Root Canal Treatment
What is a root canal?
Steps of a Root Canal Appointment
1. Diagnostic X-rays and Anesthesia: We will take one or more X-rays of the tooth to assess the shape of the roots and the extent of infection. You’ll be numbed with local anesthesia just like for a filling or extraction, so you should not feel pain during the root canal. If the tooth is very infected, sometimes getting it fully numb can be a bit more challenging, but we have techniques and will ensure you’re comfortable. A rubber dam (protective sheet) is usually placed around the tooth to keep it dry and prevent any debris from falling to your throat.
2. Access Opening: The dentist will drill an opening through the top of the tooth (or back of a front tooth) to reach the pulp chamber. In a decayed tooth, this also removes any decay. You may feel some pressure or vibration, but no pain. Once the chamber is open, the diseased pulp tissue is accessed.
3. Cleaning the Canals: Using very small instruments (root canal files), we will carefully remove the nerve/ pulp from each canal within the tooth’s roots. Most teeth have 1-4 canals depending on the tooth type. We use these files by hand and/or with a rotary instrument to scrape and scrub the inside walls of the canals, removing infected tissue and shaping the canals. You might hear a soft drilling sound, but again, you should be numb and not feel pain – just a sensation of pressure or movement. Throughout this process, we frequently irrigate (rinse) the canals with disinfectant solutions (often a mild bleach solution or others) to kill bacteria and flush out debris.
4. Medicating and Filling: After the canals are cleaned and shaped to a satisfactory size, we dry them and then fill them with a biocompatible material. Commonly, a rubber-like material called gutta-percha is used, along with a sealing cement. We usually insert the gutta-percha with a technique that compacts it, ensuring the canals are densely filled to the end of the roots. In some cases of severe infection or if multiple visits are planned, we may put medication in the canals and a temporary filling in the tooth to let it heal before sealing (this is less common nowadays but sometimes done if there’s an acute infection). Assuming we fill it same-day, once the canals are filled, the access hole in the tooth is sealed with a temporary or permanent filling. If a post (a reinforcing rod) is needed for extra support in a badly broken tooth, we might place that at a separate visit or as part of the crown procedure.
5. Temporary Filling/Crown and Follow-Up: Often, a temporary filling is placed on top of the gutta-percha if a crown or onlay is going to be done later. This keeps the tooth sealed in the interim. The tooth, now without a live nerve, shouldn’t be causing pain anymore (though the surrounding ligaments may be sore for a few days). We will give you instructions and then plan the final restoration. It’s crucial to return for the permanent filling or crown, because until that is done the tooth can be susceptible to fracture or re-contamination.
Benifits of having a Root Canal Done
– Pain Relief: The primary immediate benefit of a root canal is relief from the terrible pain of a toothache or abscess. By removing the infected nerve tissue and reducing pressure inside the tooth, the throbbing or sharp pain will be alleviated (often as soon as the procedure is done, if not, then within a few days as the surrounding inflammation calms). It’s often literally a lifesaver for people in severe pain.
– Saves Your Natural Tooth: Root canal therapy allows you to keep your natural tooth rather than extracting it. This is significant because no artificial replacement (bridge, implant, etc.) is quite as good as a natural tooth. Keeping the tooth helps maintain your normal biting force and alignment with other teeth. It also prevents the neighboring teeth from drifting into an extraction space. In short, a successful root canal preserves your tooth in the long-term, which is typically best for oral health and function.
– Quick Recovery: Compared to a surgical extraction (especially of a complex tooth), recovery from a root canal is usually quick and mild. There’s no surgical wound in the gums; any soreness is mostly from inflammation of the ligament around the tooth. Most people manage post-root canal discomfort with over- the-counter pain meds and can return to normal activities the next day (if not the same day). No stitches, no open sockets. This makes it a convenient way to address the issue.
– High Success Rate: Root canals have a high success rate, often cited around 85-95%. Many root-canaled teeth last as long as other teeth. With proper restoration (a good filling or crown) and oral hygiene, the tooth can remain healthy for decades. It’s a tried-and-true procedure with millions performed each year, and advancements (like better imaging, rotary files, etc.) have improved outcomes even more.
– Prevents Spread of Infection: By removing the infected pulp and sealing the tooth, a root canal eliminates the source of infection. This prevents the spread of infection to the jawbone (which can cause bone loss) or to other areas of the body (untreated dental abscesses can, in rare cases, lead to serious systemic issues). In essence, it stops that tooth from being a chronic infection site that could flare up repeatedly. Clearing the infection promotes healing of the bone around the roots too, allowing any abscess to resolve over time.
Risks of a Root Canal
– Post-Operative Soreness: It’s normal for the tooth and the surrounding area to be a bit sore or tender after a root canal. The process can irritate the ligaments around the tooth’s root, especially if there was infection. You might have some biting tenderness or mild throbbing for a few days. This is usually manageable with ibuprofen or acetaminophen. Any swelling or significant pain should subside as the infection clears. We may prescribe antibiotics if there was an active infection or if swelling was present to aid recovery.
– Instrument Separation or Complications: Root canals involve tiny, flexible instruments navigating curved canals. On occasion, a file might break inside a canal. If that happens, depending on its position, the dentist might be able to retrieve it or bypass it. Often if it’s near the end of the root and the canal is otherwise clean and filled up to that point, the fragment can be left with no harm. There’s also a risk of perforating the tooth (creating a little side opening) if the canal is very curved or calcified. We use tactile feel, electronic measurements, and X-rays to minimize such risks, but they can occur. These complications are infrequent, and if they do occur, we will inform you and may refer to a specialist (endodontist) for management if needed.
