Root Canal Treatment
Introduction to Root Canal Treatment
Endodontics is the branch of dentistry that deals with diseases of the tooth’s pulp, which is located in the center of the tooth and in canals (called root canals) within each tooth root.
Pulp, consisting of connective tissue, nerves and blood vessels, nourishes the tooth when it first erupts (emerges through the gum). Once the tooth matures, the pulp can be removed safely from the pulp chamber and root canals and the tooth can be maintained. This is because the tooth also is nourished by a blood supply that surrounds the tooth. Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy.
Many people refer to this as “having a root canal.” Root canal treatments are quite common. They save an estimated 24 million teeth each year in the United States.
Do I Need Root Canal Treatment?
Root canal treatment is needed for two main reasons: infection or irreversible damage to the pulp. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it opens into the root canal system, allowing bacteria to infect the pulp. Infections inside teeth don’t respond to antibiotic treatment. The inflammation caused by the infection restricts the tooth’s blood supply, so antibiotics in the bloodstream can’t reach the infection very well. The reduced blood supply also limits the pulp’s ability to heal itself.
The pulp also can become damaged from trauma, a fracture or extensive restorative work, such as several fillings placed over a period of time. Sometimes, a common dental procedure can cause the pulp to become inflamed. For example, preparing a tooth for a crown sometimes leads to the need for root canal treatment.
In many cases, when the pulp is inflamed, but not infected, it will heal and return to normal. Your dentist may want to monitor the tooth to see if this happens before doing root canal treatment. Sometimes, though, the pulp remains inflamed, which can cause pain and may lead to infection.
Once the pulp becomes infected, the infection can affect the bone around the tooth, causing an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty canals with an inert material. If root canal treatment is not done, the tooth may have to be extracted.
It is better to keep your natural teeth if at all possible. If a tooth is missing, neighboring teeth can drift out of line and can be overstressed. Keeping your natural teeth also helps you to avoid more expensive and extensive treatments, such as implants or bridges. If an infected or injured tooth that needs root canal treatment is ignored, not only can you lose the tooth, but also the infection can spread to other parts of your body.
Having endodontic treatment on a tooth does not mean that you’ll need to have it pulled out in a few years. The reason for doing root canal treatment is often a large cavity. The tooth often is weakened, but if the tooth is covered with a crown after the root canal or, in some cases, restored with tooth-colored composite filling material, the tooth can last the rest of your life.
Signs and Symptoms
If you have an infection of the pulp, you may not feel any pain at first. But if left untreated, the infection will cause pain and swelling. In some cases, an abscess will form. Eventually, the tooth may need to be extracted. Contact Sunnyvale Dental practice today before it’s too late. Experienced Sunnyvale dentist Dr. Antonious can assist you.
Some indications that a tooth may need a root canal are:
- A tooth that hurts significantly when you bite down on it, touch it or
push on it
- Sensitivity to heat
- Sensitivity to cold that lasts longer than a couple of seconds
- Swelling near the affected tooth
- A discolored tooth, with or without pain
- A broken tooth
To determine whether your tooth needs root canal treatment, your dentist will place hot or cold substances against the tooth, feel surrounding tissues and gently tap on the tooth. He or she also will take X-rays.
If the condition of the pulp isn’t clear from these tests, your dentist may use an electric pulp tester. This hand-held device sends a small electric current through the tooth and helps your dentist evaluate whether the pulp is alive. This test does not cause pain or a shock, but a tingling sensation that stops immediately when the tester is removed from the tooth.
Caution: An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.
How Long Does a Root Canal Take?
Root canal treatment can be done in one or more visits, depending on the situation. An infected tooth will need several appointments to make sure that the infection is eliminated. Some teeth may be more difficult to treat because of the position of the tooth, because they have many and curved root canals that are difficult to locate, or for other reasons. An uncomplicated root canal treatment often can be completed in one visit. Once the root canal treatment is finished, you will need to see your general dentist to have the tooth restored with a crown or filling.
Measuring and Cleaning the Root Canals
First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such as nitrous oxide, or your dentist may offer other anxiety-reducing techniques if you feel you need them. He or she will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp. Then the root canals have to be measured.
Your dentist needs to know how long the canals are so he or she can make sure all the diseased tissue is removed and the entire canal is cleaned. Also, the material used to fill the canal after it is cleaned needs to fill the entire canal.
