The Complete Guide to Root Canal Treatment
It's rare when a person has not experienced having a root canal treatment. According to Google, the keyword term "root canal" is one of the most sought after search terms. Since Google began tracking search trends in 2004, the topic of "root canal" is at an all-time high (see chart below).
Other related search queries garner similar attention such as:
- Crown after root canal
- how much root canal cost
- does root canal hurt
- root canal specialist
- root canal causes
- getting a root canal
You can see below the search terms that Google Trends has identified as topics people are searching to find relevant information.
That interest is why we have compiled the most comprehensive guide on the Internet regarding root canal treatment.
The best part is we have made it easy. Below you will find the content on root canals broken down into small chapters based on specific topics related to root canal treatment. Just click on the chapter you want to see and you will be taken to that specific part of the page.
Let's get started.
Chapter 9
How Successful Are Root Canal Treatments?
Chapter 10
Cost of A Root Canal
Chapter 1
You feel intense pain in your tooth.
Your dentist says that a cavity has progressed to an advanced stage and may have infected the inner pulp of a tooth. To save the tooth, a root canal procedure will be necessary.
You pause to consider just what such a procedure might entail.
Does it hurt?
Will it require dental surgery?
Will it be expensive?
These are the questions going through your mind.
Like many people, the first question you will ask is,
“What is a root canal?”
What Is A Root Canal?
A root canal, also known as endodontic therapy, which is a dental procedure designed to salvage and save a severely decayed or infected tooth or one afflicted with advanced dental caries.
In severe cases of dental caries, the sensitive inner pulp of a tooth becomes infected or inflamed leading to intense dental pain.
If left untreated, an infected tooth can develop an abscess that can eventually eat away at the bone beneath and around the tooth itself or, in some cases, even lead to a dangerous blood infection.
To eliminate the infection, an endodontic procedure completely removes the inner pulp, reshapes the interior space left behind, and fills it in thereby sealing the space from future infections.
Once a root canal, or endodontic treatment, is completed a dentist or prosthodontist will protect the treated tooth with a crown or some other type of aesthetic restoration.
Continued
What Is A Root Canal?
A root canal, also known as endodontic therapy, which is a dental procedure designed to salvage and save a severely decayed or infected tooth or one afflicted with advanced dental caries.
In severe cases of dental caries, the sensitive inner pulp of a tooth becomes infected or inflamed leading to intense dental pain.
If left untreated, an infected tooth can develop an abscess that can eventually eat away at the bone beneath and around the tooth itself or, in some cases, even lead to a dangerous blood infection.
To eliminate the infection, an endodontic procedure completely removes the inner pulp, reshapes the interior space left behind, and fills it in thereby sealing the space from future infections.
Once a root canal, or endodontic treatment, is completed a dentist or prosthodontist will protect the treated tooth with a crown or some other type of aesthetic restoration.
Root Canal Procedure
Why Root Canals Are Necessary?
An infected tooth must be treated. Early stage infections and cavities that have not penetrated the inner pulp can typically be treated with dental fillings.
However, once an infection has reached the sensitive inner pulp, an endodontic tooth canal is necessary in order to completely remove inflamed or infected pulp and abscesses deep within the dental roots.
The main purpose of a root canal procedure is to completely eliminate a dental infection that has advanced into the inner pulp and deep within the tooth and to seal off the space left behind once the pulp has been removed. In doing so, a root canal can structurally salvage and save a tooth from total destruction.
Furthermore, root canals are necessary to ensure that deep dental infections do not spread into the periodontal bone beneath the teeth or into the bloodstream.
Signs That A Root Canal is Needed
The number one sign that a root canal may be needed is severe dental pain. By the time dental pain becomes unbearable, it is often too late for a simple filling. Bacteria has already infected the inner pulp and more than likely has spread through the roots and into the periodontal jaw bone.
Often times, pain is accompanied by other symptoms associated with infections, including foul smelling effluence, swelling, inflammation, and noticeably enlarged lymph nodes.
If you suspect that you or a friend may have an oral infection, I highly recommend you see a dentist immediately. Catching a cavity early, before it has inflamed the pulp, may preclude the need for a root canal entirely. Catching a dental infection too late may mean that the infected tooth is beyond saving and will have to be extracted and removed.
10 Signs A Root Canal Procedure May Be Necessary
Prolonged dental pain
Chronic dental sensitivity
Tenderness when chewing or biting
Pain when touched
Unexplained dental discoloration
Loose teeth
The presence of pus or effluence
Chronic, unexplained bad taste (Dysgeusia) in the mouth
Chronic bad breath
Swollen lymph nodes
CHAPTER 3
Should I Go To A Dentist or Endodontist for A Root Canal?
