Written by Mirza R.
DR. REZA KHAZAIE, DDS, PROSTHODONTIST
The Complete Guide to Root Canal Treatment
If you are here because it’s likely that you or a loved one may be in need of a root canal — don’t be anxious. This guide will walk you through the root canal procedure and explain the entire process for you to help guide your next steps.
I have written 15 chapters on topics that I receive the most questions about related to the root canal procedure.
At Willow Pass Dental Care, the goal of our professional staff of dentists, hygienists, end endodontists is to provide you and your family with the care you and your teeth deserve.
Introduction to Root Canal Treatment
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:
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 section of content you want to see in the Navigation bar along the right side, and we will take you to that particular part of the guide.
Let’s get started.
“What is that intense pain in my tooth?”
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. A root canal procedure will be needed if the tooth is to be saved.
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, 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.
In some cases, an infected tooth may lead to an abscess, which eventually destroys the bone beneath and around the tooth or, in rare cases, results in a dangerous blood infection.
As part of an endodontic procedure, the inner pulp is completely removed, reshaped, and filled in to eradicate the infection. This process seals the space against 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 tooth restoration.
The Root Canal Procedure
Why root canals are necessary
It is important to treat an infected tooth. Infections and cavities that do not penetrate the inner pulp can typically be treated with fillings.
A root canal is required, however, if an infection reaches the sensitive pulp within the dental roots in order to remove the inflamed or infected pulp and abscesses.
A root canal procedure is designed to eliminate a dental infection that has spread to the inner pulp and deep within the tooth and to seal off the space left behind after the pulp has been removed. By doing so, a root canal can save a tooth from destruction and structurally preserve it.
Moreover, root canals prevent deep dental infections from spreading to the periodontal bone beneath the teeth or into the bloodstream.
10 signs a root canal is necessary
Severe dental pain is the number one sign that a root canal may be necessary. Often, it is too late to perform a simple filling by the time dental pain becomes unbearable. Most likely, the bacteria have already infected the inner pulp and have spread to the roots and periodontal jaw bone.
Pain is often accompanied by other symptoms associated with infections, such as foul-smelling effluence, swelling, inflammation, and noticeably enlarged lymph nodes.
It is highly recommended that you seek immediate dental care if you think you have an oral infection. Cavities caught early before the pulp is inflamed may prevent the need for a root canal. Conversely, when a dental infection is detected too late, the tooth may be beyond saving and may need to be extracted.
10 signs you may need a root canal
Should I go to a dentist or endodontist for a root canal?
Root canals are complicated, multi-step dental procedures that require adept execution and rapid responses to unforeseen circumstances that could profoundly impact a prognosis. This is why we recommend a specialist called an endodontist be charged with performing or directly supervising an endodontic (root canal) procedure.
Many general practitioners are qualified and have experience performing a root canal treatment. However, to ensure the best results, find a specialist.
What is an Endodontist?
Endodontists are dental specialists. They have specialized training and are highly skilled at diagnosing, treating, and eliminating dental pain. This is typically accomplished by performing an endodontic procedure or root canal.
To become an endodontist, one needs to become a dentist first, which requires a college degree and secondary higher education at a dental school. Their unique skills will be further developed and honed during their two-year residency program after earning their Doctor of Dental Surgery (DDS). Endodontists have a lengthy training period, which is why there is fewer than 3 percent of licensed dentists who become endodontists.
The primary goal of an endodontist is to save your teeth.
Endodontist vs. Dentist
While every endodontist is also a dentist, not every dentist is an endodontist. Generally, dentists perform more holistic and general dentistry that offers a wide range of services, from professional teeth cleaning and dental exams to diagnosing specific dental diseases.
A dentist, however, will turn to an endodontist to perform a root canal, as they are exclusively focused on diagnosing and treating dental pain.
Why choose an Endodontist?
Choose an endodontist with the proper credentials, relevant experience, and a history of successful root canal therapy history. Selecting the wrong endodontist can be highly damaging.
Failed endodontics often result in one of the following three outcomes:
1. Dental stripping
The result of dental stripping is a perforation of the roots due to the dentist accidentally removing too much material from the inside of the tooth. As a result of this perforation, sealing materials used to fill the empty socket left by a root canal can leak out, resulting in a lesion and bone deterioration.
2. Infection that persists
If a root canal treatment does not wholly and entirely remove the infected or inflamed pulp material, or if an abscess is not treated beneath the roots, the tooth can become reinfected. As a result, bone loss and tooth loss can occur.
3. Fractured roots
In some cases, a poorly executed endodontic can fracture the tooth’s roots. If this occurs, the prognosis for the tooth is poor, and it is typically necessary to remove the entire tooth. If the root of the tooth becomes fractured, quick treatment is imperative. A prosthodontist can treat an early-stage fracture with dental implants before damage occurs to the jaw bone.
Why is a root canal sometimes considered oral surgery?
It is vital to have the steady hand of an experienced specialist, typically an endodontist, and to drill the teeth to facilitate the canal. But not every root canal is considered oral surgery.
Root canals are considered oral surgery if they involve the periodontal bone, such as when there is an abscess located at the tip of an orthodontic root, or if they require penetration into the gum tissues.
