Unfortunately, the term “root canal” has received an unsavory reputation which is truly not justified. In most cases, but not all, a patient is experiencing some significant pain and its elimination requires root canal therapy. Later, the patient remembers how uncomfortable they were and repeats to friends and family that they had a root canal. They fail to mention that the root canal actually relieved their pain. The sordid stories you hear about root canals are usually second-hand from those who have never had root canal therapy, but have heard about them. All would be better served if the treatment were simply given a new and “softer” name.
In actuality, a root canal is simply the open chamber within the tooth which consists of the pulp and the associated canal(s) that run to the root tip(s) or apex. Contained within are the nerve and blood supply to the tooth. Their purpose is for the sensory perception of hot and cold on the tooth. The blood vessels within return the tooth back to normal body temperature. If these internal soft tissue items are damaged from decay, trauma, or leakage from splitting or cracking of the tooth, the nerves and blood vessels begin to break down and create gas, pressure, pain, and sometimes swelling. This can cause bone loss at the tip of the root. Sometimes, especially in a front tooth which has been traumatized, the tip of the root is moved and the blood vessels are torn and this causes internal bleeding in the tooth. This can make the tooth turn dark from the dried blood within and necessitates root canal therapy and often times, internal bleaching.
The diagnosis for a root canal, actually known as endodontic therapy, is verified by a combination of x-rays, visual tests, hot and cold tests, percussion tests, and history. In most cases, the patient is experiencing significant pain.
Although a local anesthetic my not be necessary in all cases, most often it is given so the patient will not be concerned. Access is gained through the top of the tooth followed, by the thorough cleansing and shaping of the pulp chamber and canals. Chemicals are used to sterilize the tooth and just before the tooth is sealed, it is thoroughly dried with special absorbent paper sponges. Then an inert material called gutta percha is positioned to the apex and confirmed by x-ray. The goal is to seal the apex and then compress additional warm gutta percha to the walls of the canal. The pulp and access hole in the top of the tooth are then filled. It is always recommended that the tooth be restored with a full crown for additional strength as the tooth will dry out to some degree creating brittleness. This usually occurs at the next visit.
In the greatest majority of cases, the discomfort is totally eliminated but often an NSAID is prescribed. NSAID is an acronym for non-steroidal anti-inflammatory drug such as Aleve, Motrin, Ibuprofin, and Advil. This handles any inflammation at the apex of the root. Sometimes antibiotics may be prescribed. On occasion, a chronic lesion may be found at the tip of the root and create bone loss. This can easily been seen on x-ray and will be brought to your attention and this area may take a few months to remodel with new bone.
Should the patient forgo the root canal recommended, the tooth must then be extracted. The cost to replace the extracted tooth with either a fixed bridge or an implant and crown is approximately three times the cost of a root canal.
Root canals, properly done, have a success rate of greater than 95%.
American Dental Association-Life Member, Emeritus Fellow of Academy of General Dentistry, American Academy of Implant Dentistry