Root Canal

1 What is a Root Canal?

A root canal is a term used to describe the natural cavity in the center of the tooth with pulp in the soft area within the root canal and the tooth nerve lying within the root canal.

It is also a procedure done to repair and save a tooth that is badly decayed or becomes infected.

During the procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed.

The tooth’s nerve can be removed because its only function is sensory, to provide the sensation of hot or cold so the absence of a nerve will not affect the day-to-day functioning of the tooth.

The tooth’s pulp is removed because when it is damaged, it breaks down and bacteria can multiply within the pulp chamber causing infection or an abscessed tooth. This occurs when the infection spreads all the way past the ends of the roots of the tooth.

An infection can also cause swelling in the areas of the mouth, face, neck or head, bone loss around the tip of the root and a hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin.

A tooth’s nerve and pulp can be damaged because of deep decay, repeated dental procedures on a tooth, and/or large fillings, a crack or chip in the tooth, or trauma to the face.

Symptoms of the root canal needed are:

  • Severe toothache pain upon chewing or application of pressure
  • A darkening of the tooth
  • Swelling and tenderness in the nearby gums
  • A persistent or recurring pimple on the gums
  • Prolonged sensitivity/pain to heat or cold temperatures after the hot or cold has been removed

A root canal can be performed by a dentist or an endodontist – a dentist who specializes in the causes, diagnosis, prevention, and treatment of diseases and injuries of the human dental pulp or the nerve of the tooth and requires one or more office visits.

First, an X-ray of the tooth is done so the dentist can see the shape of root canals. Then, a dentist will use local anesthesia to numb the area near the tooth and drill the hole into the tooth.

The pulp with bacteria, the decayed nerve tissue, and related debris will be removed from the tooth and then cleaning out process is done with a root canal files by placing them into the access hole and worked down the full length of the tooth to scrape and scrub the sides of the root canals. Also, the debris will be flushed periodically with water or sodium hypochlorite.

After cleaning, some dentists like to wait a week before sealing the tooth, especially if there were an infection so the dentist may put a medication inside the tooth to clear it up and other choose to seal the tooth the same day it is cleaned out. A patient with permanent filing must minimize chewing on the tooth under repair.

A week later, the medication is removed and a gutta percha – a sealer paste and a rubber compound is placed into the tooth’s root canal and to fill the exterior access hole created at the beginning of treatment, a filling is placed.

Sometimes as the final step, restoration of the tooth can be done because a tooth that needs a root canal often is one that has a large filling or extensive decay or other weakness so a crown and post or another kind of restoration is done to protect the tooth.

The first few days after the completion of a root canal of the tooth, the patient can have sensitivity and discomfort but it can be controlled with over-the-counter pain medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Most patients can return to their normal activities the next day.

Root canal treatment has more than a 95% success rate.

A complication which can occur is new infections might emerge after a root canal because more than the normally anticipated number of root canals were in a tooth so one of them is left unclean, an undetected crack in the root of a tooth is found or a defective or inadequate dental restoration is performed and it allows bacteria to get past the restoration into the inner aspects of the tooth and recontaminates the area.

In that case, a retreatment can be done or sometimes endodontic surgical procedure like apicoectomy or root-end resection must be performed.

The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function and prevent adjacent teeth from shifting but these alternatives are more expensive than a root canal procedure and require more treatment time and additional procedures to adjacent teeth and supporting tissues.

The cost of a root canal depends on how severe is the problem and how much the tooth is affected. If the procedure is performed by a dentist it can cost from $350 to $540 for an incisor and $520 to $800 for a molar, and if it is performed by endodontist the cost can be up to 50% higher, but many dental insurance policies cover endodontic treatment.

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