ENDODONTIC [ROOT CANAL] TREATMENT

Root Canal Treatment [also known as Endodontic Treatment] is a procedure that allows a severely damaged tooth to be saved for future restoration and function.

The procedure involves the extensive use of anesthetic prior to the removal of any decay from the tooth, and an opening is made through the top [chewing surface of a back tooth or back side of a front tooth] of the tooth into the chamber where the pulp tissue [the blood vessels, nerves and other tissue] is housed. In many cases, this pulp tissue is already so badly damaged that it is dead or dying at the time of root canal treatment. If the pulp is dead or dying, it may cause an abscess in the bone around the tooth.

After the opening [called an access] is made, the length of the root or roots are measured using an x-ray taken with a small wire in each root canal. When the exact length of each root is determined, these chambers or canals [the terms are interchangeable] are cleaned out and shaped using very small files that are often mechanically driven to enhance your comfort, and then washed out with sterile water and dried.

The final step of the Root Canal Treatment is the sealing and filling [called obturation] of the cleansed and shaped root canal using a cement-like sealer and a rubbery filling material called gutta percha which will harden and seal the canal from bacterial invasion.

After removing the excess filling materials from the access, the tooth is ready for a temporary filling to seal the tooth from food and saliva until definitive restoration can be accomplished. The temporary filling material used is just that, temporary. It is imperative that this temporary be removed and replaced with a more stable and wear-resistant material within 4-6 weeks [possibly sooner if large areas of tooth structure are missing] to prevent leakage and the possible failure of the endodontic treatment due to bacterial infiltration of the sealed root canal.

If the endodontic treatment fails, retreatment of the root canal will be required which is more time consuming, difficult, prone to in-treatment complications and more expensive [approximately 50% more] than the original treatment. If retreatment is required due to the failure of the patient to complete follow up care, as recommended by the dentist, any fees for retreatment will be the patient's responsibility. While endodontic treatment has become a highly successful treatment option [with a success rate of 90-95%] for patients, as with any medical procedure, there is no such thing as a treatment that is 100% successful in all cases. However, the careful selection of endodontic cases has minimized the failure rate in our practice.

There are complications associated with endodontic treatment. These complications include discomfort, infection and fracture of the tooth. In general, complications occur in teeth that had severe symptoms prior to endodontic treatment, in teeth that had a delay in receiving endodontic treatment, or in cases that post-treatment recommendations were not followed by the patient. These recommendations may include, for example, not following directions included with prescription medication or not having a definitive restoration placed on the tooth following treatment. It is extremely important that any tooth that has received endodontic treatment have a final restoration placed on it to prevent leakage of the temporary or fracture of the tooth.

Alternative treatment options to endodontic treatment includes extraction of the tooth or not treating the tooth at all. Extraction of the tooth, while less expensive in the short term, can lead to adverse effects which include bone loss, shifting of teeth in both upper and lower jaws, loss of chewing ability, loss of support of facial muscles and structures [leading to a "sunken" facial appearance], and difficulty in speaking. Tooth replacement options include partial removable dentures, a fixed bridge, or an implant-supported crown. If you have any questions about these options, please ask your dentist for more information. Non-treatment or delayed treatment of a tooth that needs or may need endodontic treatment can lead to acute pain, infection in the bone that may spread to other parts of the mouth, face or body, severe bone loss, and potential loss of the affected tooth as well as the adjacent teeth.

In rare instances, the placement of the restoration [usually, but not always, associated with deep cavities or teeth that have fillings previously placed and removed] may cause what is called a pulpitis, which is an inflammation of the pulp tissue [blood vessels and nerves] inside the tooth. There are two kinds of pulpitis, reversible and irreversible, and the symptoms include prolonged sensitivity to cold, sensitivity to heat, pain or tenderness to chewing or biting, and/or spontaneous pain. If the pulpitis is reversible, adjusting the bite on the filling, along with an anti-inflammatory medication such as Advil or Decadron, will generally relieve the symptoms. In the case of an irreversible pulpitis, the tooth will require endodontic [root canal] treatment.

A tooth that has received endodontic treatment will always require some type of restorative treatment after the root canal is finished. Many times this treatment will include a crown build-up, post and core, or cast core and a crown. Sometimes, a tooth that has not suffered extensive structural damage may be restored with a bonded composite resin filling or bonded inlay or onlay.