What Does Root Canal Therapy Mean?

What Does Root Canal Therapy Mean?  – Dr. Roy Oyangen D.M.D.

It means that the only way the dentist can save your tooth is by removing the inside part that is causing you pain, swelling and suffering.  Every tooth has a nerve, artery, vein and lymphatic system.  When this becomes inflamed or infected, it causes pain. This inflammation or infection can be caused by deep decay, a chip or crack in the enamel of the tooth, or by a traumatic injury which compromises the blood flow and nutrition to the  inside of the tooth.

Signs of nerve damage include pain, continued sensitivity to hot or cold, swelling and tenderness around the tooth and its neighbors.  Sometimes the tooth will get darker and be asymptomatic and require a root canal due to impending pathology due to spreading of infection creating dead nerve tissue.

Root Canal Therapy saves a tooth by removing all the infected and inflamed tissue inside the tooth by carefully cleaning and shaping the canals by using files of increasing sizes.  

The cleaning and shaping of the tooth’s canal can be done with hand, rotary, or ultrasonic instruments.  I could use lasers as well.  The hollowness left behind must be filled using specialized cements and fillers, otherwise it can continue to be a source of chronic infection.  An untreated tooth can be a chronic source of infection that can cause low grade fevers, generalized fatigue, and never ending sinus infection.  If the infection is not cleaned out, it can be absorbed into the blood stream and cause inflammatory based ailments.   See the Diagram below.

Systemic Health - 2.cdr

Does this procedure hurt?   

It is your dentist’s responsibility to perform Root Canal Therapy effectively and without pain.  The actual cleaning and shaping should not hurt.  Nor will the steps of filling the space created after nerve tissue removal.  How much discomfort you feel after therapy depends on how much swelling, inflammation and spread of infection was present before therapy was started.  In most cases, over the counter medications are effective post-operatively.

When Root Canal Therapy is completed:

All root canaled teeth become dehydrated and dried out over the years and may need additional treatment.  It is standard procedure to crown or cap all teeth that have had Root Canal Therapy.  If this tooth already has a crown on it, it is up to you and your dentist to discuss the need to replace it.  It all depends on the source of infection, its onset and the amount the damage done to the remaining part of the tooth.

Not All Teeth Can Be Saved

Root Canal Therapy is affective 92% of the time. Every tooth is different and can have variations and anomalies in the root tips that cannot be seen or felt by the dentist during therapy.

  • A root can be fractured, we presently do not have the technology to repair split roots.  
  • The root may not be long enough or have too much bone loss and should not be saved.
  • The remaining tooth may be so hollowed out because of decay that it will not hold up to normal daily use.
  • If a tooth needs to be extracted, sometimes dental implants can be placed the same day in the same hole, with or without simultaneous bone grafting.

What If Root Canal Therapy Was Partially Effective But it Is Still Sensitive?

90% of continued sensitivity after Root Canal Therapy is from anomalies and variations at the root’s tip.  A 0rocedure called an apecoectomy or root end resection may be needed.  This procedure is the physical removal of the root tip, scar tissue and infected bone.  The resulting hole can be filled with bone grafting material and a membrane.  

Sometimes different antibiotics are needed and more time to heal is required.  Sometimes an area can be sensitive for months until the tooth feels like it belongs.