Root canal treatment (endodontic treatment) is required when you have a tooth infection. With any infection, your body sends white blood cells and antibodies to the infected area to kill the bacteria. The tissue becomes red and swells. When that infection is in your tooth, there is no room in the canal space for extra antibodies or white blood cells. As the tissue attempts to swell, it chokes itself and dies. Now you continue to have a complication. If this dead tissue were elsewhere in your body, your body would clear it out. Since it is inside your tooth, there is no way for your body to get at it, so it becomes a perpetual source of infection, called a tooth abscess, spilling into the bone tissue around the end of the tooth.
*Image courtesy of New York Endodontists
In root canal treatment, the dentist removes this dead or diseased tissue, cleans the inside of the tooth thoroughly, and then places a sealer material completely filling the inside the tooth and sealing it so that no living tissue or bacteria can get inside.
This treatment is generally not difficult for the patient, and is usually not painful, in spite of its reputation. In my experience as a dentist, a tooth extraction appointment was the most traumatic for the patient by far. Many of these root canal appointments were very easy, and with some we didn’t even need novocain to keep the patient comfortable because the tooth was dead and had no feeling in it. Yet some people are so afraid of endodontic treatment that they choose to have a tooth extracted instead, which ends up being much more stressful for them than if they had the dentist save the tooth.
Other information related to root canal treatment:
- What to expect when you need a root canal procedure.
- Root canal cost estimated.
- Tooth infection antibiotics—When are they helpful?
- When this treatment is done on a front tooth, it can discolor after several years. Read your options for fixing this discolored tooth, including internal tooth bleaching.
- Donnie wonders, why put a crown on a dead tooth? But a dead tooth can last for many, many years if it is taken care of.
- Why a dental post may be placed in your tooth afterward.
More detail about root canal treatments
The tissue inside your tooth is called the pulp. The pulp tissue is responsible for most of the formation of your tooth. It is present well before the tooth erupts in your mouth. The tooth actually grows from the outside in. As the tooth grows, your pulp tissue shrinks.
Once your tooth is fully formed and has erupted into your mouth, the pulp tissue remains and performs a sensory function. If your tooth becomes irritated, it is the pulp tissue that senses this. Even a small cavity can sometimes cause inflammation in the pulp. The larger the cavity, the more the irritation. You may have sensitivity to cold or to air. It’s a warning system that something is wrong.
If the pulp tissue becomes infected, the toothache can become severe and constant.
There are two parts to this pulp tissue. One part is in the crown or the visible part of your tooth. This pulp is in what is called the pulp chamber. This pulp tissue extends into narrow passageways in the roots of the tooth. These passageways are the root canals. At the end of the root is an opening to the bone. A blood vessel and a nerve come from the bone and into the tooth and supply the tooth with sensation and nourishment. The very tip of the tooth is called the apex.
These endodontic treatments do not need any maintenance and they are very durable. Once one is successful, it will never wear out or need any further attention. It could last you the rest of your life.
Problems with root canal treatments are caused by the dentist’s inability to either completely clean out the inside of the tooth all the way to the apex, because of obstructions or curves, or an inability to completely seal the apex of the tooth, thus allowing leaking of living material into the tooth that can become a further source of infection. If this happens, it is called a failed root canal. A failure can be treated with root canal surgery, or the tooth can be extracted. An apicoectomy is the most common surgery. Maybe 10% of root canal treatments are failures.
Endodontic treatment is more difficult with back teeth than with front teeth. A root canal on a front tooth is the simplest. A front tooth has only one root, where back teeth can have up to four. The root of a front tooth is generally straight, as opposed to curved roots on back teeth. And the access and visibility for a front tooth is much easier. Problems with endodontic treatment usually occur with back teeth.
- Click here to read more about tooth pain.
- Read Dr. Hall’s blog posts about root canals, where he answers questions from visitors.
This content was written by Dr. David Hall. Click here to ask Dr. Hall a question.