Root Canal

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What is a root canal?

A root canal is a treatment of the pulp of the tooth that is inflamed, infected, or dead. The pulp is a soft substance in the center of the tooth that consists of nerve, blood vessels, and connective tissue. The pulp chamber is the hollow part in the center of the tooth that contains the pulp, and it continues down canals that extend through the roots of teeth and into the surrounding bone. Some roots have more than one root canal, but all have at least one canal.

Root canal treatment (RCT), or endodontic treatment, are the more correct terms for a procedure that treats the nerve of the tooth. Endodontics is a specialty of dentistry that deals specifically with the tooth pulp and tissues surrounding the root of the tooth. A root canal problem may be treated by a general dentist or by an endodontist. An endodontist is a dentist who has gone to multiple years of specialty training after dental school to focus particularly on root canal treatments. General dentists are qualified to perform root canals but may refer a patient to an endodontist if the tooth is particularly complicated or is being treated for the second time.

When the root canal is treated, the pulp of the tooth is removed and all the canals and pulp chamber of the tooth are filled and sealed to prevent bacteria from entering.

Why is a root canal necessary?

There are many things that can damage the pulp or nerve of the tooth. The following are some of the more common reasons for needing root canal treatment.

Pain: A toothache is the most common symptom of needing a root canal. The pain that comes from a tooth needing a root canal is fairly specific. If the tooth is still alive, the affected person will experience extreme sensitivity to heat or cold, and that sensitivity will continue even after the hot or cold stimulus is taken away from the tooth. The tooth may start to hurt spontaneously, in the middle of the night, or sometimes when the patient isn't even using the affected tooth to eat or drink. The pain can progress to a very severe generalized headache that may cause the person to even forget what initially caused the pain. If the tooth is dead and has become abscessed, the patient will feel pain when he or she chews or puts pressure on the tooth. An abscess may or may not produce swelling or bleeding around the tooth, and sometimes it causes significant swelling of the cheek, jaw, or throat. If this swelling is noticed, treatment needs is urgent -- even it that means going to urgent care or the emergency room of a hospital. Many other conditions of the mouth can masquerade as a toothache. Therefore, it is very important, when feeling some pain around a tooth, to get a thorough examination with pulp vitality testing by a licensed dentist for a proper diagnosis.

There are other causes of symptoms that are similar to those requiring root canal treatment. Root surfaces that have become exposed as a result of gum recession can mimic cold sensitivity. Sinus congestion can produce pressure around the roots of the upper teeth and cause pain upon chewing which mimics root canal pain. Jaw pain can either be an indication of pain in the jaw joint, or pain referred from a tooth needing a root canal. Even gum disease can mimic the throbbing pain around teeth that can feel similar to root canal pain.

Abscess: If a tooth has become abscessed, it will require a root canal. An abscess forms when the pulp of the tooth dies and a pus pocket forms around the end of the root. The pus accumulates in an area of dead nerve tissue that is infected with bacteria. Sometimes the abscess will form a bump that looks like a pimple on the outside of the gums. A patient may even notice pus draining from the pimple or notice a bad taste in his or her mouth.

An abscess that is left untreated will continue to grow and infect the bone around the root of the tooth. It may spread into surrounding bone and tissues. In rare cases, people have died from infections that started from a tooth abscess. Although antibiotics can help keep the infection from spreading, the only way to remove the infection completely is by performing root canal treatment and cleaning out all the dead tissue and bacteria inside the pulp chamber and root canals.

Deep cavity: If tooth decay extends deep into the tooth and reaches the pulp, the pulp will become infected with bacteria. When this happens, it will either become inflamed and painful or it will die and become decayed tissue. Sometimes there will be no pain, but the only way the dentist can get all of the tooth decay out of the tooth is by performing a root canal and removing the nerve that has become affected as well.

Trauma: If a tooth is hit with great force, the nerve can be severed at the end of the root and eventually die. This could happen immediately after the traumatic incident, or it may happen over many years following the trauma.

Fracture: A tooth that has become fractured may need a root canal if the fracture extends deep into the tooth and reaches the pulp. If a tooth has fractured in a way that doesn't leave very much tooth structure left above the gum line for a crown or other restoration, a root canal may need to be performed so a post and can be placed down the canal of the tooth to help retain the restoration.

Resorption: Root resorption is a condition whereby the tooth structure dissolves away as a reaction to injury, trauma, tooth replantation, or aggressive tooth movement during orthodontics. Not all of the causes of resorption are fully understood. If the defect starts from the outside of the root and goes inward, it is called external root resorption. If the tooth dissolves from the middle or inside of the tooth and progresses toward the outside, it is classified as internal resorption. In either situation, the resorption can invade the pulp canal and the vital nerve and blood vessels contained therein. If this occurs, the tooth needs root canal treatment in combination with specialized conditioning and repairing of the defect quickly before the resorption destroys more tooth structure. The defect is typically repaired with a material called mineral trioxide aggregate (MTA). Resorption usually causes no pain and is usually only diagnosed using X-rays.

Repeated dental procedures: Dental procedures produce significant stress on a tooth. Sometimes repeated drilling may cause the pulp of a tooth to become inflamed. The tooth will need to be tested by a dentist to determine whether the inflammation is reversible or irreversible.

In the past, whenever one of these situations happened to a tooth, the only treatment option was to have it extracted. Root canal treatment is an extremely beneficial option that allows for most teeth to be saved in the mouth and used effectively for a very long time. Once the teeth are formed, they don't need the pulp to function properly. The pulp provides the tooth sensation to a stimulus like hot or cold, but it isn't required for the tooth to remain functional in a healthy mouth.

Medically Reviewed by a Doctor on 7/2/2014

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