Endodontics (Root Canals)

Yes, we're talking about the dreaded root canal! I'm not sure if it's the name that sounds scary, or if it comes from patients that have had bad experiences with this procedure. If you have to have one done, or are hesitating to call your dentist because you think you might need one, there is some good news and some bad news. The good news is that root canal therapy has come a long way in becoming faster, easier and less painful. The most important advice we can give is to get the procedure done sooner rather than later. The bad news is, if you have already waited too long (maybe you are swollen now), then it will probably be more uncomfortable, and you'll take longer to heal. So get it done as soon as possible!

When you were young, there was something in your tooth called the "pulp". Your dentist may refer to it as "the nerve". This pulp initially formed your tooth, and now resides inside your tooth all the way to the bottom of the root. In adulthood, the pulp really doesn't do much other than feel cold and hot temperatures and to act as a warning device to you. Unfortunately, it only warns you through pain, because that's the only thing it can feel! It will warn you about several different things. For example, it will hurt if a cavity gets so big and deep that it contacts the pulp. (That's why it's so important to get check-ups and get your cavities taken care of ASAP!) It will also hurt if a tooth has a recent or large old filling that is too close to the pulp. And, it will hurt if a tooth gets traumatized by an accident, like a blow to your teeth or jaw. This tends to happen to the front teeth more often than the back ones. Unfortunately, in all of the above instances, the pulp ends up hurting and eventually dying inside the tooth. If left long enough, the dead pulp will rot and leak out of the root of the tooth and cause a large infection in the surrounding bone.

In a root canal, the dentist uses special cleaning instruments to go into the tooth and take out the rotted pulp. He/she will disinfect the inside of the tooth and seal it on the inside with a special material to prevent any further infection.

FAQ

Will it hurt?

Since different people have different levels of tolerance for pain, the answer is unfortunately very subjective. Having said that, dentistry has come a very long way in controlling pain, to the point of almost eliminating it during most procedures, including root canal therapy. The techniques for administering local anesthetic to the teeth have vastly improved over the last few years. One very effective new method is the " intracortical" injection. This technique has been around for a few years, and if used properly can eliminate any pain sensation during any procedure. In essence what the dentist does is drill a tiny hole into the bone right next to the tooth involved to deliver the anesthetic right to the source. Unfortunately, this technique should not be used if you have a lot of infection in the area. So again, we have to go back to the initial and most important piece of advice, which is to go in early before any infection sets in. That will make life easier (and less painful) for you.

How long will it take?

The answer to this question depends on several factors. For example, back molars usually have three roots, compared to front teeth that have only one root. Also, the farther back in the mouth the tooth is, the harder it is to perform the procedure. So molar root canals, being farthest back in your mouth and having the highest number of roots, require the most time and the most expertise on the part of the dentist. Going back five or more years, it was routine for a dentist to perform root canals over several sessions, especially molars. It was thought to be better for the patient, and was necessary due to the limited techniques available then. Thanks to a tremendous advancement in the techniques, most dentists are able to perform the whole root canal in about an hour and a half, even the difficult molars. It has also been proven to be much more comfortable for the patient to perform the whole proceedure in one appointment. The exception that may require more than one appointment would be if you have a lot of infection.

Are root canals guaranteed to work?

Thanks to the tremendous advances in treatment methods used today, root canals are over 90% successful in the majority of cases. Again, a lot depends on going in to see your dentist before a lot of the tooth gets destroyed. It is also very important that you have a cap or crown placed on the tooth following the root canal, especially on back teeth. This is because the tooth becomes weaker and drier following root canal therapy, and can easily break beyond repair if bit down upon hard enough. It's worth noting that even in the rare occasion where a root canal fails and infection develops, a surgery can be performed to save the tooth. (See section below on Surgical endodontics).

Is my tooth going to be "dead" after the root canal?

Well, the tooth will no longer have the pulp inside. This may technically mean the tooth is dead, but the tooth shouldn't feel any different from any other tooth in your mouth. The only difference will be that this tooth would no longer hurt to extreme cold or hot temperatures. This could be a blessing in disguise!

Surgical Endodontics (Apicoectomy or Retrofill)

Root canals fail on occasion. The seal at the root end leaks and a lesion will form. This shows up as a dark spot on the x-ray. These root end lesions can get infected and cause swelling and pain. A surgery can be done to repair the root canal. This is called apicoectomy.

The gum tissue is reflected back and a window is drilled into the jaw adjacent to the root end (apex). The lesion is found and removed. The root end is cut off and a preparation is made into the root with a small bur or cavitron instrument. The root is then filled with amalgam or cement to reseal the root. The tissue is then sutured back.

FAQ

Does is work?

The success rate is 80% or better.

Does it hurt?

The surgery is generally painless during the procedure. There will be swelling and mild post-op pain.

How long will it last?

The sealing of the root end should stay in place for the duration of the tooth's life.

How can you tell if it worked?

X-rays after 6 months will show that the lesion at the root end filled in with bone.