Surgical vs. Non-Surgical Root Canals
Non-surgical root canals and surgical root canals differ in their scope of intervention.
Non-Surgical Root Canal
Non-surgical root canals penetrate the tooth itself instead of the surrounding tissue. The technique works well for root canal procedures that aim to rid a tooth of inflamed or infected dental pulp that hasn’t spread to the far recesses of the root canals.
Generally speaking, a non-surgical root canal is similar to a routine tooth filling that is used for a minor cavity, except that it requires the endodontist to enter deeper into the tooth.
Surgical Root Canal
An infection that is too deep or has spread to the underlying periodontal bone may require a surgical root canal.
Is a root canal treatment a painless dental procedure?
It is understandable that many patients fear dental procedures. However, root canal therapy is relatively painless.
A root canal is often performed to eliminate the severe pain and swelling associated with infected teeth or inflamed inner pulps.
Pre-treatment pain
An infected tooth that needs a root canal treatment often causes severe to extreme pain. Therefore, root canal procedures are often sought because of a patient’s pain.
Only the needle delivering the local anesthetic can cause discomfort before a root canal procedure. The patient’s only sensation when the novocaine takes effect is mild pressure or vibrations from the endodontist while performing the treatment procedure.
Procedurally painless
With the help of local anesthesia or unconscious sedation, those undergoing a root canal procedure will feel no pain.
Depending on the patient’s needs, the type of sedation will vary. However, the standard procedure is to inject localized novocaine or apply a topical anesthetic before a root canal procedure. In this case, the patient will remain conscious during the entire process. In addition, the endodontist may give patients a sedative such as a valium to help them stay calm.
All the anesthetics we prescribe are carefully measured and administered with the utmost care and consideration to enhance patient comfort and minimize pain.
Post-treatment pain
There should be no post-operative pain following a flawless root canal procedure. As a result of the root canal treatment, the dental nerves within a tooth are removed, essentially eliminating the sensation of pain.
Nevertheless, nerves and nerve endings remain within the root ligaments that attach the tooth to the periodontal bone. Therefore it is possible for postoperative pain if a root canal procedure is performed poorly or if the infection is not entirely removed.
An alternative explanation for post-root canal dental pain could be fractured dental roots. Dental fractures are a serious issue. If a vertical root fracture (VRF) is the cause of the pain, a tooth may have no hope of survival, and it may need to be extracted.
Step-By-Step Guide to a Root Canal Procedure
Even though root canals are relatively straightforward, they are still considered oral surgery. That’s because a root canal treatment affects not only the visible tooth structure but its underlying root system. In more severe cases, root canals can also damage the gingiva and underlying periodontium.
In this Step-by-Step Guide To Root Canal Treatment, we will describe every step involved in a standard root canal procedure, which accounts for the vast majority of root canals today.
A root canal procedure involves creating a penetration in the affected tooth to extract the infected or inflamed pulp, thereby removing the pain and signs of infection. Root canals, however, are more complicated in practice.
10 Steps of a Root Canal Procedure
1. Preparation
Root canals begin with preparation by the dental team. Patients will sit in a comfortable surgical chair and be provided with a bib and other hygiene items.
Before many procedures, a dentist performs a dental exam and teeth cleaning to assess the patient’s oral health and provide a clean working environment for the dental team.
2. Anesthetics
Anesthetics are administered once the patient is comfortably seated. In addition to local anesthesia, sedatives can be administered in pill form as well to ensure maximum patient comfort and compliance.
It is possible to provide a patient with general anesthesia or anesthesia that puts them to sleep, but in most cases, this is only recommended in special circumstances.
3. Isolate the affected tooth
The next step is to isolate the affected tooth after administering anesthetics. This is done by covering the mouth except for the tooth that is to be operated on with a dental dam. Doing this ensures a sterile working environment, and the tooth in question is not contaminated while being treated.
4. Drill into the affected tooth
Access to the inflamed or infected dental pulp and roots must be gained through penetration of the tooth. To accomplish this, an access point is drilled into the enamel and through the crown of the tooth.
In some cases, an endodontist or oral surgeon may also need to remove some gum tissues to access the roots of the teeth or treat particularly deep abscesses.
5. Pulp removal
A highly specialized dental instrument, such as a barbed broach, is used to remove the infected, inflamed pulp. The extraction and destruction of pulp is known as extirpation.
During the procedure, the sensitive nerve endings that cause pain are also removed.
6. Cleansing the root canal
A liquid disinfectant such as EDTA and chelating agents is poured into the cavity of the tooth after it has been opened. This cleanses the cavity of debris and bacteria. This procedure of cleaning the pulp chamber and root canals is known as debridement.
Occasionally, hand files can be used to facilitate the cleaning process. An endodontist may also flush the canal with sodium hypochlorite to ensure no bacteria remain.
7. Drying the surgical area
The cavity is thoroughly flushed and then dried to inhibit bacterial growth. This is accomplished using simple paper points. It may not seem significant, but drying is crucial to ensuring that the filling materials seal properly.
