Root Canals

Nobody ever wants to hear the news that they need a root canal. Chances are, at some point in your life a root canal will make the difference between losing a tooth (or teeth) or keeping for life. The doctors at Southport Dental Care peform certain root canals every day, while other procedures (most root canals on back molars) are referred out to endodontists, it is important that you understand what a root canal is, why they are sometimes the only choice, and how you can best avoid the need for one in the future.

If your tooth is infected or there’s severe damage to the pulp, a root canal will be recommended. An untreated cavity is the most common cause for this infection. The pulp inside the tooth can become inflamed from trauma or extensive restorative work. It can even be affected from a series of fillings being applied in a short period of time. This inflammation usually leads to infection. Pain in the too this the most common and obvious symptom.

The two most common causes of infection in the pulp are deep cavities and fractures or broken teeth. Both expose the pulp to bacteria that live in saliva. These bacteria, which are always present in your mouth, can cause an infection that can kill the pulp. Without treatment, the pus from the infection can eventually gather down at the root tip and pass into the jaw bone, causing an abscess (a pus pocket). The abscess can then damage the bone that surrounds the tooth. The resulting pressure inside the bone and ligaments surrounding the tooth can cause excruciating pain, and left untreated, can even be life threatening.

You may have realized that you had an infected tooth because it was sensitive to hot and cold, was swollen and painful, or had given you a bad taste in your mouth. On the other hand, you may have been completely unaware that you had an infection because you experienced no symptoms at all.

An infected tooth will never heal on its own, and as it gets worse, it will continue to be a source of infection that depletes your immune system, which can affect your entire body. Years ago, your only option would be for us to extract the tooth. But today, we can remove the infection with root canal therapy, and save your tooth. When a tooth becomes infected, it’s absolutely necessary to remove the source of infection through root canal therapy. We understand that some patients have anxiety about root canal therapy, but we want to assure you that it will be comfortable for you. Treatment, in fact, is your most comfortable option, because an infected tooth will never heal. The unpleasant consequences of infection only get worse and more painful with time.

Root canal therapy refers to the process by which a dentist treats the inner aspects of a tooth, specifically that area inside a tooth that is occupied by its “pulp tissue.” Most people would probably refer to a tooth’s pulp tissue as its “nerve.” While a tooth’s pulp tissue does contain nerve fibers it is also composed of arteries, veins, lymph vessels, and connective tissue.

For the purposes of this discussion, so to use terminology that people seem to be most familiar with, we will use the terms “nerve” and “nerve tissue” to refer to a tooth’s pulp tissue.

Where precisely in a tooth is its nerve?

Teeth are hard calcified objects but their inner aspects are not completely solid. Inside every tooth there lies a hollow space which, when a tooth is healthy, contains the tooth’s nerve tissue. Dentists use the following terms to refer to various portions of this nerve area:

The pulp chamber – A hollow space that lies more or less in the center of the tooth.

The root canals – Each tooth’s nerve enters the tooth, in general, at the very tip of its root(s). From this entry point the nerve then runs through the center of the root in small “root canals” which subsequently join up with the tooth’s pulp chamber.

Initially a tooth’s nerve tissue plays an important role in the formation and development of the tooth. Then, once the tooth has formed, the function of this tissue becomes one of helping to preserve the tooth’s health and vitality. The nerve tissue keeps the organic components of the tooth’s mineralized tissues (dentin and enamel) supplied with nutrients and moisture. The nerve tissue also produces new tooth structure (reparative dentin) as is needed so to help to wall off and protect the nerve from insult or injury (such as advancing tooth decay).

A tooth’s nerve tissue does provide a sensory function but this role is probably different from what you expect. Under normal circumstances the nerves inside our teeth provide us with very little information. Yes, when activated by extremes in pressure, temperature, or severe insult (such as a cracked tooth or advancing tooth decay) teeth do respond with a painful sensation. But under normal circumstances the nerves inside our teeth remain relatively “quiet.”

