Root Canal Procedure Costs, Complications, Symptoms and Signs of an Infected Tooth on MedicineNet.com

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Root Canals

A root canal is a treatment used to repair and save a tooth that is badly decayed or becomes infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Without treatment, the tissue surrounding the tooth will become infected and abscesses may form.

"Root canal" is the term used to describe the natural cavity within the center of the tooth. The pulp or pulp chamber is the soft area within the root canal. The tooth's nerve lies within the root canal.

A tooth's nerve is not vitally important to a tooth's health and function after the tooth has emerged through the gums. Its only function is sensory -- to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth.

Featured patient discussions on root canal

"I just had my first root canal today on a lower molar. The tooth had been sensitive to heat, cold, and pressure for a long time. I had a crack also. I found that the rubber mouth guard helped a lot in keeping my mouth open, so it didn't take much effort. The worst part was the nervousness at the beginning -- mostly for nothing -- and the needles, not because they were painful, but because I needed four of them to get my tooth numb enough to work on. At the very beginning of the drilling, I felt a tiny little bit of pain, but it quickly went away. The dentist said, �From here on, it's just boring,� and he was right. The drilling, filing, and cleaning had to be repeated over and over, and it did take a lot of time. After the canals were all cleaned out, he took another X-ray and said it had come out alright. Then he filled each canal with filling material and used what he called a "warm instrument" that made stinky smoke and sealed the material. The entire left side of my mouth, tongue, and lips were more numb than they'd ever felt in my life, but otherwise I felt fine. I came home and was able to eat dinner, chewing on one side. Now, three hours and 400 mg of ibuprofen later, I am feeling comfortable. I have no soreness or jaw pain, just a little tenderness around the tooth area itself, which he told me to expect for a few days. All in all, this was not as bad as I thought it was going to be!"

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Patient Discussions are not a substitute for professional medical advice, or treatment.
See the disclaimer at the bottom of the comments page.

Why Does the Pulp Need to Be Removed?

When nerve tissue or pulp is damaged, it breaks down and bacteria begin to multiply within the pulp chamber. The bacteria and other decayed debris can cause an infection or abscessed tooth. An abscess is a pus-filled pocket that forms at the end of the roots of the tooth. An abscess occurs when the infection spreads all the way past the ends of the roots of the tooth. In addition to an abscess, an infection in the root canal of a tooth can cause:

Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

What Damages a Tooth's Nerve and Pulp in the First Place?

Nerve and pulp can become irritated, inflamed and infected due to deep decay, repeated dental procedures on a tooth and/or large fillings, a crack or chip in the tooth, or trauma to the face.

What Are the Signs that a Root Canal Is Needed?

Sometimes no symptoms are present; however, signs to look for include:

Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
Discoloration (a darkening) of the tooth
Swelling and tenderness in the nearby gums
A persistent or recurring pimple on the gums

What Happens During the Procedure?

A root canal requires one or more office visits and can be performed by a dentist or endodontist. An endodontist is a dentist who specializes in the causes, diagnosis, prevention and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth. The choice of which type of dentist to use depends to some degree on the difficulty of the root canal procedure needed in your particular tooth and the general dentist's comfort level in working on your tooth. Your dentist will discuss who might be best suited to perform the work in your particular case.

The first step in the procedure is to take an X-ray to see the shape of the root canals and determine if there are any signs of infection in a surrounding bone. Your dentist or endodontist will then use local anesthesia to numb the area near the tooth. Anesthesia may not be necessary, since the nerve is dead, but most dentists still anesthetize the area to make the patient more relaxed and at ease.

Next, to keep the area dry and free of saliva during treatment, your dentist will place a rubber dam (a sheet of rubber) around the tooth.

An access hole will then be drilled into the tooth. The pulp along with bacteria, the decayed nerve tissue and related debris is removed from the tooth. The cleaning out process is accomplished using root canal files. A series of these files of increasing diameter are each subsequently placed into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Water or sodium hypochlorite is used periodically to flush away the debris.

Once the tooth is thoroughly cleaned, it is sealed. Some dentists like to wait a week before sealing the tooth. For instance, if there is an infection, your dentist may put a medication inside the tooth to clear it up. Others may choose to seal the tooth the same day it is cleaned out. If the root canal is not completed on the same day, a temporary filling is placed in the exterior hole in the tooth to keep contaminants out between appointments.

At the next appointment, to fill the interior of the tooth, a sealer paste and a rubber compound called gutta percha is placed into the tooth's root canal. To fill the exterior access hole created at the beginning of treatment, a filling is placed.

The final step may involve further restoration of the tooth. Because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness, a crown, crown and post or other restoration often needs to be placed on the tooth to protect it, prevent it from breaking and restore it to full function. Your dentist will discuss the need for any additional dental work with you.