Root canal procedures are complex, multi-step dental processes. They require adept execution and responses to unforeseen circumstances that could drastically alter a prognosis. Because of this, we recommend a specialist known as an endodontist to either execute or directly supervise an endodontic (root canal) procedure. While many general practice dentists have the skills and experience to execute a root canal treatment, in order to ensure the best results opt for a specialist.
What Is An Endodontist?
An endodontist is a dental specialist. They are highly skilled and specially trained to diagnose, treat, and eliminate dental pain. This is typically achieved through the execution of an endodontic, or root canal, procedure.
In order for a person to become an endodontist, he or she must first become a dentist which requires a college degree and secondary higher education at a dental school. They must earn a Doctor of Dental Surgery (DDS) and spend two years in a residency program to further hone and develop their unique skills. As a result of the lengthy training period, only about 3 percent of licensed dentists go on to become endodontists.
An endodontist's primary objective is to save your teeth.
Endodontist vs. Dentist
While every endodontist is also a dentist, not every dentist is an endodontist. Dentists perform more holistic and general dentistry that can vary widely from providing professional dental cleanings and checkups to diagnosing specific dental diseases. However, when it comes to implementing a root canal, a dentist will defer to an endodontist whose sole focus it is to diagnose and treat dental pain.
Why Choose An Endodontist?
Endodontists specialize in performing root canals. As a result, it makes sense for patients to choose an endodontist to complete their root canal therapy.
A doctor who is a family practitioner would not perform a triple bypass heart surgery procedure. Instead, he would defer to a heart surgeon who specializes in executing such treatments. Likewise, dentists will refer patients to an endodontist when it comes to root canals for the best outcomes.
What Can Happen If A Root Canal Goes Awry?
When choosing an endodontist to perform a root canal therapy, look for the right credentials, relevant experience, and a history of successful results. Selecting the wrong endodontist can lead to terrible results.
Three common results of a failed endodontic include:
Dental stripping occurs when a dentist accidentally removes too much material from the inside of the tooth, leading to a perforation in the walls of the dental roots. Eventually, this perforation can cause sealing materials, used to fill the empty dental cavity left behind by a root canal, to leak out which results in a lesion and subsequent bone destruction.
If the infected or inflamed pulp material is not entirely and completely removed by a root canal treatment, or if an abscess beneath the roots is left untreated, the tooth can become reinfected. Bone loss and tooth loss can occur as a result.
Sometimes, a poorly executed endodontic can fracture a tooth’s roots. When this occurs, the prognosis for the tooth is poor and typically requires complete extraction of the problem tooth. Early detection and treatment of a tooth with fractured roots is critical. Treating an early-stage fracture before damage to the underlying jaw bone can allow for dental implants.
CHAPTER 4
Why Is A Root Canal Sometimes Considered Oral Surgery?
Root canals require the steady hand of an experienced specialist, typically an endodontist, and the drilling of teeth. However, not all root canals are considered oral surgery.
Surgical vs. Nonsurgical Root Canals (Deep Fillings)
The difference between a surgical and nonsurgical root canal is typically the scope of the intervention.
In a nonsurgical root canal, the part of the body penetrated is the tooth itself. This works well for root canal procedures designed to clean out a tooth of inflamed or infected dental pulp that has not spread into the far recesses of the dental roots and beyond. When an infection is too deep or has spread into the underlying periodontal bone, a surgical root canal may be necessary.
During a surgical root canal, the endodontist must not only drill deeper into the dental roots to attack problematic pockets of infection, but they must also sometimes make an incision in the gums. This is done to access the dental roots to ensure complete removal of infected tissues.
In many ways, a nonsurgical root canal is very similar to a standard filing procedure that one might receive for a minor cavity, except that the root canal requires the endodontist to penetrate deeper into the interior of the tooth.
A root canal is considered oral surgery when the periodontal bone, such as in the case of an abscess located at the tip of the dental roots, is affected, or when the soft tissues of the gums must be penetrated.
CHAPTER 5
Is Root Canal Treatment A Painless Dental Procedure?
Many patients may have an understandable fear of pain when undergoing dental procedures. Root canal therapy is, however, relatively painless. It is often done to eliminate the severe pain and swelling associated with an infected tooth or inflamed inner pulp.
Pre-treatment Pain
Patients with an infected tooth that requires a root canal treatment often report severe to extreme pain. Pain is often one of the motivating factors for a patient to seek a root canal procedure.
During a root canal operation, the only pretreatment pain a patient can expect is from the prick of the needle that delivers the local anesthetics. Once the novocaine takes effect, the only sensation a patient will feel is mild pressure or vibrations as the endodontist does his work.
