What is Root Canal Treatment?

According to the American Association of Endodontists (www.AAE.org), root canal treatment, also known as endodontic treatment, is the salvation of millions of teeth every year. Endodontics refers to treatment of the innermost part of the tooth, the pulp. The pulp is a delicate collection of blood vessels, connective tissue and nerve fibers. While there are many reasons to perform endodontic treatment, infection from tooth decay and damage from an accident are the most common.

Dentists diagnose the need for root canal treatment and rule out other problems such as heart disease or sinus pain by asking the patient questions and listening to the answers. "How long has this tooth been uncomfortable?" "Does it hurt when you chew?" "Does the pain change when with a change in position?" "Do cold or hot temperatures make the tooth uncomfortable and for how long?"

Then, the dentist tests the tooth. Percussion is usually the first test. The dentist taps the teeth in the painful area with the handle of the dental mirror. Infection makes the tissue around the tooth tender. Percussion puts pressure on this tender tissue and the patient will let the dentist know it. When more than one upper tooth is sensitive to percussion, the dentist might suspect that the patient has a sinus infection.

Ever notice that eating ice cream can be uncomfortable? Teeth are usually sensitive to cold. Stressed dental pulps react to cold differently from healthy pulps. To figure out if a tooth has an endodontic problem, the dentist will cool the tooth with ice, a very cold liquid on a piece of cotton, or a blast of air. This is cold testing the tooth. The dentist will ask the patient to say both when the tooth hurts and when the pain stops. If the pain stops immediately, the tooth is fine. Lingering pain indicates a dental pulp that is dying. It is important for the dentist to test a few teeth so that the patient may compare the sensation.

Healthy teeth conduct electricity and sense the current. The electronic pulp tester works by putting a small current through the tooth. The dentist asks the patient to indicate when they sense the current as the voltage rises. It is important to compare the electrical sensitivity of the suspect tooth to at least one other.

Finally, the dentist will use x-ray images to look for signs of infection and mechanical defects in and around the roots of the teeth.

There are many effective techniques for providing root canal treatment. All of them have two characteristics in common. The dentist removes the remaining pulp and infection from inside the tooth and fills the root canal with a material that prevents reinfection of the tooth. Finally, the dentist will protect the root canal filling with a silver or tooth colored filling or rebuild and protect the tooth with a crown.

All dentists know how to provide this kind of treatment. Some have more training and experience than others. Endodontists are root canal specialists. These dentists spend two years after dental school learning everything about root canal treatment and dental pain. General dentists who provide this kind of treatment will refer more complex cases to such a specialist. More difficult cases include teeth with unusually shaped roots, retreatment of teeth that have failing root canal treatments, and endodontic treatment of teeth that have crowns.

Before the endodontist treats a tooth, it is important for the dentist who will restore the tooth (with a filling or a crown) to declare that the tooth is salvageable. A tooth may not be restorable if it is badly broken or decayed. Patients considering straightening their teeth with braces may ask their orthodontist if it is possible to close the space from the lost tooth by moving the other teeth around..

Generalists send patients to endodontists who have earned their trust. If your dentist trusts the endodontist, and you trust your dentist, then you know how to choose the best endodontist.

There are some complications that may effect the outcome of root canal treatment. There may be small canals that the dentist is not able to find or fully clean. The tooth may have a cracked root. The small files which are necessary to clean the canals may break within the canal. Any of these issues might lead to a bad outcome. This is a risk of a complicated dental treatment. Usually, a poor outcome does not indicate that the dentist did something wrong or improper.

While root canal treatment normally allows the body to heal the infection, sometimes the infection lingers or returns. Antibiotics or a surgical procedure called an apicoectomy is usually effective to remove the infection from around the root of the tooth.

Correctly treated, and properly cared for (including regular dental examinations, and daily brushing and flossing) the tooth may last for many years. However, it is possible for an endodontically treated tooth to develop decay, gum disease or even break like any other tooth. Is root canal treatment the best way to save your tooth? Who should provide your endodontic treatment? Ask your dentist.