Root Canal Therapy
When a tooth has become fractured due to trauma or biting, or has large decay (cavities), it may become infected. Infection occurs when bacteria from the mouth gain access to the live portion of the tooth: the nerve. The nerve is located on the inside of the tooth. If you picture the roots of a tooth as cylinders, the nerve runs down the middle of the cylinder. The nerve is where the blood supply and sensation for the tooth are located. Once bacteria gain access to this blood supply, it will become infected. Infected teeth can be very painful and can have swelling in the surrounding tissues. There are two solutions to infected teeth: extraction or root canal therapy. Both treatments remove the source of the infection (the infected nerve) from the body. Extractions are an inexpensive solution to the infection, but may cause a myriad of problems with the other teeth and tissues in the mouth. A root canal is a highly effective method of treating infections and keeps the tooth in the mouth. Many people have a negative connotation associated with root canals. Sometimes when there is an infection around a tooth, it can be difficult to anesthetize (get numb). However, in most cases, root canals are completed without pain. Root canal therapy removes the infected material in the pulp, disinfects it, and seals the tooth to prevent further infections. Periodically, a tooth may require re-treatment if the tooth is not properly sealed or the root canal fails. Typically, root canal therapy is highly successful and teeth are restored to normal appearance and function.
Teeth that may require root canal therapy are teeth that have fractured or have large decay (cavities). Symptoms of teeth that may require root canal therapy are: sensitivity to hot or cold especially when the pain lingers, abscesses or swellings of the gum tissues around the tooth, purulent (pus) discharge around the tooth, severe pain that wakes patients at night, or teeth that are sensitive to biting. Sometimes a tooth that does not hurt may have an abscess that appears on a dental radiograph. In these cases, the infection must be resolved. If you have a tooth with this situation, we will show you on the x-ray and explain your options.
Root canal therapy may be completed in one appointment or it may take multiple appointments depending on the severity of the infection. In some situations, a patient may be referred to an endodontist (root canal specialist) to treat particularly difficult teeth. A root canal consists of gaining access to the pulp or nerve of the tooth and removing it using special files. Once the live portion of the tooth (nerve) is removed, the space is cleaned, disinfected, and sealed with rubber. The access opening may be sealed with a permanent or temporary restoration depending on the situation. We usually recommend that back teeth (molars) have full coverage crowns to protect them from fracture once the root canal is completed. Other teeth with large restorations or teeth under heavy biting forces may also require full coverage crowns.
The area around the root canal treated tooth may be sore or sensitive for a short period of time. This sensitivity should subside quickly. We will review the post-operative instructions following the procedure. Teeth that have had root canal therapy and/or crowns are still susceptible to decay and fracture, so good homecare practices are important to maintain the health and function of the teeth.
Some teeth cannot be saved despite our best efforts. In these situations, the teeth must be extracted. Difficult extractions or patients that have high anxiety levels may be referred to oral surgeons (tooth extraction specialists). We will review each case and make the best decision.
Dental tooth extractions involve removal of the entire tooth, including the root of the tooth. A dental radiograph will be taken of the tooth to help the dentist plan for the extraction and to verify that the tooth is not restorable. If a tooth is infected, an antibiotic may be prescribed before the procedure. A dental extraction can be one of two types:
- Simple extraction: the tooth is visible and does not fracture during the procedure
- Surgical extraction: the tooth may need to sectioned (cut in half) during the procedure or bone may need to be removed around the tooth to help the extraction proceed more smoothly. Impacted wisdom teeth typically fall into this category.
Once the tooth has been completely removed, post-operative instructions will be given to the patient and prescriptions will be given, if necessary. Restorative procedures to restore the extraction site back to full function will be discussed with the patient.