Procedurally Painless
Thanks to a dose of local anesthesia, or unconscious sedation for patients that require it, those undergoing a root canal procedure will feel absolutely no pain during the process.
The type of sedation given to each patient will vary based on needs. In general, the standard procedure is to inject a localized dosage of novocaine or apply a topical anesthetic before the root canal procedure. Patients will remain awake and aware of the process throughout the procedure. In many cases, Valium or another sedative may be administered to help patients remain calm.
The anesthetics we offer are carefully measured and administered with the utmost care and consideration, with the end goal of enhancing patient comfort and minimizing pain.
Post-treatment Pain
When a root canal procedure is flawlessly performed, there should be no postoperative pain. The root canal treatment itself removes the dental nerves within a tooth essentially eliminating the sensation of pain from the tooth and its roots. However, nerves and nerve endings remain within the root ligaments that attach the tooth to the periodontal bone.
If a root canal procedure is executed poorly, or if the underlying infection is not entirely removed, post-operative pain can result. Another possible explanation for post root canal dental pain in a treated tooth could be fractured dental roots. This is a significant problem. If the cause of pain is a vertical root fracture (VRF) the prognosis for the tooth may be hopeless, and the tooth may have to be extracted.
CHAPTER 6
Step-By-Step Guide To A Root Canal Treatment
Although root canal procedures are relatively straightforward, they are still considered to be oral surgery. That’s because a root canal treatment affects not only the visible dentition but the underlying dental roots as well. In more severe cases, root canals may also affect the gums and underlying periodontium.
However, for this Step-By-Step Guide To Root Canal Treatment, we will be describing each step involved in a standard root canal procedure which accounts for the vast majority of root canals performed today.
A root canal procedure involves creating a penetration in the affected tooth to extract infected or inflamed pulp and thereby eliminate both pain and signs of infection. In practice, however, a root canal treatment is much more complicated.
10 Steps of A Root Canal Treatment
Step 1: Preparatory Actions
The first step in a root canal procedure is the preparation by the dental team. Patients will sit in a comfortable surgical chair where they will be prepped with a bib and other hygiene items.
Many procedures are preceded by a professional dental checkup and cleaning in order to evaluate a patient’s oral condition and provide as clean of a working environment for the dental team as possible.
Step 2: Anesthetics
Once a patient is seated comfortably, anesthetics are administered. This can include local anesthetics such as a shot of novocaine combined with a sedative in pill form to ensure maximum patient comfort and compliance. Although it is possible to provide general anesthesia or anesthesia that puts a patient to sleep, this is generally only recommended in special situations.
Step 3: Isolation
After anesthetics are administered, the next step is to isolate the affected tooth. This is achieved with a dental dam that covers that mouth except for the tooth that is being operated on. This helps to ensure a sterile working environment and prevents contamination of the tooth in question while it is being worked on.
Step 4: Drilling
To access the inflamed or infected inner pulp and dental roots, penetration must be made in the tooth. This is done by drilling an access point at the top of the tooth and through the enamel. However, in some cases, an endodontist or oral surgeon may also need to remove some gum tissues to access the dental roots better or to treat particularly deep abscesses.
Step 5: Pulp Removal
Finally, the infected or inflamed pulp is removed using highly specialized dental equipment such as barbed broaches. This process of removing and destroying the pulp is known as extirpation. It also removes the sensitive, pain-causing nerve endings within the pulp.
Step 6: Cleaning
Once a tooth has been opened up, liquid disinfectants such as EDTA and chelating agents are poured into the cavity to wash away any debris and bacteria. This process of cleansing the root canals and the pulp chamber is known as debridement. Sometimes a hand file may also be used to aid in the cleaning process. Some endodontists may also flush the canal with sodium hypochlorite to ensure that no bacteria remain in the tooth.
Step 7: Drying
After thorough internal flushing, the cavity is dried to inhibit bacterial growth. This is done with simple paper points. While it may not seem significant, drying is a crucial preparatory step to allow the filling materials to seal correctly.
Step 8: Filling and Sealing
Also known as obturation, the filling and sealing step involves filling in the endodontic root spaces left behind by a root canal procedure. This can be accomplished with a variety of materials including specialized root canal sealants, gutta-percha, dental pluggers, and spreaders.
Step 9: Temporary Filling
Once the root canals have been filled, a temporary filling will often be used to seal the endodontic cavity from the external environment. The objective is to prevent bacteria, food debris, and other unwanted detritus from entering into the cavity space. The temporary filling provides patients with a degree of functionality while they await a more permanent solution depending on their particular individual needs.
Step 10: Permanent Crown
Some patients require a dental crown, or cap, to finish off their endodontic procedure. This crown is typically custom fabricated often the same day in our office. A protective dental crown can help protect a tooth that has been structurally compromised by an endodontic procedure. This will prevent the tooth from potentially cracking or fracturing in the future.
