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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 21, 2010
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Sunday, March 21, 2010
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NetWellness receives many questions about root canals. The following content has been developed to help you understand and better prepare for this procedure. Root canals help people keep their natural teeth longer. To this end, a positive experience with a minimum of discomfort is the goal of your endodontist or dentist.
A root canal is done to preserve the tooth in the mouth and to allow a filling and/or a crown to be done on the tooth. There may be reasons particular to your tooth that would put your tooth at risk of needing a root canal. Among others, these include:
It is also possible to have decay under a filling and the nerve could be exposed while removing the decay, necessitating a root canal.
Bacteria invading the pulp is one of the reasons that a root canal is necessary. These bacteria give off products that can destroy the bone around the tooth. The root canal is done to rid the tooth of the infection. Once the root canal is completed and the source of the infection is removed, the bone in the area can heal. You can not eliminate the infection without doing the root canal or having the tooth extracted. It is perfectly normal and common to have a root canal done while swelling or pain is present.
A cracked tooth may be able to be repaired, depending on the tooth and the crack. If the fracture is too extensive, the tooth may not be able to be saved. If a tooth is fractured on the root surface, there is no way to seal that area, and bacteria will continue to infiltrate your tooth - even with a root canal treatment and a crown. Extraction is the only option in that case.
If a tooth is "dead" that means that there is no longer an adequate nerve and/or blood supply to the tooth and there is ingress of bacteria and byproducts. When this occurs a root canal is necessary.
For more information, please visit What is Endodontic Treatment? and Cracked Teeth, provided by the American Association of Endodontists.
You do not need to have pain to determine that a root canal needs to be done. Actually, many patients that require root canal therapy have no symptoms at all. This may cause you to wonder why you should have the procedure done at the time. Wouldn't it make sense to wait until the tooth becomes symptomatic? If you just "wait and see", there is no telling when problems will arise. Often, patients develop pain and swelling at inconvenient times in the future when they have important events like weddings or job interviews, etc.
Whether or not the root canal is necessary is a discussion you should have with your dentist or endodontist who knows the specifics of your particular case. Your endodontist or dentist can do an evaluation to determine if you need a root canal and explain the exam/tests necessary for your particular situation. Unfortunately, x-rays do not help with diagnosis since cracks in teeth are so tiny and are at different angles such that they usually aren't detected until fairly late in the process.
For more information, please visit What are the signs of needing endodontic treatment?, provided by the American Association of Endodontists.
Tooth infections, or abscesses, do not resolve themselves. Symptoms may disappear (swelling, pain, drainage), but until the underlying cause of the infection is treated, the symptoms will continue to reappear. If a root canal is necessary due to an infected tooth, no type of antibiotic will cure the infection permanently because antibiotics do not penetrate into your tooth. Antibiotics only treat the symptoms. A root canal or extraction would be needed to treat the infected tooth.
It is normal for the body to "take care of" the infected tooth, meaning that there is usually a period of time that you will no longer have symptoms, but these will always come back. We cannot predict when this will occur, but it usually happens at the most inconvenient time. The best way to prevent future problems is to have the root canal done.
A root canal is done to eliminate infection or inflamed tissue and allow you to keep your natural tooth. The endodontist first makes a hole in the top of your tooth. Usually the endodontist puts a temporary filling in your tooth and then replaces that filling with a more permanent one before a crown is seated. Sometimes, if there is not enough tooth structure left, a post may be needed instead of just the filling.
After root canal treatment on a tooth with an existing crown, you should return to your dentist to have a permanent filling placed inside your crown or possibly to have a new crown made.
Most tooth infections take some time to clear up, and that is why frequently endodontists do not do the return check-up on a root canal-treated tooth for about 6 months. A very common course is to give things time to heal. If new symptoms develop, you should consult your dentist or endodontist for an evaluation. An exam can detect problems occurring that need to be addressed or rule out any problems, leading to piece of mind.
The following animation will help you understand more about the process: Root Canal Treatment (American Dental Association). For more information, please visit Endodontic Procedure, provided by the American Association of Endodontists.
In general, most root canal-treated teeth should have crowns placed to help prevent fractures. Whether or not the root canal should be done before the crown is a discussion you should have with your dentist or endodontist who knows the specifics of your particular case. If you still have concerns, you may seek out a second opinion which would include an examination. The advantage of having a root canal done prior to a crown is that if the root canal needs to be done later, your dentist will need to drill a hole through the top of your new crown.
Sometimes a root canal can be done through the crown, but there are a number of reasons why a root canal can not be done through an existing crown (i.e. insufficient tooth structure, difficulty of the root canal (or retreatment), recurrent decay under the crown, leaking crown, etc.). Your dentist/endodontist can evaluate whether that is an option.
You definitely can have a root canal done when there is an infection. In fact, that is often the reason people present for a root canal. Even after the root canal is done, it will take about a week for the swelling to go down again.
