What is endodontic treatment?
Endodontic treatment is the analysis and therapy of conditions that affect the inside portion of the tooth. Treatment is needed for disease-causing bacteria that has gained access to the pulp of the tooth and infected the material.
To help patients better understand endodontic treatment, we often like to show and discuss the anatomy of the tooth itself. Your teeth consist of layers, most notably is the visible portion of the tooth, the hard outer layer known as the enamel. The enamel protects the tooth and allows us to chew food. Below the enamel is another hard layer, known as dentin, it is calcified tissue that protects the centum and pulp. The pulp is the inner portion of the tooth, it is soft and contains blood vessels, nerves, and connective tissue. The pulp of the tooth is vital to the development of your teeth, but once the tooth is fully formed, the tooth can survive without it.
Endodontic treatment involves gaining access to infected pulp, removing the source of the infection, along with the pulp, cleansing the area and then restoring the health of the tooth.
Why would I need an endodontic procedure?
Endodontic treatment is considered necessary when the pulp, or inner portion of your tooth, has become inflamed or infected. The most common cause of infection is bacteria finding its way inside the tooth through a deep cavity, a chip or fracture in the tooth, or following shrinkage or breakage of a dental filling. Patients can sometimes be surprised that they have infected pulp because the answer is not always so visible, we can receive tiny hairline cracks in our teeth from chewing hard foods or some impact injury. These tiny fractures may not be visible but are large enough for bacteria to pass. Once the pulp is infected, it can not heal on its own. Choosing to ignore the signs of infected pulp leaves the patient with an active bacterial infection which can grow into an abscess and even spread to nearby teeth. Though patients are aware of the large root chambers of their teeth, they are unaware that there are tiny branches of root that connect with neighboring teeth.
What are the signs of needing endodontic treatment?
There are signs and symptoms that can indicate your tooth is battling an infected pulp. This may include pain or sensitivity to hot or cold on the tooth. Some patients may feel tenderness in the area, or even the development of an abscess. Other symptoms of infection may include the discoloration of the tooth, swelling or even drainage from the tooth. You may experience, one, multiple, or even none of these symptoms, which is an additional reason that regular dental visits are so important.
How does endodontic treatment save the tooth?
When the pulp of a tooth becomes infected, the options are limited. The pulp will not heal on its own and ignoring it can cause considerably more problems. The two options a patient has is to restore the tooth through Root Canal therapy, known as endodontic treatment, and then restoring the tooth with a dental crown, or the extraction of the tooth. We would never counsel a patient to consider extraction as a first option, extracting a tooth can lead to many larger problems.
Endodontic treatment is the treatment of choice. We will first ensure the patient’s comfort with the use of a local anesthetic. A dentist from our team will then create space in the tooth to gain access to the pulp. The pulp and infected material are removed, we then carefully clean the cavity with an antibacterial wash, fill the tooth with a rubber material, and seal the space back up. This surgery is traumatic to the tooth, and its overall strength has been compromised, so we will recommend a dental crown to be placed over the tooth to shield and protect it. Following the placement of the crown, the tooth is fully restored and ready for regular use.
Will I feel pain during or after the procedure?
There is a misconception that root canal therapy is painful, when in fact we are relieving the pain that the bacterial infection was causing. Patients are given a local anesthetic before treatment, we also have some conscious sedation options
, including nitrous oxide or laughing gas, and prescribed relaxant pills, if needed. The inflammation of infection can be very painful to the patient, but the endodontic procedure is meant to relieve it.
Following treatment, the patient may feel some temporary discomfort. Endodontic treatment can be very jarring to the tooth, and you may feel the sensitivity that comes from recovering from an infection. Patients are advised with tips and education to better assist in rapid healing, which often includes taking a day or two for rest. Many patients find relief from the use of over-the-counter pain medications, and some patients may be prescribed medication depending on the severity of treatment.
Will the tooth need any special care or additional treatment after the endodontic treatment?
Following treatment, you will need to treat the area with caution for a few days. You were suffering from a bacterial infection, and we did perform traumatic care to your tooth. You will need to use caution in the foods you eat for 1-2 days, chewing only soft, manageable foods. Your tooth is susceptible to fracture following endodontic treatment before your general dentist has been able to place a dental crown.
After the crown has been placed, and the tooth is fully restored, the tooth should last as long as your other natural teeth. Failure of the endodontic treatment is rare but does occur. This means that bacteria had moved from the main root into one of the tiny branches that stem from the root, additional treatment will then be needed.
What causes an endodontically treated tooth to need additional treatment?
Known as apicoectomy, sometimes additional treatment is needed. This is an endodontic surgical treatment, meaning gaining access to the roots through the soft tissue. Our dentist had been unable to get all of the bacteria through the regular step of root canal therapy. An apicoectomy is a surgical treatment that requires us to open the gum tissue near the tooth. We then remove any infected or inflamed material along with the very end of the root.
Besides missing hidden bacteria, patients can also experience new trauma, a new source of deep decay, new cracks and newly broken fillings, leading to a new source of infection. The source of this new infection can be in tiny canals, or curved canals at the root.
For more information, see our page on Endodontic Re-Treatment
Can all teeth be treated endodontically?
Not all, but most teeth can be treated with endodontic treatment. In rare cases, we may determine that a tooth can't be saved. This is often due to the root canals being inaccessible, or the root is severely fractured. Some patients may also have an insufficient bone to support the tooth. However, we always attempt first to save a tooth, the only other step would be extraction, and extraction should always be a last resort.