Root canal treatment — also called endodontics (“endo” – inside, “dont” – tooth) — is a set of specialized procedures designed to treat problems of the soft pulp (nerve) tissue inside the tooth. While some mistakenly think of it as an unusually painful treatment, in most cases the procedure is no more uncomfortable than getting a filling. It’s actually one of the most effective ways of relieving some kinds of tooth pain.(281) 559-7019
Root canals are tiny passageways that branch off from beneath the top of the tooth, coursing their way vertically downward, until they reach the tip of the root. All teeth have between one and four root canals.
Many tooth problems involve infections and inflammations that spread to the pulp, which is the inner chamber of the tooth containing blood vessels, nerves, and other soft, connective tissues. When the infection becomes worse, it can begin affecting the roots. Common causes of root canal problems include:
One potential cause of infection is deep tooth decay. Untreated dental cavities eventually allow bacteria to work their way down to the center of the tooth, where they may infect the pulp tissue.
Another path by which bacteria may come into contact with pulp is via chipped or cracked teeth. Any opening in the protective enamel coating has the potential to allow bacteria access to the tooth’s pulp.
A traumatic injury to a tooth can also compromise the pulp, leading to similar problems. Trauma to the tooth – the kind that might result from a sports injury or automobile accident, for example — is also a major cause of pulp tissue damage. In this case, it’s essential to seek treatment immediately, both to try and save the tooth and to prevent future problems.
In some cases, extensive dental work itself may cause damage to the pulp tissue that will need to be treated via a root canal. Having multiple fillings or restorations on the same tooth increases the chances of this type of injury. Occasionally, common procedures like crown preparation or orthodontics may eventually lead to root canal problems.
A diseased inner tooth brings a host of problems, including pain and sensitivity, as the first indications of a problem. In time, the pain may go away, at least temporarily. Without treatment, however, the infection won’t. Inside, a spreading infection can cause small pockets of pus to develop, which can lead to a dental abscess and may even contribute to systemic problems in other parts of the body.
A root canal procedure becomes necessary when this infection or inflammation develops in the pulp tissue of the tooth; it can save the infected tooth and prevent the chances of needing to perform an extraction.
How do you know when you need a root canal? Sometimes, it’s painfully obvious. If you feel constant and severe pain and pressure in your mouth, or noticeable swelling and extreme sensitivity in your gums, then it’s clear you need an evaluation and treatment right away. Another telltale symptom of pulp tissue damage is a sharp pain when you bite down on food. Lingering pain after eating hot or cold foods is also an indication of potential trouble. If you notice any of these symptoms, you need to have an examination as soon as possible.
If an examination shows that you do need root canal therapy, don’t worry — it’s one of the most routine and effective procedures in the arsenal of dental treatments and can often be accomplished in just one visit. The root canal process generally begins the same way as a filling does, and with no greater discomfort: an anesthetic is administered to numb the tooth and the surrounding area. For many patients, the worst is already over.
Next, a small opening is drilled through the surface of the affected tooth to give access to the inner pulp chamber and root canals. Tiny instruments are used, sometimes with the aid of a microscope, to remove the dead and dying pulp tissue from inside these narrow passageways. The chamber and empty canals are then cleaned and disinfected, while the tiny canals are reshaped. Then the area is prepared to receive a filling of elastic, inert, biocompatible material, and medication designed to prevent infection. Finally, adhesive cement is used to seal the opening in the tooth, preventing future infection, until a permanent seal is made with a crown.
Following root canal treatment, your tooth may feel some sensitivity or tenderness for a few days. Over-the-counter pain relievers like ibuprofen are generally effective in relieving discomfort, but prescription medications may also be given if needed. During this period, it may help to avoid biting hard on the affected tooth. All of these symptoms, however, should be temporary.
To further protect the tooth and restore it to full function, it’s usually necessary to have a crown or other restoration placed on it. Restorations can take many forms, from traditional gold crowns to tooth replicas made of high-tech tooth-colored material. In any case, you will have made an investment in preserving your dental health for years to come.
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If endodontic retreatment is appropriate for you, the procedure is similar to a routine root canal, with a few added measures. After giving you a numbing shot, any preexisting restorations, such as crowns, are removed. This is usually accomplished by making a small opening into the inner part of the tooth, removing filling material or obstructions, and cleaning the pulp chambers with tiny instruments.
We use a microscope and light to search carefully for additional canals or unusual structures. If the treatment process becomes extremely complex, we will finish it in a subsequent visit. Finally, we will clean all canals and thoroughly disinfect them. Afterward, we fill it with inert material to seal it. Then we implant a temporary filling in the tooth. We complete the permanent restoration during another visit.
Medicine and dentistry are as much art as science, and neither one can guarantee that any procedure will be 100% successful. While endodontic retreatment can be more complex than initial root canal therapy, it offers a good chance of success in many instances. And, since the field of endodontics is constantly evolving, it may be possible to use new techniques that weren’t available when your first root canal procedure was done.
Dentists take our responsibility seriously to help you understand the risks, benefits, and alternatives for treating root canal problems. When we recommend retreatment, it’s because we feel it is the best way for you to preserve your natural teeth. We want you to enjoy them for many years to come.
Occasionally, root canal treatment proves unsuccessful at resolving an infection in the tissues near a tooth’s roots. That’s when we recommend an apicoectomy – a minor surgical procedure. This procedure is endodontic microsurgery because of the need for a microscope and other small specialized tools. Probably the most common type of root canal surgery, an apicoectomy involves removing a small portion of the apex (tip) of the tooth’s root, along with any surrounding hard or soft tissue that may be infected.
What would cause you to need an apicoectomy? Blocked, fractured roots or inaccessible canals can require the procedure. We recommend the procedure after one or more root canal treatments fail. This problem generally occurs near the apex of the root. Therefore the procedure is often an effective way to treat a persistent infection.
Before an apicoectomy procedure, we take diagnostic images (such as X-rays) of the tooth along with the surrounding bone. We carefully review your medical history, including medications you take (both prescription and non-prescription.) We will discuss the need for the procedure prior to beginning.
We perform root canal surgery under local anesthesia with a numbing shot to prevent pain. To begin the procedure, we make a small incision in the gum to expose the tooth’s root. We remove the infected tissue along with a few millimeters of the root tip itself. A dye helps make cracks or fractures easy to see. So, if we discover a tooth fracture, an extraction may be the best option.
Next, we’ll use a microscope and light to examine the tiny canals. We’ll clean them with an ultrasonic instrument, and fill them with an inert material to properly seal them. To finish the procedure, we’ll apply a small bone graft at the affected site. Finally, we’ll suture the gum tissue covering the tooth’s root. We will take x-rays as the procedure nears completion. Afterward, we’ll provide postoperative instructions before you go home. Most apicoectomies take about 30 to 90 minutes to complete.
Although apicoectomy is typically a safe and effective procedure, there are slight risks with any type of minor surgery. We don’t recommend apicoectomies unless we know further root canal treatments won’t work. An alternative treatment, in most cases, would be the extraction of the tooth. However, our goal as dentists is to help you preserve your natural teeth for as long as possible.
While there are excellent methods of tooth replacement, these involve further and more complex treatments. An apicoectomy is generally a permanent and cost-effective solution, which can help the tooth last for the rest of your life.