Because crowns do not fit perfectly tight, there is always some microleakage around the margins. However, there can be other reasons for leakage, such as a cavity under the crown or broken crown margins. Root canals are not successful unless the crown or top of the tooth is sealed well. You should see your general dentist if you notice that your crown is leaking.
It is normal to have pain or tenderness and swelling after root canal therapy because it is, in essence, a microsurgery, and some postoperative discomfort is common. We see this with teeth that are painful before treatment and teeth that are not painful before treatment.
Usually the pain is the greatest in the first few days, peaking at about day 3, and then decreases, but it is normal for pain to last throughout a week's time. Individuals vary greatly in the time it takes for the pain to dissipate after a root canal procedure.
The length of time of discomfort can also vary greatly depending on the condition of the tooth at the time of the root canal. Additionally, every root canal treatment is different. This means that even if you had a root canal before and had no pain, that may not be the case for a different tooth in your mouth. There can be differences in the type of tooth infection and how your body reacts to them.
It is also not unusual for many teeth in the area to hurt when there is an infected tooth since the inflammation is not limited to just the area around one tooth.
Motrin and Vicodin are common methods to control postoperative pain. Other pain medications and ways to take those medications that can be discussed with your dentist/endodontist. It is important to take care of yourself (sleep, liquids, etc.). Hot or cold packs can help. If there is significant swelling or a fever, you may need a prescription for antibiotics or other medications. Over-the-counter medications can help relieve this discomfort, with Advil (ibuprofen) being the most common one taken. However, you should not take ibuprofen if you have medical contraindications.
If you are having problems managing your pain, you should speak with your dentist or endodontist. If you continue to have pain longer than the normal range of time, or if you have a change in your pain or new symptoms develop, it would be best to be re-evaluated to rule out any potential complications.
For more information, please visit Will I have pain during or after the procedure?, provided by the American Association of Endodontists.
Following certain root canals, a flare-up can develop. A flare-up is significant pain and/or swelling a few hours to a few days after treatment. This happens in about 10% of the population, and we can not predict when it will occur. The risk is greater with retreatments (root canals being redone).
If you are having a true "flare-up," the pain and swelling usually start in the first few hours to days and usually peak around day 3 and then come down throughout the week. We usually treat the symptoms of a flare-up with antibiotics, pain medications, and some other adjuncts to help you feel better, such as ice packs, drinking fluids, rest, etc. If you get any significant swelling or pain that is not resolving, you should contact your dentist/endodontist.
Tapping (or percussion) sensitivity should go away eventually. It takes a different amount of time for every person. Some ways to combat this are to avoid chewing on the area to help let it settle down and to take anti-inflammatory medication if you are able.
Thermal sensitivity is not a typical symptom of previously-treated root canals developing problems. However, if you are having a reaction to hot/cold liquids, it could indicate that there may be a problem with another tooth in the area.
There are a few possible reasons for continued sensitivity following root canals, such as:
None of these can be diagnosed without a thorough examination.
Teeth that have had root canal treatment can become painful when they become reinfected or when there is residual infection. This can occur for a number of reasons (cracks, recurrent decay, residual bacteria/tissue, etc.). A crack in a tooth can create a space for bacteria or other irritating substances to enter a root canal that was previously protected from these ingresses. This may lead to symptoms.
Treatment of the tooth differs, depending on the cause. Cracking usually occurs long before it is clinically evident, (i.e. before anything actually breaks), allowing a pathway for bacteria to get in and reinfect the tooth. This is similar to what happens with decay (a cavity) and could necessitate a retreatment.
For more information, please visit Why do I need another endodontic procedure?, provided by the American Association of Endodontists.
If a root canal is failing, there are usually three options:
Having a root canal done a second time on the same tooth is called a retreatment. Retreatment is a very common endodontic procedure. Retreatments need to be done for a number of reasons, with leakage and reinfection being predominant ones. You will not always have pain when a root canal is reinfected. Pain is usually the exception rather than the rule.
Redoing a root canal can help in some cases, but if a crack extends too far down the root, the tooth can not be held together and would not be able to be saved.
For more information, please visit Endodontic Retreatment and Endodontic Surgery, provided by the American Association of Endodontists.
Root canal treatment is a difficult procedure; that is why there are specialists who have received extensive training in the field. However, root canal treatment has a success rate in the high 90 percents when done well.
If you interested in locating an endodontist or dentist, the links below may be helpful. You could also ask friends and family since most people's dentists have an endodontist to whom they refer patients.
Bureau of Primary Health Care Service Delivery Sites (Bureau of Primary Health Care)
Find a Dentist (Academy of General Dentistry)
Find a Dentist: ADA Member Directory (American Dental Association)
Find an Endodontist (American Association of Endodontists)
Local Dental Schools (National Institute of Dental and Craniofacial Research)
State Dental Associations (American Dental Association)
This article is a NetWellness exclusive. 
Last Reviewed: May 29, 2008
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Melissa McCartney Drum, DDS, MS Assistant Professor Section of Endodontics College of Dentistry The Ohio State University |
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