– Incomplete Removal of Infection: In some cases, despite our best efforts, a root canal might not heal perfectly. This could be due to undetected extra canal anatomy (some teeth have tiny accessory canals or unexpected splits), or persistent bacteria. If the tooth doesn’t settle down or if an abscess doesn’t heal on follow-up X-rays, a re-treatment might be needed. Root canals can fail initially or even years later (perhaps due to new decay or leakage under a crown). The success is high but not 100%. If a root canal fails, the alternatives are redoing it, doing a minor surgery at the root tip (apicoectomy), or extracting the tooth. We will do our utmost to fully clean the system and reduce this risk.
– Tooth Fracture: A root canal-treated tooth is not “dead” in the sense of being brittle overnight, but having no pulp and often being hollowed out somewhat, it can be weaker. That’s why a crown is usually recommended. Until that crown is on, there’s a risk of the tooth cracking if you bite something hard or the temporary fills dislodges. Even long-term, if a crown isn’t done or if huge pressures occur (like grinding without a night guard), the tooth could fracture. A vertical root fracture is particularly bad – often leading to extraction. You can mitigate this by getting the recommended crown, not chewing ice or hard objects, and wearing a guard if you grind. We consider crown protection part of the root canal treatment’s success.
– Staining or Aesthetic Changes: Sometimes a tooth that has had a root canal may darken slightly over time, especially if it had old blood products inside from trauma. Internal bleaching or a crown/veneer can address that if it’s an anterior tooth. Additionally, a small risk with front teeth root canals is that if the procedure is complex, there could be slight enamel cracking or change, but that’s rare and usually not visible. We mention it mainly so you know to report any changes you notice.
Alternatives to a Root Canal Treatment
– Extraction of the Tooth: The primary alternative to having a root canal is to remove the tooth. This, of course, resolves the source of infection/pain as well, but then you have to consider how to replace the missing tooth. Options would include a dental implant, a bridge, or a partial denture. These can be as (or more) costly and time-consuming than the root canal + crown, and no replacement is exactly like a natural tooth. Extraction might be the choice if the tooth is not worth saving (for example, if it’s severely cracked through the root, or if finances/health preclude a root canal). We respect your choice if you opt for extraction, but our goal is to help you keep your natural teeth when possible.
– No Treatment / Palliative Care: You could choose to do nothing to the tooth, but this is not advised if infection is present. An infected tooth will not heal on its own; the pain might come and go as the infection festers, but eventually it can become serious. Palliative options may include taking antibiotics to temporarily calm an abscess (this does not fix the problem, only buys time) or opening the tooth to drain it (partial treatment) and not completing it – again, not a definitive solution. Ultimately, doing nothing risks the infection spreading (to bone, other teeth, or even systemically in rare cases). Thus, while you always have the right to decline treatment, the consequences of no treatment for a tooth needing a root canal can be significant, including severe pain and tooth loss.
Post-Procedure Care Instructions
– After the Root Canal (first few days): It’s common to feel some tenderness in the area. The tooth may feel a bit “different” when biting, or mildly achy – this is normal and should decrease each day. You can take ibuprofen (Advil/Motrin) or acetaminophen (Tylenol) as directed for a day or two. If antibiotics were prescribed (e.g., if there was significant infection or swelling), complete the full course even if you feel better. Avoid chewing hard foods on that tooth until it’s fully restored with a crown, because the temporary filling or the remaining tooth structure could be vulnerable. Maintain good oral hygiene – continue brushing and gently flossing the area. There’s usually no wound on the gum, so you can clean normally, just be mindful if it’s tender.
– Temporary Filling/Crown Care: If we placed a temporary filling, be aware it’s not as strong as a permanent restoration. Try not to chew sticky candies or excessively hard things on it; those could pull it out or crack it. If a small piece of the temporary filling comes out, or if it wears down, as long as the tooth isn’t sensitive it’s usually fine until your next visit. But if the whole thing comes out, contact us – we may need to replace it to keep the area sealed. If you have a temporary crown, similar rules: avoid very sticky foods, and if it comes off, let us know so we can re-cement it. Keep the area clean to prevent gum inflammation which could complicate the final crown placement.
– Follow-Up Restoration: It is extremely important to return for your permanent filling or crown as scheduled (usually within a few weeks of the root canal). A root canal-treated tooth without a proper final restoration is at risk – saliva can leak in, potentially causing re-infection, and the tooth can fracture under biting forces. If you delay too long, the root canal might end up failing or the tooth breaking, undermining the whole purpose of treatment. So please prioritize the follow-up appointments to build up the tooth and place a crown/onlay as recommended. If finances are a concern, talk to us about temporary build-up options or phased treatment; but do not leave the tooth unprotected long-term.
– Monitoring and Oral Care: In general, treat the tooth like any other once fully restored. Brush twice a day with fluoride toothpaste, floss daily (yes, you can and should floss around a root-canaled tooth and its crown). There’s no nerve, so you won’t feel decay if it happens – that’s another reason why consistent check- ups are needed; we’ll take periodic X-rays and examine the margins of the crown to catch any new decay early. Most root canal teeth do well indefinitely, but if you ever feel a recurrence of pain or swelling in that area, report it promptly. Sometimes a treated tooth can develop a new issue years later if the seal fails or a crack develops. Early intervention often can save it again (through re-treatment or surgery).
– Be Gentle Immediately: If your jaw was open for a long time during the procedure, you might have some muscle soreness or jaw stiffness afterward. This typically resolves in a day or so. A warm moist towel on the jaw and some gentle stretching (slowly opening and closing) can help. Eating softer foods that don’t require wide opening (sandwiches instead of big burgers, etc.) for a day might be wise if you’re sore. This isn’t directly related to the tooth, but to the lengthy appointment, especially for back teeth root canals that take longer.