CHAPTER 7
Benefits of A Root Canal
The core goal of an endodontic root canal procedure is to rescue a badly infected tooth from destruction. The benefits of this approach to treating a deep dental abscess or infection can be demonstrated in terms of functionality, aesthetic, cost, and in terms of patient comfort. To understand why root canals are so commonly recommended, it is helpful to look at alternative treatments such as extraction and replacement with an artificial tooth.
Because a root canal salvages the original structure of a natural tooth, no extraction is necessary. The tooth remains in place and embedded in the underlying jaw bone (provided that the infection did not damage the periodontium). With proper filling and protective measures such as the placement of a dental crown, the tooth can continue to function perfectly fine. More importantly, maintaining the original tooth structure means retaining the original aesthetics. No artificial replacement teeth are necessary. No implants need to be embedded. Without the need for labor-intensive extraction and implantation, root canals are also considerably more affordable than completely replacing an infected tooth. Of course, not every tooth can be saved. In situations where a tooth must be extracted, dental implants and other teeth replacement treatments are good solutions. But, when it comes to maintaining the natural functionality and aesthetics of a patient’s smile, most dental professionals will recommend a root canal procedure.
4 Benefits of a Root Canal Procedure
Saves the tooth
Whenever possible, it is always best to try to save rather than replace a person’s natural teeth. An endodontic procedure does just that by retaining the outer shell of a tooth while replacing the inner pulp with a filling material.
Eliminates pain
An endodontic procedure will completely eliminate the sources of a person’s dental pain. This is accomplished by removing the source of the infection and by extirpating the sensitive inner pulp and nerve ending therein. A properly executed endodontic procedure will completely eliminate dental pain.
Prevents spread of infection
Endodontics eliminate the underlying sources of the infection in a tooth by physically removing and eliminating infected inner pulp, abscesses, and bacteria. More importantly, stopping the infection is crucial for the long term health and stability of a person’s mouth. Left unaddressed, a tooth infection can spread into the periodontium and beyond. Bacteria related to dental decay have been found in other parts of the body, via the bloodstream, including the heart valves. If an infection spreads into the blood, sepsis and deadly septic shock can result. If the infection spreads into the underlying periodontal bone, bacteria can attack and destroy the bone. Dental infections can also attack the ligaments that attach teeth to the underlying alveolar bone leading to tooth loss.
Prevents future pain and infection
Finally, by removing the organic pulp matter from a tooth and completely sealing the endodontic chamber, a properly treated tooth will never be infected again. There will be no pain and no opportunity for reinfection. That’s why choosing the right specialist to execute a root canal procedure is so important. Quality of work plays a large role in determining the long term success (or failure) of endodontic treatment. In fact, it is not uncommon for some patients to receive two root canal treatments on the same tooth.
CHAPTER 8
What Is An Emergency Root Canal?
Emergency root canals are considered necessary when a neglected tooth infection spreads into the root canal chamber inside the tooth or into the periodontal bone causing extensive pain, swelling, sensitivity, and tenderness. By the time patients are experiencing pain and other symptoms associated with a severe dental infection, it is often too late for more conventional treatments. Consequently, root canal procedures can be considered an emergency dental procedure performed as a final effort to rescue an infected tooth.
Unfortunately, most dental clinics are not 24-hour treatment facilities. As a result, many patients end up going to the emergency room (ER) for dental pain.
When To Go To The ER
In general, most ER doctors do not recommend that patients go to the emergency room for dental pain. Even those with severe dental pain should cope the best they can and see a dentist as soon as possible. ER doctors can’t do much about a tooth infection. They aren’t trained to pull teeth or perform root canal procedures. Emergency rooms aren’t staffed with dentists or dental specialists of any kind. The most an ER can provide dental patients is access to antibiotics and provide some pain relief medications.
There are some situations where a dental infection may justify a trip to the ER. If dental pain is accompanied by swelling of the face, pain shooting down the neck, or difficulty breathing, then go to the ER.
Avoid A Dental Emergency
With modern diagnostic imaging and the expert eyes of a trained dentist or endodontist, many dental issues can be identified and treated long before they require a root canal or even cause any pain. Many cavities never progress to the point of causing patients pain. Furthermore, early diagnosis and treatment of dental issues are generally much less demanding and less expensive than treating an infection that has spread into the root canals.
It’s far better to avoid a dental emergency. Regular dental checkups can help ensure that dental infections are caught in the early stages. If an infection is discovered close to the inner pulp, a preventative root canal treatment may be in order. Remember, if it hurts you should probably be already at the dentist.
