What is root canal treatment?
Where precisely in a tooth is it nerve?
HOW DO YOU KNOW WHEN YOUR TOOTH NEEDS ROOT CANAL TREATMENT?
a) Problem teeth identified by x-rays.
b) A persistent or reoccurring pimple on your gums.
c) Exposure of a tooth's nerve
d) Teeth which have been traumatized in an accident.
WILL YOU EXPERIENCE PAIN DURING YOUR ROOT CANAL TREATMENT?
a) Placing a rubber dam around your tooth.
b) Gaining access to the nerve area of the tooth.
c) Cleaning the tooth out.
d) Placing the root canal filling material.
WHAT ROOT CANAL FILLING MATERIAL IS USED?
WILL THERE BE ANY PAIN OR DISCOMFORT AFTER THE ROOT CANAL TREATMENT?
What is root canal treatment?
Root canal treatment of the inner aspects of a tooth, specifically that area inside a tooth originally occupied by the tooth's pulp tissue.
Most people would probably refer to a tooth's pulp tissue as it's nerve. While a tooth's pulp tissue does contain nerve fibers it is also composed of arteries, veins, lymph vessels, and connective tissue.
Where precisely in a tooth is it nerve?
The pulp chamber:
This is a hallow space that lies more or less in the center of the tooth.
The root canals:
Root canals
Pulp Chamber
 Each tooth's nerve enters the tooth, in generalities, at the tip of its root(s). From this point the nerve then runs through the center of the root in small root canals which subsequently join up with the tooth's pulp chamber.
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How do you know when your tooth needs root canal treatment?
It will take an examination by your dentist to determine if root canal treatment is indicated for your tooth. Not only must your dentist determine that this treatment is an appropriate solution for your situation but also that the overall condition of the tooth in question warrants the time and expense involved.
Here are some situations where root canal therapy might be the proper solution:
- A tooth is currently causing you pain or else has a history of being painful.
- You have noticed the presence of tenderness and/or swelling in your gums near a tooth.
There can be times when you have a tooth that does need root canal treatment but you are unaware of this fact because there has been no swelling or pain associated with the tooth.
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a) Problem teeth identified by x-rays.
The nerve tissue in a tooth can die quietly. The degeneration of a tooth's nerve is not always a painful experience. Because of this, on occasion, a tooth's need for root canal treatment can remain undiscovered, even for some years. This is because in these instances the virulence of the infection in the tooth is low and your body's defense mechanism, while not being able to clear up the infection totally, is able to keep it in check.
It is not uncommon that a dentist will identify a tooth which needs root canal treatment during a routine x-ray evaluation. In the most obvious of these cases the x-ray will show a dark spot at the tip of the tooth's root. This dark spot indicates a decrease in the density of the bone surrounding the root's tip. This bone damage has occurred as a result of an infection that is present inside the tooth.
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b) A persistent or reoccurring pimple on your gums.
Sometimes a tooth whose nerve has died will produce a pimple like lesion on a person's gums. The presence and/or size of these pimples (dentists call them fistulous tracts) can come and go. Because they are literally drains for pus from an infected tooth, a person might notice that they discharge a bad taste (the pus). It is possible that a dentist will pick up on the presence of this type of lesion during their examination, even though the patient hasn't noticed it at all.
c) Exposure of a tooth's nerve.
There can be times when your dentist will find that your needed dental work has resulted in the exposure of your tooth's nerve tissue. The term "exposure" simply means that your dentist, while performing your dental work, has literally been able to visualize your tooth's nerve tissue. Sometimes a patient will feel a little prick of pain when the exposure occurs, however many times a patient is totally unaware of the event. An exposure can lead to the degeneration of a tooth's nerve tissue. Your dentist may determine that in your situation it is best to go ahead and perform root canal treatment on the tooth now so to avoid possible problems and complications with the tooth later (such as a painful tooth abscess).
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d) Teeth which have been traumatized in an accident.
The health of the nerve tissue in teeth which have a history of having been traumatized (such as being bumped in an accident) can deteriorate, thus leading to the need for root canal treatment.
Immediately after a traumatic event the outlook for the health of a tooth's nerve can be difficult to predict. Sometimes these teeth do quite well, even for many years.
It is always possible however that at some point the health of the tooth's nerve tissue will go ahead and degenerate (often without symptoms). A tip off that the nerve tissue inside a tooth is undergoing degenerative changes is that the tooth, in comparison to its neighbors, appears darkened.
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Will you experience pain during your root canal treatment?
We'd be the first to acknowledge that root canal treatment has a reputation for being painful, but we'd be the last to agree that this reputation is deserved.
