canal therapy. If you have the choice, it is usually better to keep your original teeth.

What is involved in root canal therapy?

Once your dentist performs tests on the tooth and recommends therapy, he can perform the treatment or refer you to an endodontist (specialist). Treatment usually involves one to three appointments.

First, you will be given a local anesthetic to numb the area. Next, a hole is placed in the center of the tooth from the crown into the pulp chamber, which, along with any infected root canal, is cleaned of all diseased pulp. Medication may be inserted into the area to fight bacteria. Depending on the condition of the tooth, the crown may then be sealed temporarily to guard against recontamination, or the tooth may be left open to drain, or the dentist may go right ahead and fill the canals.

If you're given a temporary filling, usually on the next visit it's removed, and the pulp chamber and canal(s) are filled with rubberlike gutta percha or another material to prevent recontamination. If there is insufficient tooth structure to support a crown, then a metal or fiber post will be placed to help hold the onto the crown. Once filled, the area is permanently sealed. Finally, a crown is normally placed over the tooth to strengthen its structure and improve appearance.

What are the risks and complications?

More than 95 percent of root canal treatments are successful. However, sometimes a case needs to be redone due to diseased canal offshoots that went unnoticed or the fracturing of a canal filing instrument used, both of which rarely occur. Occasionally, a root canal therapy will fail altogether, marked by a return of pain.

What happens after treatment?

Natural tissue inflammation may cause discomfort for a few days, which can be controlled by an over-the-counter analgesic. A follow-up exam can monitor tissue healing. From this point on, brush and floss regularly, avoid chewing hard foods on the treated tooth, and see your dentist regularly.

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