Root Canal (cont.)
Steven B. Horne, DDS
Steven B. Horne, DDS
Dr. Steve Horne began his career at Brigham Young University obtaining his BA in English. He earned his Doctorate of Dental Surgery in 2007 from the University of Southern California where his pursuit for academic excellence landed him on the Dean's List. He was recognized for his superior clinical skills and invited to help teach other dental students in courses on restorative dentistry, prosthodontics, and tooth anatomy. During dental school, he provided dental care for underserved populations of Los Angeles and Orange County, Mexico, and Costa Rica with AYUDA. Following dental school, Dr. Horne entered active duty with the U.S. Army and practiced dentistry at Fort Knox, Kentucky, for four years. During this time, he was deployed to Baghdad, Iraq, and received multiple Army Achievement Medals, the Army Commendation Medal, and served as Company Commander. Dr. Horne currently practices full time at Torrey Pines Dental Arts in La Jolla, California, as a general dentist. Dr. Horne is a member of the American Dental Association, the California Dental Association, and the Academy of General Dentistry. Dr. Horne is married to his wife, Christy, and they have a chocolate Labrador named Roscoe.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
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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