At this point you might be thinking that if you push on your tooth with a finger or close your teeth together you will feel a pressure sensation. Because of this you might assume that that sensation must come from the nerve inside the tooth. Well, in reality, that sensation comes from the nerves found in the ligament that binds the tooth to the jawbone, not from inside the tooth itself. This implies then, from a standpoint of the normal functions we perform with our teeth, that the presence of a live nerve inside a tooth is somewhat academic. If a tooth’s nerve tissue is present and healthy, wonderful. But if a tooth has had its nerve tissue removed as a part of root canal treatment then that’s fine too. You will never miss it.


Concerned about your upcoming Root Canal?

Q – Are there any risks involved in root canal treatment?
  A – Yes, as with any medical or dental procedure, there are some risks. The common risks are as

   1. Bleeding, pain, soreness and infection: After your root canal treatment you may experience
   pain, swelling or discomfort for several days, which may be treated with pain medication. You
   may also experience an infection following treatment, which would be treated with antibiotics.

   2. Reaction to local anesthetics: Local anesthetics may cause your heart rate to increase and
   your hands to feel shaky.

   3. Stiff or sore jaw joint: Holding your mouth open during treatment and dental injections
   (shot) may temporarily leave your jaw feeling stiff and sore and may make it difficult for you
   to open your mouth wide for several days afterwards. Treatment may leave the corners of your
   mouth red or cracked for several days.

  4. Numbness: With any dental procedure that requires anesthetic (numbing), there is a
   possibility of lingering numbness. This numbness can last for an extended period of time
   (usually 1 to 4 months). Problems with numbness are most likely occur in the lower jaw and
   can leave your lip or tongue numb for a time. This occurs because of damage to a nerve during
   the shot. The condition is called parenthesis and is described as transient, since it
   will eventually go away and the numb sensation will not be present. In addition a severe
   infection and or swelling can also result in numbness that is not a lasting condition, but goes
   away a few weeks after the infection or swelling clears up. Again, this condition
   occurs mostly in the lower jaw.

   5. Broken instrument: Occasionally a root canal cleaning instrument will break off in a root
   canal that is twisted, curved or blocked with calcium deposits or prior filling materials.
   Depending on its location, the fragment can be retrieved or it may be necessary to seal it in the
   root canal (these instruments are made of sterile, non-toxic surgical stainless steel or nickel
   titanium, so they cause no harm). The broken instrument can be sealed in the canal with the
   root filling material or it can be removed by performing an apicoectomy.

   6. Overfill: As a result of filling the root canal, the incomplete formation of your tooth or an
   abscess at the end of the tooth (called the apex), an opening may exist between the root canal
   and the bone or tissue surrounding the tooth. This opening can allow filling material to be
   forced out of the root canal into the surrounding bone and tissue. A surgical procedure
   (apicoectomy-see #8) may be necessary to retrieve the filling material and seal the root canal.

   7. Fracture of the tooth: Most teeth having root canal treatment are weakened by the original
   cavity or large filling. These teeth are prone to fracture. You should return to your dentist for
   a permanent filling as soon as possible. Sometimes the tooth may already be fractured, or
   fracture before the final root canal visit. This may result in the extraction of the
   tooth or persisting symptoms.

   8. Need for further treatment: In some cases, root canal treatment may not relieve all
   symptoms. If you suffer from gum disease (also called periodontal disease), this can increase
   the chance of losing a tooth even though root canal treatment was successful. Twisted, curved
   or blocked root canals may prevent removal of all the inflamed or infected pulp. Leaving
   pulp in the root canal may cause your symptoms to worsen. If the pulp tissue cannot be
   removed you may need an additional procedure. An apicoectomy, mentioned above is a
   surgical procedure involving cutting a small opening in the gum and bone, removing the root
   tip and placing a filling or seal over the end of the root canal. An apicoectomy may also be
   necessary if your tooth does not heal (symptoms or infection continue).