Dentists use X-rays to determine the length of the canals or use an electric device called an apex locator. In the first procedure, your dentist will place a file into the canal he or she is measuring then take an X-ray to determine how close the file is to the end of the canal. An apex locator makes a calculation based on the resistance to a small electric current. This gives an accurate measurement of a root canal. Often, the two methods are combined.
After the canals have been measured, your dentist or endodontist will use the specially designed instruments to clean out the diseased pulp. After the pulp has been removed, the canal is cleaned with an antiseptic solution, which helps to treat the source of the infection.
For root canal treatment to be effective, all the canals within the tooth must be cleaned. Generally, the top front teeth have one canal, the bottom front teeth one or two canals, the premolars one or two, and the molars three or four canals. However, the location and shape of these canals can vary significantly. Some endodontists are now using a microscope to see inside the tooth to make sure all the canals have been located and all the pulp has been removed.
Once the canals have been thoroughly cleaned and the endodontist or dentist has made sure that the infection has been removed, the roots are filled. A temporary filling is then placed to cover the new root filling. The crown of the tooth should then be restored with a permanent filling or crown within a relatively short time.
In most cases, the tooth will need a crown, especially with molars that are under stress from chewing. A crown will help to restore the tooth’s strength and protect it from cracking. A crown should be placed as soon as possible, ideally within a month of the root canal. It’s important to get the tooth permanently restored to prevent damage to the tooth later. The temporary filling you receive is not meant to last.
The pulp that was removed during root canal treatment is the part that responds to temperature. The tissues and nerves surrounding your tooth remain, however, so your tooth will still respond to pressure and touch.
After Root Canal Treatment
Your tooth may be sore for two to three days after the procedure, and your dentist will tell you to avoid chewing on the affected side. The worse the infection and inflammation was prior to root canal treatment, the sorer the tooth will be after treatment. You can take over-the-counter pain relievers to ease the discomfort.
As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.
Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing, causing inflammation and pain.
Bacteria may get pushed out through the tips of the roots. Blood vessels enter the tooth through a small hole (the apex of the root) at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed out through this small hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers, and sometimes antibiotics, but the site could be painful until it clears up.
A root canal treatment can puncture the side of the tooth. This can happen if the canal is curved or if the canal cannot be located. The instruments are flexible so that they bend as the canal curves, but sometimes the instrument makes a small hole in the side of the tooth. If saliva can get into the hole, the tooth will have to be treated further or extracted. If the hole is far enough under the gum line that saliva can’t reach it, it may heal.
A root canal may be missed or an entire canal may not be fully cleaned out. Locating canals within the tooth can be difficult. If a canal or an offshoot of a canal isn’t located and cleaned out, the tooth can remain infected and the root canal procedure will have to be repeated. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. Occasionally, root canals have branches that are not accessible to traditional treatment.
A file may break. The tip of a file may break off inside the tooth. Usually, it’s possible to leave the piece in the tooth and finish the root canal. But if the cleaning of the canal has not been finished, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small incision is made in the gum to access the root of the tooth, and the portion of the root containing the file piece is removed. At Sunnyvale Dental Care we will discuss with you any possible complications in your particular case.
Pain, or the Lack of It
In most cases, you will not experience any pain during the root canal procedure. Your dentist will completely numb your tooth and the surrounding area. If this doesn’t seem to be working, alert your dentist right away. Some people fear the anesthetic injections more than the procedure itself, but numbing gels and modern injection systems have made injections virtually painless. Let your dentist know immediately and he or she can modify the technique to avoid repeating the pain.
In addition to anesthetic, you may receive sedation, such as nitrous oxide treatment. You can take over-the-counter pain relievers to ease the discomfort.
Our office philosophy is to thrive and to be among the best Sunnyvale dental practices
Dr. Antonious says, “What good does it do to our patients if they can’t afford our best dental treatment.”. With the new advancement of dental materials and more efficient dental equipments delivering great local dentistry should be better, simpler, faster, convenient and more affordable. We are honored that many of our patients took the time to review us and to write few lines of nice comments about our office. We also take our patients criticism to heart and do our best to improve and excel.
