Endodontic treatments help you maintain your natural smile, enable you to continue eating the foods you love, and limit the need for ongoing dental work. With proper care, teeth that have had root canal treatment can last as long as comparable natural teeth, and often for an individual's lifetime.
A typical visit to an endodontist begins with completing paperwork, which includes your medical history and consent forms. It is advisable to bring a list of all the medications (over-the-counter and prescription) that you regularly/have taken within the past month. Once all forms are complete, an assistant will review and chart your chief complaint, referring dentist’s information and history of the tooth pain before taking x-rays of your teeth.
Once your first set of X-rays are complete, your endodontist will review your paperwork and evaluate your symptoms prior to testing the tooth in question along with adjacent teeth. After the tests are complete, a diagnosis will be given to determine the best treatment care and prognosis. The endodontist will make you aware of the benefits, options and risks involved in order for you to understand how endodontic treatment can relieve your pain and save your tooth. Possible post-treatment decisions such as a crown on the treated tooth also will be addressed.
If you decide to receive treatment, the procedure may start immediately. Before treatment begins, you will receive local anesthesia to numb any sensations you may feel during the procedure. If the procedure is unable to be completed within one visit, medicine may be placed inside the tooth between appointments.
Once your procedure is complete, more X-rays are taken to track the success of the treatment. You will be provided with review sheets that include your post-operation instructions and what to expect over the next few days.
Be sure to contact your endodontist if you have any questions or concerns regarding your treatment.
Endodontic (Root Canal) Treatment, Step By Step
Preliminary treatment to remove the decay and the source of infection of the pulp is necessary, along with a determination of whether the lost tooth structure can be restored. If a fracture of the tooth has reached the pulp, or infection is associated with gum disease, it could be more difficult, if not impossible, to save the tooth.
The general sequence of a root canal procedure is as follows:
Local anesthesia is administered via injections to numb the tooth to be treated
and the surrounding tissues. If the pulp in a tooth is acutely inflamed, and
therefore very painful, it may take a while to get it numb, but your dentist
will not start the treatment until it is.
Dental dam in place, used to isolate infected tooth from the rest of mouth to
facilitate root canal treatment. A dental dam — a thin sheet of rubber or viny
l — will be placed over the affected and adjacent teeth. The tooth undergoing
treatment protrudes through a hole punched in the dam, isolating it from the
rest of the mouth. This allows the root canal treatment to be carried out in
a sterile environment free from contamination by bacteria found in saliva or
the rest of the mouth.
A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.
The diseased and dead pulp tissue is removed from the tooth with specially designed instruments used to clean out the root canals and pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain.
The canals are disinfected with antiseptic and antibacterial solutions.
The canals are then shaped with tiny flexible instruments to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them.
Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.
A temporary or permanent filling material will then be placed to seal the access hole that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration (filling) in place, the dentist or endodontist may place a post (either metal or a very strong plastic) in one of the canals inside the tooth to help retain it.
Root canal filling material (gutta percha) is placed in the canals and the tooth is sealed with a temporary filling to protect it from contamination. Then a crown is usually placed over the tooth to seal and protect it from recontamination and future damage.
After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.
Your tooth will need a permanent restoration — a filling or a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. Your endodontist will send you back to your general dentist to determine which type of restoration is best for you. This step is of particular importance since many studies show that if the filled root canals are recontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.
Knowledge Is Power
Almost like the root system of a plant, the root canals of a tooth have a main branch and many smaller side branches, and the whole system needs to be sealed during root canal treatment to be successful long term. Since root canals are very small spaces, they require a great deal of precision and care to treat well. Therefore, most endodontists today use state-of-the-art technology including digital (radiographic) imaging to diagnose root canal problems, and after treatment to verify that the canals are properly sealed; ultrasonic instrumentation to remove old canal fillings and posts and clean canals; and operating microscopes to accurately locate, visualize and seal root canal systems; it really is quite high-tech.
Guidelines for Post-Treatment Care
It is normal to feel some tenderness in the area for a few days after your root canal treatment as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications. It is important for you to follow the instructions on how to take these medications. Remember that narcotic medications, if prescribed, may make you drowsy, and caution should be exercised in operating dangerous machinery or driving a car after taking them.
Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, please contact us
Do not eat anything until the numbness in your mouth wears off. This will prevent you from biting your cheek or tongue.
Do not chew or bite on the treated tooth until you have had it restored by your dentist.
Be sure to brush and floss your teeth as you normally would.
If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin layer to wear off in-between appointments. However, if you think the entire filling has come out, contact your endodontist.
Contact your endodontist right away if you develop any of the following:
a visible swelling inside or outside of your mouth;
an allergic reaction to medication, including rash, hives or itching (nausea is not an allergic reaction);
a return of original symptoms; or
your bite feels uneven.
Taking Care of Your Tooth
Root canal treatment is only one step in returning your tooth to full function. A proper final restoration of the tooth is extremely important in ensuring long-term success.Contact your dentist as soon as possible to arrange your next appointment. If your tooth is being treated in more than one visit by an endodontist, do not return to your dentist for the final restoration until the root canal treatment is completed.