8. Filling and sealing
Filling and sealing, also known as obturation, is the process of filling in the endodontic root spaces left by a root canal procedure. Various materials are available for sealing root canals, including specialized sealants, gutta-percha, dental plugs, and spreaders.
9. Temporary tooth filling
After the root canals have been filled, a temporary filling is often used to seal the endodontic cavity from the external environment. The goal is to prevent bacteria, food debris, and other unwanted detritus from entering the cavity. Temporary fillings provide patients with a level of functionality while they wait for a more permanent solution that meets their particular needs.
10. Place a permanent dental crown
Patients may require a dental crown, or cap, to complete their endodontic treatment. Custom-made crowns are frequently made in our office on the same day. An endodontic procedure can cause a tooth to be structurally compromised, so a protective dental crown can help protect the tooth. As a result, the tooth will be more resistant to cracks and fractures in the future.
4 Benefits of a root canal
An endodontic root canal procedure is designed to save a badly infected tooth. This approach to treating dental abscesses and infections has many advantages in terms of functionality, aesthetics, treatment cost, and patient comfort. However, it may be helpful to consider alternative solutions to root canals, such as tooth extraction and replacement with an artificial tooth. This will enable you to understand better why root canals are so commonly recommended.
Since a root canal preserves the original structure of a natural tooth, there is no need for a tooth extraction. The tooth remains intact as long as the infection did not damage the periodontium. If the tooth is properly filled and protected with a dental crown, it can continue to function well for many years. Further, maintaining the original tooth structure means maintaining the original aesthetics. Therefore, a replacement tooth is unnecessary, and no need for dental implants.
Furthermore, root canals are considerably more affordable than completely replacing an infected tooth since there is no need for labor-intensive extraction. Of course, not every tooth can be saved. When a tooth must be extracted, dental implants and other tooth replacement treatments are a good option. However, most dental professionals recommend root canal procedures to maintain the natural function and aesthetics of a patient’s smile.
1. Saves the tooth
Natural teeth should always be saved whenever possible, rather than replaced.
An endodontic procedure preserves the tooth’s outer shell while the inner pulp is replaced with a filling material.
2. Eliminate dental pain
A dental endodontic procedure eliminates the source of a person’s dental pain. To achieve this, the endodontist must remove the infection and the sensitive inner pulp and nerve endings.
A correctly performed endodontic procedure will permanently eliminate dental pain.
3. Eliminates infection
The endodontic treatment eliminates the underlying sources of infection in a tooth by physically removing and eliminating infected inner pulp, abscesses, and bacteria. In addition, stopping the infection is vital to a person’s long-term oral health and stability.
An infection in the tooth can spread to the periodontium and beyond if left untreated.
Other parts of the body, including the heart valves, can be infected with bacteria related to dental decay via the bloodstream. Sepsis and deadly septic shock can result from an infection that spreads into the bloodstream.
The underlying periodontal bone can be attacked and destroyed by bacteria if the infection extends there.
Additionally, dental infections can damage the ligaments that attach teeth to the underlying alveolar bone, resulting in tooth loss.
4. Prevents future pain and infection
A properly treated tooth that has been completely sealed inside the endodontic chamber and has had the organic pulp removed will never relapse into an infection. There will be no pain, and there will be no chance for recurrence. That’s why it’s crucial to choose a root canal specialist.
The quality of the work performed heavily influences an endodontic treatment’s long-term success (or failure). It is not uncommon for some patients to undergo two root canal procedures on the same tooth.
What is an emergency root canal?
If a neglected tooth infection reaches the root canal chamber inside the tooth, or the periodontal bone, causing severe pain, swelling, sensitivity, and tenderness, an emergency root canal is required.
It is often too late for more conventional treatments when a patient experiences pain and other symptoms associated with a severe dental infection. Consequently, root canals may be considered an emergency procedure performed as a last resort to save an infected tooth.
Unfortunately, most dental clinics don’t offer 24-hour services. Due to this, many patients end up at the emergency room (ER) for dental pain.
When should I go to the emergency room?
Generally, most emergency room doctors do not recommend patients go to the ER for dental pain. Even if you suffer from severe dental pain, the best thing to do is see a dentist as soon as possible.
A tooth infection isn’t something that an emergency room doctor can diagnose or treat. Emergency room doctors aren’t trained to pull teeth or perform root canals. Emergency rooms aren’t staffed with dentists or dental specialists of any kind. The most an ER can offer dental patients is antibiotics and pain relief.
A dental infection may sometimes justify a trip to the ER. Also, go to the emergency room when dental pain is accompanied by facial swelling, neck pain, or difficulty breathing.
Avoid a dental emergency
The use of modern diagnostic imaging and the expertise of a trained dentist can identify and treat many dental problems well before they require root canal treatment or cause any pain. For example, cavities are seldom painful and can be detected using modern diagnostic imaging. In addition, early diagnosis and treatment of dental issues are typically more manageable and less expensive than treating an infection that has spread into a root canal.
Preventing dental emergencies is much better than dealing with them. A regular dental exam will ensure dental infections are caught as early as possible.
You may require preventative root canal treatment if an infection is found close to the inner pulp.