Sunnyvale Dental Care is located right on El Camino Real which is a major artery that goes through the city of Sunnyvale. Which makes it very convenient for patients that reside on Sunnyvale city codes 94085, 94086, 94087, 94088 and 94089 to seek our dental services. Root canal therapy (RCT) and endodontic treatment are among these services.
The majority of Root Canal Treatment (RCT) or retreatment are performed on patients with severe toothache. Some of these patients have not slept all night and they are looking for a root canal dentist near me that can offer them immediate pain relief. Therefore, our office welcomes emergency root canal treatment appointments and root canal treatment walk in patients.
PPO dental insurance is one with the most popular types of dental insurance because it saves the patient on their out of pocket expenses. Sunnyvale Dental Care is a preferred PPO provider with Aetna, Ameritas, Assurant, Anthem BlueCross, Cigna, DenteMax, Geha Connection, Guardian, HealthNet, Humana, MetLife, Maverest, United HealthCare, First Dental Health, Avesis, Dental Benefit Providers, Dentegra, and Principal. Dr. Antonious joined Delta Dental as a primier provider since 1995.
Learn more when you visit Sunnyvale Dental Care practice. Call Sunnyvale dentist Dr. Antonious at 408-720-0900 to schedule a consultation today!
Endodontic Treatments (Root Canal) FAQs
What is Endodontic Treatment?
Endodontic treatment removes infection from the inside of your tooth. Underneath the hard enamel and the dentin of your tooth is a soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.
The pulp extends from the crown of the tooth to the tip of the roots where it connects to the tissues surrounding the root. The pulp is important during a tooth’s growth and development, but once a tooth is fully mature it can stay in place without the pulp. Your teeth stay attached via the supporting ligament (or periodontal ligament).
Why Would I Need an Endodontic Procedure?
Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected, or when the pulp dies. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
What is Endodontics?
Endodontics is the branch of dentistry dealing with the cause, diagnosis, prevention, and treatment of diseases of the dental pulp, usually by removal of the nerve and other tissue of the pulp cavity and its replacement with suitable filling material; pulp canal therapy; root canal therapy.
Sunnyvale dentist Dr. Antonious has an advanced post-graduate training in this field. Although he can perform endodontic treatment, patients are referred to an endodontist when the case is complicated or more difficult than usual.
How Would I know that I Need an Endodontic Treatment?
Signs include: pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gingival tissues. Sometimes, however, there are no symptoms.
How Does Endodontic Treatment Save the Tooth?
Sunnyvale dentist Dr. Antonious removes the inflamed or infected pulp, carefully cleans and shapes the inside of the canal, a channel inside the root, then fills and seals the space with Gutta-Percha. Sunnyvale dentist Dr. Antonious afterwards will place a crown or other restoration on the tooth to protect and restore it to full function. After treatment, the tooth continues to function like any other tooth.
What is Gutta-Percha?
Gutta-percha is the purified coagulated exudate from a tree, commonly called the “mazer wood” tree, of the Malaysian archipelagos. The substance is similar to that of the rubber tree, which is then processed to obtain the dental compound. This is the only ADA approved material to be used as a filling in root canals.
How Much Time Will A Root Canal Take?
Root canals can be done in one, two or multiple appointments, depending on the tooth, how many roots there are, the current conditions of the tooth, the accessibility to area, the canals, and time available. Each visit or appointment can take from under 1 hour, to over 2 hours.
What is an Abscess?
An abscess is a localized collection of pus (infection) within a tissue or a confined space.
Does Every Abscessed Tooth Hurt?
No. Some abscessed teeth can be pain-free, which are most commonly found and diagnosed accidentally by a dentist, usually through a dental x-ray and exam. Whenever possible, the recommended treatment is a root canal.
What Happens When an Infected Dental Pulp is not Treated?
The infection will continue its progress, extending from the confines of the dental pulp and involving the surrounding tissues, such as the root, the bone, the gums etc. A progressing infection could easily involve facial spaces and the patient would then start observing swelling of the face. Such condition could become life threatening if left unattended.
Do I Need to Take Antibiotics Every Time a Root Canal is Done?
Not always, today we are very conservative in determining the need for an antibiotic. It is usually determined by the dentist on an individual basis, per case, per tooth. Usually, if there are systemic signs and symptoms such as swelling, fever, generalized sense of malaise (ill feeling), and/or lymph node tenderness, then an antibiotic will be prescribed. The common toothache even when it is associated with a minor localized infection or abscess will not automatically require an antibiotic. Since a high number of cases will respond favorably to the dental treatment, antibiotics are not prescribed on a preventive basis.
