Root Canals

You may have heard of root canals and they sound like a scary, painful experience. The truth is, they are a fairly routine procedure, which is usually used to relieve pain. Root canals can be totally painless using local anesthetics just like for a filling.

Why is a Root Canal Needed?

When the pulp (nerve) of the tooth is infected or injured in some way it will require removal of the pulp to relieve any symptoms and heal the infection. Usually a root canal is needed when:

a cavity becomes large enough for bacteria to enter the pulp and cause bacterial infection
a crack in the tooth reaches to the pulp, but is not extensive enough to cause root fracture.
A previous filling was deep and close to the pulp. Sometimes the pulp takes time to react to this type of injury.
A traumatic event, such as being hit in the face could be enough to injure the pulp. It may immediate or it may take years to become symptomatic, even if the tooth seems fine.

What is a Root Canal?

Root canal treatment (also called endodontic treatment) involves removing the nerve and other tissues (called pulp) located in the center of the tooth and its root(s). The following illustration will help to explain the procedure:

The first tooth represents a normal healthy tooth.
A small cavity is developing through the top of the tooth, where cavities typically begin. This cavity is probably not painful at all, and will go unnoticed unless a routine dental exam is performed.
The cavity has extended deeper into the tooth and has reached the pulp. It has caused inflammation in the pulp and is probably sensitive to cold and hot foods/drinks at this point.
If left untreated, the inflammation in the pulp turns to infection, and the pulp is now dead. This tooth is not sensitive to cold any longer, but it may still be sensitive to hot and will hurt biting, chewing, and touching the tooth due to the infection at the root tip. Cold drinks now might actually relieve some of the pain.
The infection has increased in size and has become an abscess. Sometimes this infection will create a swelling in your gums or cheek around the tooth, or it may drain out the side of the tooth and you can see a bump on your gums that oozes pus if you press it. Other times it may drain into the sinus or other spaces and go unnoticed. Usually this stage will be very sensitive to chewing and pressure on the tooth.
To treat the tooth, we open the tooth from the chewing surface to expose the pulp. We would remove all the decay as well.
The pulp is removed and the root canal is cleaned and shaped to disinfect the tooth and prepare it for a filling material. Depending on the tooth, there may be 1 canal to 4 canals. In rare instances there are even more than 4 canals in some molars.
Each canal is then sealed and filled with a rubber-like material called gutta percha, and the access opening is filled in with a build-up material.
Following root canal treatment, the tooth will need a final restoration, usually a crown. It is essential to return promptly to have treatment completed because a temporary seal is designed to last only a short time. Failing to return as directed to have the tooth restored permanently could lead to the deterioration of the seal, resulting in decay, infection, and/or fracture that could lead to treatment failure or loss of the tooth. The infection should begin to decrease as the source of the infection is removed.
After some time, the infection should be completely gone and the tooth should feel healthy again.

Complications

Occasionally some complications can occur. A root canal can be a difficult procedure and therefore 100% success cannot always be guaranteed. If the canals are curved or closed up for various reasons it can be a more difficult tooth to treat. During the procedure a file could break in the canal, which may affect the success of the treatment.

Every attempt will be made to increase the likelihood of success, which may include referring you to an endodontist who specializes in this procedure. This decision might be made before starting the procedure or during the procedure if any complications occur.

Alternative Treatment

Other treatment options include doing nothing or extracting the tooth. If nothing is done, the infection will increase and could become more painful and could cause problems for the neighboring teeth and surrounding bone. Extracting the tooth is a decent option, however it will leave you with an empty space that you may or may not want to restore. These options should be discussed with your doctor.

Cost of the Procedure

This is an important discussion to have with your doctor or the financial consulting staff. It really depends on which tooth needs treatment. A back tooth typically needs a crown afterward due to a high risk of fracture after a root canal, however a front tooth can sometimes be restored with a filling. A root canal alone may cost around $700 to $1200, and if it requires a build-up and crown the total cost may be closer to $2000-$2500. This all depends on your individual tooth, the extent of the problem, your dental insurance plan if you have one, and will certainly vary depending on the dental office that performs the procedure. An extraction would be a cheaper option, however if you want to replace the missing tooth with an implant, bridge or denture, the cost can be similar.