It seems most likely that a majority of the derogatory remarks you hear in regards to root canal treatment must be including in them references to that period of pain and discomfort the person experienced leading up to their need for their treatment.
For the average person and the average case, root canal treatment is a non-event and not any more uncomfortable than having a filling placed.
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a) Placing a rubber dam around your tooth.
After numbing your tooth but before beginning the actual process of performing the root canal treatment, your dentist will stretch a sheet of rubber around your tooth. Dentists call this sheet of rubber a "rubber dam". It is held in place by a small clamp that grasps your tooth.
The purpose of a rubber dam is as follows. Since one of the fundamental goals of root canal therapy is to clean bacteria out of a tooth, and since saliva does have bacteria in it, the placement of a rubber dam allows the dentist to keep your tooth saliva free so it doesn't get re-contaminated with bacteria while your root canal treatment is being performed.
b) Gaining access to the nerve area of the tooth.
So the process of performing your root canal treatment can begin, your dentist must first gain access to that area inside the tooth that needs to be cleaned. This is accomplished by using a dental drill and making an access hole which leads to the pulp chamber of the tooth. On back teeth this hole is made on the chewing surface of the tooth. On front teeth the access hole is made on the tooth's backside.
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c) Cleaning the tooth out.
The next step of the root canal treatment process is for your dentist to clean out the interior of your tooth. As we discussed previously, this cleaning process will remove any bacteria, toxins, nerve tissue, and related debris harbored inside your tooth.
The bulk of the cleaning process is accomplished by way of your dentist using "root canal files". These objects look like straight pins but on closer inspection you will find that their surface is rough, not smooth. These instruments literally are files and are used as such. Your dentist will work a series of root canal files, each of increasing diameter, up and down in your tooth while simultaneously using a twisting motion. This action will scrape and scrub the sides of the tooth's root canal(s), thus cleaning it out. Additionally, as part of the cleaning process your dentist will wash your tooth out periodically so to help flush away any debris that is present.
The goal is for your dentist to clean the entire length of the tooth's root canal(s), but not beyond. So to determine the length of a root canal your dentist may place a root canal file in your tooth and then take an x-ray, so to see if it extends the full length of the tooth or not. Alternatively, your dentist may have an electronic device that can make this same determination when it is touched to a file positioned in your tooth.
Traditionally root canal files are manipulated by a dentist by way of using their fingers. There are, however, special dental drills (dental drills are called "handpieces") which can hold and twist these files, and your dentist may choose to use one. As a variation on this same theme, there is yet another type of dental handpiece that produces a cleaning motion by way of holding a root canal file and vibrating it vigorously.
d) Placing the root canal filling material. Once the tooth has been thoroughly cleaned your dentist can fill in and seal up its interior by way of placing root canal filling material. Sometimes a dentist will want to place the filling material the same day that they have cleaned the tooth out. Other times a dentist might feel that it is best to wait about a week before completing the root canal process. In the latter case your dentist will place a temporary filling in your tooth so to keep contaminates out during the time period between your appointments.
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What root canal filling material is used?
The most common root canal filling material being used by dentists now days is a rubber compound called gutta percha. Gutta percha comes in preformed cones that are sized to match the files which have been used to clean out the inside of the tooth.
A root canal sealer (a paste) is usually used in conjunction with gutta percha cones. It is either applied to the cone's surface before the cone is placed into the tooth's root canal, or else applied inside the root canal itself before the gutta percha cone is positioned. Sometimes several cones of gutta percha need to be placed before the interior of the tooth has been adequately filled.
At times a dentist will warm the gutta percha cones (either before or after they are placed into the tooth) so they become softened. This allows the gutta percha to more closely adapt to the precise shape of the interior of the tooth.
As an alternative to the use of preformed cones, sometimes a dentist will place the gutta percha via the use of a gutta percha "gun". This apparatus is somewhat similar to a hot glue gun. It warms a tube of gutta percha so the material is very soft. The gutta percha is then squeezed out into the tooth.
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Will there be any pain or discomfort after the root canal treatment?
The hope is that after your root canal treatment you will notice very little discomfort from your tooth. It is not uncommon however that for the first day or so after its work a tooth may feel a little tender. Whenever you have a question, in all cases, you should feel free to contact your dentist's office just to ensure that what you are experiencing seems to them to be within normal limits.
A tooth's sensitivity can often be minimized by the use of over-the-counter analgesics, especially those that also possess anti-inflammatory properties. Ibuprofen (Advil or Motrin) can be an effective choice for this type of discomfort, of course you should always read the label, indications, and warnings of any product you anticipate using so to make sure it is appropriate for you.
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