Title: What is a root canal and why do I need one?

Diagram of a tooth's inside

Anytime you say the woods “root canal” most people suddenly have the urge to be somewhere else, even at work, driving in heavy rush-hour traffic, doing their taxes, or visiting with their in-laws.

Okay, so if this is such a terrible event, why is it done?  And if it must be done, how can we make it any better?

The fact is that deciding to do a root canal is a very complex process and can take several visits to diagnose.  Pain is the main reason that leads a patient to finally decide to go to the dentist.  Initially, cavities are not painful.  It isn’t until the cavity infection nears the nerve of the tooth that it hurts.  This is why routine dental exams are so important to keep this from happening in the first place.

Okay, so your tooth is stressed out and it is letting you know by giving you pain.  Now what?  If your dentist determines that the tooth is dead or that the tooth will no longer return to normal, then it is time to have the “root canal discussion” with your dentist.  This can take a while to occur and this is not a clear-cut decision.  This is because the decision is such a lasting one.

At the point of determining the need for a root canal you have two choices: to remove the tooth-generating infection or to remove the infection inside the tooth.

Basically that’s what a root can is, removing the infection inside the tooth then sealing it off from the rest of the body.

It should be understood that a root canal is a last-ditch effort to save a tooth that otherwise is a serious health hazard and capable of leading to a potentially life threatening infection.  Root canals are a “mummification” of the tooth that is otherwise dead and harmful to your body.

That doesn’t sound good does it?  BUT root canal-saved teeth can last many years before being lost.  Five years could be considered successful; 20 years would be an extremely successful root canal.  However, eventually the tooth will fail.  Infection will leak into the surrounding bone and start another abscess.  The tooth will fracture or the body will reject the tooth which might start dissolving it.

I hate the idea of having a tooth pulled; I’ll get the root canal!  How can you make the experience better?  Nitrous oxide and or an oral sedative can help.  Profound anesthesia is a must.

I always do my root canals in at least two visits.  Why?  Root canals are long procedures.  Breaking them up in two appointments is easier on your jaw not to mention your busy schedule.  Profound anesthesia usually lasts an hour anyway. Another reason is that it gives me the opportunity to pack medicine inside the opened canals during the first appointment to kill more bacteria while you are waiting for the next appointment. A second appointment also lets the tooth, ligament, and bone start healing before the final sealing of the canals leading to a greater chance of longer survival of the root canal.  Speaking of…

To prolong the life of root canal teeth, it is important to have a crown, especially on the larger teeth like molars, to hold it together and to provide a tough biting surface for protecting the tooth.  This adds to the expense of a root canal, but at least most insurance will cover some of it.  However you might be looking at merely delayed costs…

Even with a perfectly performed root canal and crown, it might not work.  The best root canal specialists with eleven years of college (Endodontists) have about a 90% five-year survival rate.  The root canal might very likely be just delaying eventually pulling the tooth.

What if we just pull it doc?  That will solve the infection and pain problems for sure, but losing a tooth leads to other problems like drifting of adjacent teeth and over-loading the remaining teeth with the biting forces.  Teeth will move toward the space vacated by the missing tooth.  Over time this might work to close the space but can cause unhealthy hyper-eruption of opposing teeth, painfully altering your bite, and tilting teeth that are loaded in a destructive way leading to more tooth loss and pain/fractures.

If the tooth cannot be saved at all or if you decide you don’t want a root canal, there are several options to restore the missing space left behind:

1. Dental Implants- titanium screws that act to anchor new replacement teeth to the jaws.  They can also be used to retain dentures or even whole-arch fixed bridges that stay put.

2. Bridges- fixed restorations that span the space using the adjacent teeth as support like….well….a bridge.

3. Partial dentures- if you want to replace an end tooth it might not be possible with a bridge if there is no possible anchor tooth.  Partials are removed and cleaned each day.  They can be a great solution especially if you are missing several teeth on both sides of an arch with good teeth elsewhere.  They are difficult to adapt to but are more affordable than implants, plus dental insurance might cover them as well.

4. Complete dentures without implants- this in my opinion is the ultimate thing to avoid if at all possible in dentistry.  Preventing dentures is the goal of comprehensive dentistry.  IF this is necessary, look at upgrading to implants that attach the dentures to the jaws.  The cost of implants is going down and new techniques are constantly being developed to replace a complete arch, even without bone grafts!  (More to follow on that topic)

BOTTOM LINE: root canals are the conventionally way to save a tooth that otherwise must be removed due to pain and or infection.

I hope that you have enjoyed this short discussion on root canal treatment and that it helps you in the future.  Please ask questions related to this blog and I will answer them each week.

Blessings to you all,
Dr. Philip Estes