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What happens during a root canal procedure?
To confirm that a tooth does indeed require root canal treatment, the dentist will take an X-ray of the root and may perform a pulp test. Most pulp tests involve placing a cold stimulus on the tooth to check for a healthy response. Many teeth will be tested to compare the responses. Then the root canal will be completed in either one or two appointments. The dentist will determine whether the root canal will be treated in one or two appointments based on the size and duration of an abscess and other factors. A tooth is likely to be treated in two appointments if it is getting a retreatment (being treated a second time). An endodontist, and some general dentists, will often perform root canal treatment using a microscope that attaches to the wall and hangs over the patient's mouth. This provides magnification that helps the treatment provider locate and treat all the necessary anatomy inside the tooth.
Before starting the root canal, the dentist will numb the tooth with local anesthesia (such as lidocaine) to ensure patient comfort. When the tooth has become sufficiently numb, the dentist will place a rubber dam over the tooth. The rubber dam consists of a metal clamp that holds a latex sheet in place around the tooth so it can remain clean and isolated from saliva and contaminants.
An opening is made through the top of the tooth and the pulp is removed from the chamber and canals. The canals are then cleaned with sodium hypochlorite or another disinfecting solution. The canals are then shaped with a series of files of increasing diameter to make sure all of the infected tooth structure is removed and there is room for an adequate root canal filling. A series of X-rays will be taken throughout the procedure to make sure the files are reaching the end of the root and all the canals are being adequately cleaned and shaped.
If the root canal is to be completed in two appointments, the dentist will place medicine like calcium hydroxide down the canal to help kill the bacteria at the end of the root and may prescribe an antibiotic to help combat the infection. A temporary filling will be placed to seal the opening in the tooth and a second appointment will be made for a week later or more. If the tooth is being treated in one appointment, the dentist will skip this part and go right to filling the root canal.
When the root canal is to be filled, the dentist will again numb the tooth, place a rubber dam, and remove the temporary filling material. The canals are filled with a rubber-like material called gutta percha surrounded by a sealing paste. If an endodontist has performed the root canal, a temporary filling will be placed in the opening and a general dentist will place the permanent filling. After the root canal is completed, the tooth will likely need a crown to protect it from fracturing in the future. A post may be placed down one of the canals to provide an anchor for the filling and the tooth will be built up with a permanent filling. The dentist may choose to do the crown immediately, or may wait a brief period of time to make sure the tooth is free of pain before continuing with the crown.