Since Treatment Was Done, My Tooth No Longer Hurts. May I Start Chewing On It?
At Sunnyvale Dental Care, we do not recommended to start chewing on the tooth immediately after the root canal treatment. Most times it will be very tender, but even if it is not painful to chew, you should avoid chewing on it until the crown of the tooth is properly restored (repaired) by your dentist. The sooner you see your dentist; the sooner you will be able to re-start normal function on the tooth.
What Happens if I Wait Longer Than Recommended to Get the Crown of the Tooth Permanently Repaired?
If the remaining tooth structure is not properly and permanently covered and protected, your tooth could fracture and not be salvageable at all. The bacteria in saliva, as well as food debris, can go between the temporary filling and the tooth surface and contaminate the root canal treatment. This may cause treatment failure. If a re-infection occurs, often, another root canal treatment will need to be done (endodontic retreatment). If the damage is very extensive, extraction should be considered.
What are the Benefits of Root Canal Therapy Versus Extraction?
The single most important benefit of root canal therapy is that you keep your tooth. Extraction may lead to other dental problems. For instance, drifting of teeth, bite problems, TMJ pain, and the need to treat adjacent teeth that do not otherwise need dental treatment in order to restore the missing tooth.
How successful are Root Canals?
Root canal treatment has a high degree of success if done properly by a trained skilled professional. The success of root canal therapy is equally dependent upon the technical skill of the doctor, as well as the follow through of the patient, to have the tooth immediately restored.
What is Resorption?
Resorption is a physiologic or pathologic condition associated with loss of bone, cementum and/or dentin. There are different types of resorption such as external, internal, inflammatory, replacement and surface. Its etiology is unknown, even though it commonly is associated with trauma.
- External: a pathologic process that initiates from the periodontium affecting the external surface of the tooth. Can be further classified by location: cervical, lateral or apical. Or type: surface, inflammatory or replacement.
- Internal: a pathologic condition that initiates within the pulp causing loss of dentin and sometimes, cementum. It may or may not perforate the external root surface.
- Inflammatory: a pathologic loss of bone, cementum and dentin in the root.
- Replacement: Also known as ankylosis, it is a pathologic loss of cementum, dentin and periodontal ligament with simultaneous ingrowth and fusion of bone to the tooth surface. A loss of the physiologic mobility is common.
- Surface: a physiologic condition causing small surface defects in the cementum and dentin that are usually self-repaired by deposition of new cementum in the defect.
What is Endodontic Retreatment?
Retreatment is a term used to describe a procedure when a root canal has to be redone. The reason for retreatment is because germs or bacteria in the mouth have re-entered the tooth, usually due to decay. A patient may experience pain to biting or swelling. Sometimes, a patient may have no symptoms and your dentist sees something on the x-ray that shows a root canal has not healed and advises a patient to see a root canal specialist for an evaluation.
What is an Apicoectomy?
This is an endodontic micro-surgical procedure for a tooth that has had a root canal. The purpose is to remove persistent infection at the end of a root and seal the root end to prevent re-entry of bacteria. This procedure also provides the opportunity to detect possible root fractures.
How Long Will I Be Numb After Root Canal Treatment?
The numbness will last for several hours after your treatment. It is best to avoid chewing until the local anesthesia has completely disappeared to prevent accidentally biting your lip, cheek, or tongue. It is okay to drink or to use a straw to have liquids after treatment.
Why Do I Still Feel My Tooth if I Had Root Canal Therapy? I Thought My Tooth Was Dead.
A tooth that has had a root canal is not “dead”. It is still considered a “live” or vital part of your body. There are nerve endings that are present in the jawbone underneath the tooth, as well as nerves that attach from the jawbone to the tooth. This is why there is still feeling in a tooth that has had root canal therapy.
Will I Feel Pain During or After the Procedure?
Sunnyvale Dental Care’s dentist Dr. Antonious is dedicated to providing root canal treatment that is painless and comfortable. Our entire team goes out of their way to make you feel at ease.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow the directions on the bottle.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed.
