Although much maligned, Root canal (Endodontic) therapy is a great service and not nearly as horrible as many people think. This blog will discuss the tooth anatomy, the reasons why root canal treatment may become necessary in order to save a tooth, how the procedure is performed, and how to minimize discomfort before and after the procedure. Note that when root canal therapy is indicated, the other option is extraction of the tooth.
The natural tooth is composed of the crown and the root. The crown contains Enamel on the outside, Dentin below it, and the pulp chamber (called the “nerve”, but not really) in the center. The tooth is alive, except for the Enamel, which is harder than bone and acts as an insulator to prevent air, hot and cold from causing sensitivity. The pulp chamber contains blood vessels and nerves, and it nourishes the tooth with nutrients from the bloodstream which enter through the tip of the root. When the tooth is first formed, the pulp is sterile, leading a “sheltered life” inside the tooth. The pulp chamber divides into tiny tubes that go down the center of each root- these are referred to as the root canals. Front teeth usually have one root, Bicuspids(premolars)have one or two roots, and Molars usually have three roots (and root canals).
When tooth decay goes through the enamel into the dentin, a filling is placed. When tooth decay goes deeper, it can reach the pulp chamber. This can cause bacteria to communicate with the pulp and eventually cause the pulp to die. Trauma to a tooth can also lead to pulp death. Sometimes the Dentist can determine if the pulp is dying based on symptoms, most commonly, a “toothache”. But oftentimes the pulp can die slowly with few or no obvious symptoms. Once the pulp has died, the Dentist can diagnose it with a pulp test, where a small electric current is applied, and no sensation is elicited. After 6 months or so, a dark area (abcess) can often be seen on an x-ray at the tip of the root. When the pulp is dying or dead, Root canal therapy is indicated.
The surgical operation referred to as Endodontic therapy is a highly successful operation statistically when compared with all types of operations. For instance, Hernia surgery is not very successful overall with roughly a 50% success rate. Root canal procedures are roughly 90% successful for 10 years and 50% success after 20 years. When root canals fail they can be redone (lower success rate ) or surgical root canals called Apicoectomies can be performed to extend the viability of the tooth. An opening is made at the top or chewing surface of the tooth (usually with local anesthesia) and the pulp chamber is accessed. Using a series of files (think of a plumber using a “snake” to clean a pipe) and a disinfectant irrigation solution- usually Chlorox – the root canal is filed and shaped and irrigated in order to remove all of the pulp tissue which may be in the form of red bleeding tissue or putrefied pus if the pulp has died. The tissue must be completely removed and the canal space made as close to sterile as possible. In order to accomplish this without exposing the patient to Chlorox, or the canals to the patient’s saliva germs, a mask is placed over the tooth with a clamp on the tooth to secure it. This is called a rubber dam. Rotary machines are also used to shape the canals. Once the canal is clean and the length to the root tip has been measured to facilitate complete cleaning and shaping, the canal is dried with paper sticks and a filling is placed. The most commonly used material is Gutta Percha, a thermoplastic rubber. The fillings are fitted to seal the tip of the root and cemented with waterproof cement. X-rays verify that the entire root canal is filled and the material is subsequently condensed, often with heat, to insure the entire root canal space is filled. A temporary filling like clay is placed in the access opening at the chewing surface, and the tooth is reduced (drilled) out of contact with the opposing tooth. This is because as the tooth begins to heal, it is tender and one should not chew hard on it for several days. Return to the Dentist 1-4 weeks later- the temporary will leak and the root canal will fail or the tooth is more likely to fracture if you don’t.
What can you do to make the root canal procedure as painless as possible? It is easy! Remember, there are two things to worry about: Infection and Inflammation. If the pulp has died, then Infection is a concern. If there is swelling associated or the pulp has been dead for a while, an antibiotic may be prescribed. The best thing to do, if possible, is to take the antibiotic for at least two days, or until symptoms and/or swelling subsides before completing the procedure. Sometimes the first antibiotic is only partially effective, or not effective, and a second antibiotic may be prescribed.
Next is Inflammation- it is always part of the picture. When the pulp is dying, it is inflamed, when there is a toothache, there is inflammation, when the pulp is dead, there is inflammation around the outside of the tooth. Finally, the root canal procedure causes inflammation. The solution is to take Aspirin, Advil, or Aleve as directed with food, when the tooth is symptomatic, and one hour before the root canal procedure, and after the procedure for a day or two. Do not take these meds all day for more than a few days because they decoagulate, or thin the blood, and can cause internal bleeding. Do not take these meds if your doctor tells you that you should not. If you have Asthma, ask your doctor. These medications stop the synthesis of Prostaglandins which is the chemical that your body produces in response to inflammatory processes(which causes you to experience pain). Also, if you take Tylenol with the aspirin after the root canal procedure, it works a little better, because that addresses other aspects of the pain experience. NOTE: This article is not to be construed as Medical advice. It is only my opinion and you must speak with your Doctor about all information and suggestions I have given. Thank you. Michael Acquista DDS