Root Canals: A Blessing, Not a Curse!

Your teeth are full of nerves, and when the nerve becomes infected or experiences trauma, it can cause big problems. If you don’t address it, the tooth can die. Dentists save teeth by performing root canals (also called endodontic therapy), which removes the nerve.

So why does a tooth die? Two reasons: trauma (if it sustains a blow or is subjected to traumatic occlusion for prolonged periods of time) and cavities (the bacteria in our mouths feed on sugar, and over time the acid byproducts can eat its way into the center of the tooth).

We used to just pull these teeth. Now we can safely and predictably save the teeth by removing the “pulp,” or the nerve and blood vessels inside the tooth.

Here are the questions patients most often ask about root canals:

How do teeth die?

If decay infects the center of the tooth, the nerve will die and produce gases. These gases have nowhere to go, so they create pressure and pain, which is transmitted by the remaining nerve that runs under each tooth.  In the case of trauma, the tooth may be sheared off, which can expose the nerve chamber – also causing it to die.

Do all teeth hurt when they die?

No, sometimes nerves can die quietly, and the only way that a dentist will know that it is dead is by seeing an abscess on an x-ray. An abscess will appear as a dark, radiolucent circle that is about the size of a pea and is located at the tip of a root.

What are some symptoms of a diseased or dying tooth?

Sensitivity to hot, cold or sweets can be a sign of advanced decay and pulpal death.

Usually this pain will feel intense and sharp, and will last eight to 10 seconds or longer.

The pain associated with a dying tooth can be intense and radiate up to the ear or down the jaw and neck. There may be swelling associated with the troubled, dying tooth. This swelling can be small and barely noticeable or can be severe and the size of a baseball!

What is a root canal, and how is it performed?

The tooth should not be “hot” and painful prior to treatment. Usually the dentist will give a patient antibiotics and pain medication to calm the tooth down prior to initiating treatment.

To start, the dentist will gently drill a small opening in the tooth and place a rubber barrier called a “rubber dam.” This will prevent medication and instruments from going into the mouth. The dentist will now use fine instruments called files to go down in to the canals and clean out the diseased nerve and connective tissue and shape the canals so they can be filled.

During the root canal appointment, the dentist will take x-rays to ensure that the canals have been properly cleaned. The dentist will take great care to use bleaching agents and medicaments to lubricate the files and prevent binding of the files as well as helping to clean out all of the diseased tissue in the root canal system.

The last step is to use a rubbery material called gutta percha to seal these canals. This special cement seals these canals from the oral cavity as well as any bacteria that may be in the bone at the root apex of the tooth. Usually, a dentist will perform the entire procedure in one visit, but at times more visits may be required.

What will my dentist do after the root canal?

You’ll need a “permanent” filling after the root canal. This may require placing a post into the canal to help hold on to the filling. That is called a “post and core” procedure. During this procedure, the gutta percha is removed to a certain length, and the post is cemented into the root. It’s a bit like putting in a screw so that the filling can hold on to the head of the screw to secure the filling to the underlying tooth structure.

Do teeth always need caps after root canals?

Teeth usually need crowns, although there are exceptions. A root canal causes the removal of the moisture within the tooth, which can leave the tooth dry and brittle. This can lead to fracture of the tooth and the need for an extraction. Your dentist can tell you if a crown is needed for your particular situation.

Why do I have pain when I bite down?

The tooth may be “high,” or hits higher than the other teeth, and requires an adjustment to give it a rest. Teeth should be adjusted prior to performing the root canal so that the inflamed ligament can rest without the trauma of constant biting.

I still feel cold and pain – will it stop?

If the dentist did not completely remove the nerve tissue to the end of the root, there can be some vital nerve tissue left. The solution is to remove the remaining tissue. This may require reopening and retreating the tooth.

My tooth feels loose; will this go away?

Not necessarily. Tooth mobility could be caused by an abscess under the tooth. This may require an antibiotic; sometimes, it must be cleaned out surgically. If the tooth is loose, it may be because of hitting it too hard, or “traumatic occlusion.” This must be adjusted immediately to prevent fracture of the tooth. Lastly, the tooth may already be fractured. This can be diagnosed by using a periodontal probe, or ruler, to check for loss of attachment of the ligament to the tooth. In this case, the tooth may need to be removed.

It should be noted that root canals are the dentist’s last attempt to save a sick tooth. It may not always work, but it is a highly successful procedure when all steps of the procedure are performed.

What are the steps required to save a tooth?

A root canal is performed, and then the post and core filling is completed. Lastly, a crown is done to protect the remaining tooth structure. It is important to perform all three of these steps to ensure long-term success.

How long can I wait before I have a crown done?

In theory, you can wait until the day before it breaks, but that’s not a sustainable approach. People who wait until their tooth breaks and then visit the dentist are upset to find out that it must now be removed and replaced with an implant or a bridge. Do it sooner than later to protect the weakened tooth.

Is it better to pull the tooth and do an implant rather than performing a root canal, post and core and crown?

This is an excellent question – one that your dentist can answer by evaluating the level of the remaining bone around the tooth and the canal morphology of the tooth to be saved. It is also important to look at all the teeth and see whether there are other questionable teeth and what the biting scheme is for all of the teeth. There is no single answer to this question. Your dentist will need to evaluate the situation and work with you to come up with the treatment plan that makes the most sense.