Root Canals…Did you know?

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

The Perfect Road Map For Your Child’s Oral Health

On July 3rd, 1806, two years into their journey to chart the uncharted west of America, pioneer explorers Meriwether Lewis and William Clark reached a challenge of epic proportion – the Rocky Mountains. What next, they wondered? Without a map, they were forced to do what explorers do – explore, and hope for the best. So, that got us thinking. Wouldn’t it be nice to have a handy map you could use to chart your own dental health? With that in mind, and in honor of our “Dog Days of Summer” explorers, we wanted to share with you a few mile markers you can use to stay on top of your child’s health today, next year, and for years to come!

6 to 24 months

When you’re a new parent, life is a whirlwind, and the dental care of your newborn may not be top of mind when you look in their mouths and see no teeth! Here are some things to keep in mind:

Schedule a visit: As soon as that first tooth comes in, you’ll want to give us a call to schedule a visit and set up a periodic exam schedule. Also, be aware the ADA recommends fluoridated toothpaste now for all children under the age of three. Don’t wait!

Ask us about:

  • Home hygiene basics: Things like, tips and tricks on brushing and other care. There’s nothing better than having our hygienists give brushing tutorials – they’re experts!
  • Preventative dentistry: The possible need for fluoride supplements
  • Dietary strategies: Achieving a balanced diet early in life for good oral health later
  • Feeding practice awareness: Bottle, breastfeeding, and no-spill training cups
  • Non-nutritive oral habits: Thumb sucking, pacifiers

2 to 12 years old

Ah, the little ones are growing up. Teeth are coming in at all sorts of crazy angles, and you’re going crazy from the rise in obligations. Here’s a quick list of what to consider during this time frame:

  • Preventative dentistry: Pit and fissure sealants can do wonders for keeping your child’s dental bills down, and their teeth in their head until they’re ready to fall out naturally. Ask us about them. They’re affordable AND useful. And, super-fast, you’ll be in and out in no time.
  • Orthodontic Consultation: Visiting an orthodontist for an early consultation is best done around your child’s seventh birthday. With today’s technology, early intervention can reduce the cost and duration of braces when your child gets older.

The Teen Years

The years “everything” happens! As children start to come into their own, new habits and desires begin to unfold as well. You’ll have to address every imaginable concern during these years, from piercings, to calls for whitening, braces, and the need to refer yourself away from your pediatric dentist and to a general dentist for continuing oral care. So, speak with us about:

  • Cosmetic Dentistry: What solutions are advisable now, and what things should be avoided.
  • Teen social pressures: Smoking, alcohol, intraoral/perioral piercings and the like. Believe it or not, we can help a lot with this. Does your teen have a favorite [insert your practice name here] hygienist? We might be able to arrange for that person to help when your teen comes in so they can address these concerns with an intermediary they trust. Give us a call at [insert your practice phone number here] to see how we can help!
  • Orthodontics: Options for minimizing appearance and health problems later in life.
  • Home hygiene tips: Brushing, flossing, choosing the right mouthwash.
  • Craniofacial injury prevention: With your children’s possible participation in sports, you’ll want to get them a mouthguard. Hands down it’ll be one of your best investments in a healthy mouth. And we make great ones!

Staying on top of your child’s oral health isn’t as hard as you think, and if you keep this schedule handy, you’ll be ahead of most of your neighbor’s kids when it comes to a healthy mouth and body. Come to think of it … why not share it with them as well? They’ll thank you for the help.