Most every patient has heard the term “root canal”, but without a dental degree or commitment to watching YouTube videos, few patients could effectively describe what a root canal is. Honestly, it wasn’t until mid-way through second year of dental school that a root canal was thoroughly discussed to the point that I could say “Ooooh, I get it.” So there should be no shame in asking the dentist “What does that mean?” when he or she recommends that a tooth needs a root canal. (To be fair, there should never be any embarrassment when asking one of the dentists to explain a procedure in detail, we all love to educate.) So, let’s discuss some of the major points of root canal treatment (RCT).
First, WHAT is a root canal? In simplest terms, a root canal is the procedure that removes the nerve and blood supply, otherwise called THE PULP, from inside the tooth. All healthy teeth have a blood and nerve supply that enters from the root portion inside the bone, and provides the tooth vital function such as immune response to fight infection, and sensitivity to perceive stimulus. The root canal procedure uses fine reamer-like instruments that remove this tissue from inside the tooth, which is then followed by medicine to sterilize the nerve chambers. As it was told to me in dental school, “it’s like taking the lead out of a pencil.” Once the nerve and blood supply has been removed, the nerve chamber is plugged with a biocompatible material called gutta-percha, and the tooth is considered ready for next phase of treatment. When treating back-teeth, the treatment typically concludes with crown placement (this is a separate procedure and requires a blog post all on its own.) Front teeth can sometimes be restored after RCT with a simple filling, but if too much natural tooth structure is missing or esthetics are a concern, it may be recommended to complete treatment with crown placement as well.
Finally, it’s necessary to clarify WHY a tooth may need a root canal. Most teeth fall into two major categories for RCT:
- The tooth is infected to the point that the infection is irreversible without RCT (or even extraction in severe cases)
- The tooth needs something more permanent than a filling to restore it back to function (such as a crown), and therefore requires more work (i.e. RCT) to save the tooth.
Scenario 1 has a vast range of causes. Teeth may become infected with bacteria due to neglect, fractured tooth structure, leaking restorations, gum related issues, or a combination of any of these. This is only a short list of potential sources of tooth infection, and the pain associated with an infection can manifest in a variety of ways. Typically, these teeth are symptomatic before any physical indicators arise, such as swelling or pus drainage. Symptoms may include pain on biting, cold sensitivity that lingers for more than 10 seconds, or spontaneous throbbing pain that can wake you up during the night. Regular dental checkups (every 6-12 months), with radiographs (every 12-24 months) will minimize the risk of a tooth infection progressing past the point of saving the tooth. If tooth decay has reached the point of encroaching on the nerve chamber, it is likely a RCT will be recommended.
Scenario 2 is certainly the trickier situation for the patient to fully understand. Many times, teeth need more than a simple filling placement to restore them back to “clinical health”, and the dentist will recommend something more substantial, such as a crown placement. If a tooth is broken down beyond the point of repair with just a crown, it may be recommended that the tooth have a “post and core” placed before the crown is completed. A post and core procedure helps rebuild the center of a tooth, replacing missing structure that has been removed over the years with subsequent filling placements. A post helps support the core material that is replacing the missing tooth structure, much like how rebar helps support concrete. The post is a small rod that is cemented INSIDE the pulp chamber of the tooth, which requires the tooth be sterilized prior to its placement. This is where the root canal comes in. The tooth is cleaned and de-nerved (root canal treatment) so that the post can be cemented, which will then act to help support the core material, which will in turn help hold our crown in place.
It’s important to remember, root canal treatment SHOULD BE PAINLESS. The pain associated with a root canal is usually from the infection BEFORE THE PATIENT CAME INTO THE OFFICE. During the procedure, the tooth will be anesthetized with local anesthesia, the same as it would if it were have a filling placed. There may or may not be some post-operative sensitivity, but these symptoms typically resolve within a few days of treatment.
Although this may seem like a lot of work to save an infected or broken tooth, the alternative treatment is often tooth extraction, which harbors its own risks and complications. If the RCT process is still unclear, no need to worry. This concept can take a few different explanations to fully understand, and typically models and diagrams will help clarify. Next time you’re in the office, please ask and a dentist will gladly explain!
Spencer Platt, DMD