Why does a tooth need a root canal?
Inside every tooth is a soft core of nerve and blood vessels, the pulp, running down through narrow canals in the roots. Deep decay, a crack or an old knock can let bacteria in or injure it. Once the pulp is badly inflamed or infected it cannot heal, and the infection can spread through the tip of the root into the bone.
At that point there are two choices: clean out the inside of the tooth and seal it, or take the tooth out. Root canal therapy is the first. It is done here as a non-surgical treatment, working through the top of the tooth.
Signs you might need a root canal
Some teeth give plenty of warning and some give none, turning up only on an X-ray. If you notice any of these, call and tell whoever answers what is happening. They will get you seen.
- Sensitivity to hot or cold that lingers after the drink is gone, rather than a quick twinge.
- Pain when you bite down, or a tooth that feels bruised.
- Swelling in the gum near the tooth, or in your face. Swelling that is spreading, closing an eye, or making it hard to swallow or breathe needs an emergency room now; call us afterward for the dental side.
- A tooth that has turned darker than the ones beside it, sometimes years after a knock.
- A pimple on the gum near the tooth that comes and goes. That is usually infection draining from a dental abscess.
What happens during a root canal?
The tooth is numbed with a local anesthetic, and we make sure it is numb before we start. A small opening is made in the top of the tooth, the infected or dead pulp is removed, and each canal is cleaned, disinfected and shaped with fine instruments.
The clean canals are then filled and sealed so bacteria cannot get back in, and the opening is closed with a temporary filling. Some teeth are finished in one visit and some need two, depending on the tooth and how much infection there is.
Afterward the tooth is often tender for a few days, especially when you bite, and ordinary pain relievers usually handle it. Go easy on that side until the tooth has its permanent restoration.
Does a root canal hurt?
A root canal has a worse reputation than it deserves: with the tooth properly numb it is a long filling appointment, and the pain people remember is the abscess that sent them in. Removing the infection is what relieves that pain.
A badly inflamed tooth can take more anesthetic than usual to numb, and we would rather give more than rush. We explain each step before we do it and agree on a signal for stopping. If you are anxious, nitrous oxide and oral sedation are both available.
Why a back tooth usually needs a crown afterward
A tooth that has had a root canal no longer has a living nerve, and it is often already weakened by the decay or crack that caused the trouble. Back teeth take heavy chewing force, so they usually need a crown to hold them together and keep them from splitting. A front tooth can often be closed with a filling instead.
Putting the crown off is a risk. A brittle back tooth can crack before it is covered, and a crack into the root can cost you the tooth the root canal saved. The temporary filling is not built to last, so plan the crown when you plan the root canal.
Root canal or extraction?
Taking the tooth out is the other option, and sometimes it is the right one. A tooth cracked down into the root, or with too little left to rebuild, may not be worth saving, and we will tell you so. When a tooth can be saved, keeping it is usually the better choice.
An extraction costs less on the day, but the gap usually needs filling with an implant, a bridge or a partial denture, and that is a cost of its own. We give you a written estimate for both routes so you can compare them.
When we refer to a root canal specialist
Some teeth are harder than others: very curved or narrowed canals, a tooth that has had a root canal before and needs it redone, or anatomy that only shows itself once the work begins. When a root canal specialist, called an endodontist, would do a better job, we will refer you and explain why.
Questions patients ask
Is it better to have a root canal or pull the tooth?
When the tooth can be restored, keeping it is usually the better choice. When it is cracked into the root or too broken down to rebuild, taking it out is the honest answer. We explain which applies to your tooth and give you an estimate for each.
Can antibiotics fix an infected tooth instead?
Not on their own. Antibiotics can help control an infection that is spreading, but they cannot clean out the inside of the tooth, so the infection returns while the source is still there. The tooth still needs a root canal or an extraction.
How many visits does a root canal take?
One or two, depending on the tooth and how much infection there is. A back tooth then usually needs a crown, which has appointments of its own.
Will the tooth hurt afterward?
It is often tender for a few days, especially when you bite, and ordinary pain relievers handle that for most people. Pain that gets worse instead of better, or new swelling, is worth a call.