A root canal is a treatment of the pulp of the tooth that is inflamed, infected, or dead. The dental pulp is a soft substance in the center of the tooth that consists of the nerve, blood vessels, and connective tissue. The pulp chamber is the hollow part in the center of the tooth that contains the pulp, and it continues down canals that extend through the roots of teeth and into the surrounding bone. Some roots have more than one root canal, but all have at least one canal.
Root canal treatment (RCT) and endodontic treatment are the more correct terms for a procedure that treats the nerve of the tooth. Endodontics is a specialty of dentistry that deals specifically with the tooth pulp and tissues surrounding the root of the tooth. A root canal problem may be treated by a general dentist or by an endodontist. An endodontist is a dentist who has gone to multiple years of specialty training after dental school to focus exclusively on root canal treatments. General dentists are qualified to perform root canals but may refer a patient to an endodontist if the tooth is particularly complicated or is being treated for the second time.
When the root canal is treated, the dental pulp is removed and all the canals and pulp chamber of the tooth are filled and sealed to prevent bacteria from entering.
How do you know if you need a root canal?
There are many things that can damage the pulp or nerve of the tooth. Often a patient will feel pain or other symptoms that alert them to needing root canal treatment, but many times there are no symptoms or warnings. The following are some of the more common reasons for needing root canal treatment.
A toothache is the most common symptom of needing a root canal. The pain that comes from a tooth needing a root canal is fairly specific. If the tooth is still alive, the affected person will experience extreme sensitivity to hot or cold liquids or foods and that sensitivity will continue even after the hot or cold stimulus is taken away from the tooth. Heat sensitivity, instead of cold, is a symptom that is very specific to a tooth requiring root canal treatment. The tooth may start to hurt spontaneously, in the middle of the night, or sometimes when the patient isn’t even using the affected tooth to eat or drink. The pain can progress to a very severe generalized headache that may cause the person to even forget what initially caused the pain. If the tooth is dead and has become abscessed, the patient will feel pain when he or she chews food or puts pressure on the tooth. An abscess may or may not produce swelling or bleeding around the tooth, and sometimes it causes significant swelling of the cheek, jaw, or throat. If this swelling is noticed, treatment needs are urgent — even if that means going to urgent care or the emergency room of a hospital. Many other conditions of the mouth can masquerade as a toothache. Therefore, it is very important, when feeling some pain around a tooth, to get a thorough examination with pulp vitality testing by a licensed dentist for a proper diagnosis.
Sometimes a patient may feel intense tooth pain that makes them think they need root canal treatment, but the pain is a symptom of another problem requiring a different treatment. Root surfaces that have become exposed as a result of gum recession can mimic cold sensitivity. Sinus congestion can produce pressure around the roots of the upper teeth and cause pain upon chewing, which mimics root canal pain. Jaw pain can either be an indication of pain in the jaw joint or pain referred from a tooth needing a root canal. Even gum disease can mimic the throbbing pain around teeth that can feel similar to root canal pain.
How is a root canal done?
To confirm that a tooth does indeed require root canal treatment, the dentist will take an X-ray of the root and may perform a pulp vitality test. Most pulp tests involve placing a cold stimulus on the tooth to check for a healthy response. Many teeth will be tested to compare the responses. If the test confirms the need for root canal therapy, it will be completed in either one or two appointments. The dentist will determine whether the root canal will be treated in one or two appointments based on the size and duration of an abscess and other factors. A tooth is likely to be treated in two appointments if it is getting a retreatment (being treated a second time). Patients are often curious how long a root canal takes to finish. They can generally expect one or two appointments of about 90 minutes each. An endodontist, and some general dentists, will often perform root canal treatment using a microscope that attaches to the wall and hangs over the patient’s mouth. This provides magnification that helps the treatment provider locate and treat all the necessary anatomy inside the tooth.
Before starting the root canal, the dentist will numb the tooth with local anesthesia (such as lidocaine) to ensure patient comfort. When the tooth has become sufficiently numb, the dentist will place a rubber dam over the tooth. The rubber dam consists of a metal clamp that holds a latex sheet in place around the tooth so it can remain clean and isolated from saliva and contaminants.
How long does a root canal take?
An opening is made through the top of the tooth and the pulp is removed from the chamber and canals. The canals are then cleaned with sodium hypochlorite or another disinfecting solution. The canals are then shaped with a series of files of increasing diameter to make sure all of the infected tooth structure is removed and there is room for an adequate root canal filling. A series of X-rays will be taken throughout the procedure to make sure the files are reaching the end of the root and all the canals are being adequately cleaned and shaped.
If the root canal treatment is to be completed in two appointments, the dentist will place medicine like calcium hydroxide down the canal to help kill the bacteria at the end of the root and may prescribe an antibiotic to help combat the infection. A temporary filling will be placed to seal the opening in the tooth and a second appointment will be made for a week later or more. If the tooth is being treated in one appointment, the dentist will skip this part and go right to filling the root canal.
When the root canal is to be filled, the dentist will again numb the tooth, place a rubber dam, and remove the temporary filling material. The canals are filled with a rubber-like material called gutta-percha surrounded by a sealing paste. If an endodontist has performed the root canal, a temporary filling will be placed in the opening and a general dentist will place the permanent filling. After the root canal is completed, the tooth will likely need a crown to protect it from fracturing in the future. A post may be placed down one of the canals to provide an anchor for the filling and the tooth will be built up with a permanent filling. The dentist may choose to do the crown immediately or may wait a brief period of time to make sure the tooth is free of pain before continuing with the crown.
What types of Dental crown materials are available?
Permanent crowns can be made from all metal, porcelain-fused-to-metal, San Diegol resin, or all ceramic.
- Metals used in crowns include gold, palladium, nickel or chromium. Metal crowns rarely chip or break, last the longest in terms of wear down, and only require a small amount of tooth to be removed. They can also withstand biting and chewing forces. The metallic color is the main drawback. Metal crowns are a good choice for out-of-sight molars.
- Porcelain-fused-to-metal dental crowns can be matched to the color of the teeth beside them. They have a more natural tooth color. However, sometimes the metal under the crown’s porcelain cap shows through as a dark line. Other drawbacks are that the crown’s porcelain portion can chip or break off and there is more wearing down of the teeth opposite them in the mouth. (The top and bottom tooth that come into contact when the mouth is closed.) These crowns can be a good choice for front or back teeth.
- All-resin dental crowns are less expensive than other crown types. However, they wear down over time and are more likely to break than porcelain-fused-to-metal crowns.
- All-ceramic or all-porcelain dental crowns provide the best natural color match than any other crown type. They are also a good choice for people with metal allergies. However, they are not as strong as porcelain-fused-to-metal crowns. They also may wear down the teeth opposite them in the mouth a little more than metal or resin crowns. All-ceramic crowns are a good choice for front teeth.
- Pressed ceramic crowns have a hard inner core. They replace the metal liner that is used in the all-ceramic crown-making process. Pressed ceramic crowns are capped with porcelain, which provides the best natural color match. They are also more long-lasting than an all-porcelain crown.
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