Endodontics, Root Canals

What is Endodontics, also known as Root Canal Procedure?

Endodontic treatment is a way to preserve the tooth in the mouth in a functional form so that it does not have to be extracted. When the tooth is abscessed the only two options that are available to the patient are either to have the tooth removed or to have a root canal procedure (endodontics) done on the tooth. What we do in that process is to take out the infected material, usually the nerve along with that, and clean up the root canals. Then we fill the root canals and seal them up. Then the tooth remains functional in the mouth.

Why is an Endodontic Root Canal necessary?

It’s necessary in order to preserve the teeth in the mouth. If you start taking teeth out of here and there as they are infected or abscessed then you get migration sometimes some teeth with drift backwards, some teeth will drift forward, some teeth will drift down or up as the case may be. So that in order to preserve the integrity of the bite and the integrity of the teeth in the mouth, it’s best to save and preserve what is in the mouth, the way that is in the mouth and that’s done through root canal.

Why are people afraid of Root Canals?

Most people are afraid of root canals because years ago root canals could be quite painful. Comedians have seized upon that; “I’d rather have my mother-in-law coming and visit and have a root canal. I’d rather poke a spoon in my eye than have root canal pain.” So, it’s perceived by the public as probably the worst experience that you could go through. I really enjoy doing root canals. I think part of enjoyment I get as a dentist, is the idea is turning people around. In other words, letting them know, no, it’s not painful. As a matter of fact, the only reason the root canal is painful is if the tooth is so far gone or so inflamed that it is very difficult to get anesthesia on it. That represents less than 1% of all root canals that are done.

Most people come in when they have root canal pain or when they have an ache, they don’t wait and wait and wait, hoping that it will go away until they are swollen and so inflamed that it gets very difficult. When that happens it’s not possible to achieve or complete anesthesia. But if you are patient enough and if you wait for the anesthetic to go to work and if you have other adjuncts to use such as oral sedatives, nitrous oxide, you can get the patient very comfortable. In the rare instance, when we just can’t get the patient comfortable, we’ll do what we call initiation, in order words we will just give him enough to medicate the tooth enough so that two three weeks down the road when the patient comes back, then we can go ahead and get the patient comfortable much easier and the inflammation will be under control and then we can complete the procedure.

Is the tooth dead after a Root Canal?

The tooth is dead, yes and we of course say that the tooth is non-vital. The reason for that is because the tooth even though it is non-vital, still has a function in the mouth and still functions normally. Now what do I mean by that? What I mean is that tooth is attached to the socket by very small tiny fibers called ligaments. The ligaments are tiny fibers that hold or attach the root to the bone. The periodontal ligament acts as a cushion without this cushioning affect, you would not have any give to that tooth and without that give you will have multiple fractures. So, even though the tooth itself is non-vital, we render it preserved or sterile through root canal. Even though the tooth is non-vital, it acts as a normal vital tooth because the ligament is still alive. The ligament still has nerve structure, innervation. It still has vascular structure, vascular innervation as the blood supply and nerve supply. It will act as though the tooth is alive, even though the fact that the tooth is non-vital. We render the tooth non-vital but we preserve the tooth so that it can be used in a normal function.

How long does an Endodontic Root Canal treatment last?

Root canals themselves should last really as long as the patient can keep the tooth. The only reason a root canal will fail is if the seal at the root tip for some reason or the other fails and this can happen. It does not happen very often but when it does what we do is we re-access the tooth, we reenter the tooth and we re-perform or retreat the root canal. My experience is that that less than 2% of all root canals need to be retreated. If it needs to be retreated, it’s a simple procedure in the dentist’s office. The other reason that a root canal might fail is that the tooth might be fractured. We try not to do any root canals on multi-rooted teeth; bicuspids and molars. We try not to do them at all until the patient agrees to have them crowned. If the tooth isn’t crowned, then you risk of having it fracture because the tooth is non-vital and can become brittle. And if it isn’t protected with a dental crown, you run the risk when biting down on something hard while chewing, the tooth can become fractured. If the tooth fractures, the root canal can fail and in that case the only alternative is extraction. We want to make sure that on multi rooted teeth, especially, that those teeth are protected by dental crowns.