Endodontics
Endodontic (root canal) treatment is the removal of the pulp (the nerves and blood vessels inside the tooth) either to prevent or resolve an infection (abscess). Teeth become infected because the pulp tissue inside the tooth becomes injured or diseased. This can cause pain and swelling in the tissues surrounding the tooth. Performing root canal treatment removes the source of the infection and allows the bone and tissue around the tooth to heal. According to the American Dental Association, over 22 million root canals are done in the U.S. every year and allow many people to retain their natural teeth.
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Endodontic treatment may require one or more appointments. The number of appointments is dependent on the condition of the tooth and the complexity of the case. Like any other dental procedure, root canal therapy is performed under local anesthesia. With profound anesthesia, patients remain comfortable throughout the treatment. If necessary and appropriate, various levels of sedation are available for our patients. Once the tooth is anesthetized (numb), a small opening is made through the top of the tooth to gain access to the pulp system. The root canals are then cleaned, shaped and disinfected. Radiographs are taken to ensure the roots are completely treated. A filling material is then placed inside the cleaned canals to fill the space the nerves and blood vessels used to occupy. The filling material typically used is a rubber-like material called gutta-percha. This helps to prevent bacterial recontamination of the canal space. Finally, the opening on the top of the tooth is filled with a temporary filling. It is usually necessary for patients to return to their general dentist to get a permanent filling or crown placed on the tooth.
Soreness is to be expected after any dental procedure, and a softer diet and over the counter pain medications are effective for most patients. If more than mild discomfort is experienced, prescription medications are given if indicated. Most pain and soreness is manageable and is usually gone in 24-48 hours.
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Studies show that root canal treatment is usually 90% successful. Although this procedure enjoys a high success rate, no medical or dental treatment can be guaranteed. The reasons for those that do fail can be inadequate cleaning, shaping and filling of the canal system, missed canal spaces, cracks or fractures of the root, and re-infection of the canal space. When root canal treatment fails some teeth may still be salvaged by retreatment or a surgical procedure; however, the prognosis of each tooth is dependent on many factors, which vary from case to case. Furthermore, proper oral hygiene and a sound filling or crown after the root canal is vital to success. It is essential for patients to see their general dentist after the root canal procedure for any additional treatment and periodic follow-up.
Unfortunately the options are limited. The only alternative to root canal treatment is often extraction of the tooth. After an extraction the surrounding teeth may have a tendency to shift and move into the newly created space. This can cause aesthetic concerns and occlusion (chewing) problems. It is thus recommended that this space be filled with an implant or a fixed bridge, both of which are more costly than a root canal. Although these are adequate and quite successful replacements, nothing is as good as your natural tooth.