However, if you have severe pain or pressure, swelling or pain that lasts more than a few days, please call Sunnyvale Dental Care.
Will the Tooth Need Any Special Care or Additional Treatment After Endodontic Treatment?
You should not chew or bite on the treated tooth until you have had it restored by your dentist. The tooth is susceptible to fracture and should be restored to health (usually with a crown) as soon as possible. Then you just need to practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.
Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, removing the previous endodontic filling, medicating the canals, then placing a new endodontic filling can save the tooth.
What Causes an Endodontically Treated Tooth to Need Additional Treatment?
New trauma or cracks, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, we may discover, using a microscope, that there are additional very small and/or curved canals that could not be found or treated during the initial procedure.
Can All Teeth be Treated Endodontically?
Most teeth can be treated. Occasionally, a tooth cannot be saved because the root canals are not accessible or the root is severely fractured. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth. Some teeth are so broken down or decayed that they cannot be restored or do not have adequate bone support, so while a root canal could be performed, the long-term prognosis of the tooth due to other factors, makes spending money on a root canal a poor investment.
Will I be Able to Drive and go Back to Work After My Root Canal Treatment?
Yes. A local anesthetic is used for root canal treatment just like it is used for your general dental work, like fillings and crowns. When you leave the office, you will be numb for 1 to 3 hours. Going back to your daily activities should be of no concern. Surgical endodontic treatment may involved more healing time and require rest at home for the remaining part of the day.
What if I Need to Talk to Dr. Antonious After Working Hours?
You are welcome to call our office after hours. Our answering service will contact Dr. Antonious immediately and he will call you as soon as possible.
Root Canal Post-Operative Instructions
The root canal spaces inside your tooth have been cleaned, medicated and filled. The tooth opening through which endodontic treatment was done has been sealed with a temporary cement filling.
It is likely that your tooth and jaw will be sore for as little as one day to as much as a couple of weeks. This is due to the prior condition of the tooth and the procedures done at today’s visit. This is a normal situation. There are three things that you can do to possibly alleviate discomfort.
- Take 3 or 4 Advil, Motrin, ibuprofen (these amounts are equal to the prescription amounts) or two extra strength Aspirin or Tylenol every 3-4 hours to keep this post-treatment inflammation under control. Even if you are taking an antibiotic (Penicillin, Erythromycin, Clindamycin or others), continue pain medication until the tooth and surrounding areas are comfortable.
- You might find that warm salt water mouth soaks will alleviate the soreness. Use one teaspoonful of table salt in a glass of warm water. Hold a mouthful near the tooth for one-half minute. Repeat until the glass is finished. This might be used once per hour.
- Avoid chewing on the treated side, if possible. If pressure persists, and you are biting high on the tooth, contact us so we can adjust the bite.
Usually a tooth that requires root canal treatment has had a past history of decay, large fillings or trauma. It is often necessary for this type of tooth to receive additional protection in the form of a crown. Until you have that done, it’s wise to be careful biting or using the treated tooth so that you do not fracture it. Delay in obtaining a final permanent restoration of the tooth could result in root canal failure, fracture and loss of the tooth.
In approximately six months we would like you to have an x-ray film taken of this tooth so the progress of healing of your tooth can be evaluated. This is important since a small percentage of such teeth will not heal without further care.
Apico-surgery (Root Canal Surgery) Post-Operative Instructions
- Swelling, minor pain and / or skin discoloration may be experienced following the surgical procedure. This will be temporary.
- In order to keep the swelling to a minimum, use an ice pack for the first few hours (on for 10 minutes and off for 5 minutes).
- The day after the surgery use lukewarm water rinses for the treated area following each meal. This should continue for the first 3 days following the surgical procedure.
- Eat only soft foods. Avoid hard and chewy foods.
- Get plenty of rest and insure normal intake of food, especially liquids such as fruit juices, soup, and milk. Use a vitamin supplement if desired. Try not to sleep on the operated area for 2-3 days.
- DO NOT raise your lips with your fingers to inspect the treated area.
- DO NOT brush teeth near the surgical site. Brush teeth in the rest of your mouth.
- There is often a temporary loss of feeling in the operated area and the tooth may feel loose.
- Take medications according to the instructions.
- Should any difficulties occur, do not hesitate to call our office anytime. In case of an extreme urgency call 911.