Author: Adam R. Pershing, DMD

What is a root canal?

The roots of your teeth have small openings, called root canals, which allow blood vessels and nerve fibers to bring nutrients and sensation to your teeth. If infection occurs in or around these small openings, it can damage the pulp inside of the tooth.

A root canal treatment is a procedure that removes damaged pulp from inside the tooth, and protects it from future infection.

Why do I need a root canal?

If tooth pulp becomes acutely inflamed or infected, it needs to be removed in order to save the tooth.

Pulpal damage is commonly caused by:

• Physical trauma, like a sports injury, that impacts the teeth
• Tooth decay (like a cavity) that advances into the root canal. Bacteria reaches into the pulp and nerve endings, causing infection, decay, and extreme sensitivity
• Broken teeth that expose the pulp to bacteria

Symptoms include:

• Tooth pain while chewing
• Tooth sensitivity to temperature
• Swollen gums or face
• Discolored or gray teeth

Is there an alternative?

The only alternative is to have a tooth extraction, which isn’t recommended because extraction can cause problems like teeth shifting position, difficulty chewing, and loss of jawbone density.

Root canal treatment has a 98% success rate, and can heal the tooth for a lifetime.

Is a root canal treatment painful?

A root canal treatment is done under local anesthesia, and might feel very similar to getting a filling.

What will happen during the procedure?

First, the affected area is numbed, and a dental dam is placed around the tooth to keep it dry during the procedure. A small opening is made at the top of the tooth and small tools are used to take out the infected pulp. Then the tooth is disinfected and filled with an inert, biocompatible material, and sealed with adhesive cement.

What will happen afterwards?

Pain and sensitivity might last for a few days after treatment, and can be relieved with over-the-counter medication like ibuprofen. You might be instructed to avoid chewing on the affected tooth for a few days. After a few days, the temporary filling is removed and replaced with a permanent filling or crown.

How can I avoid the need for root canal treatment?

You can prevent the need for root canal treatment by brushing and flossing every day, and scheduling regular cleanings. Acidic beverages, like soda, and sugar can contribute to infections in the mouth, so it’s best to avoid them. If you’re active in sports, it’s best to wear a mouthguard to protect your teeth from injury.

When it comes to cosmetic dental treatments, teeth whitening is the most popular because it offers a simple, safe, and effective way for you to achieve a better smile. However, the teeth whitening procedure can be more challenging depending on the condition of the teeth. Traumatized teeth, due to sports injury, automobile accident, or other trauma, may react differently to whitening treatments than teeth unaffected by trauma.

Tooth Pulp Determines Procedure

There are two procedures available to whiten traumatized teeth, each specialized to the unique trauma your teeth have suffered. The first step is to evaluate the traumatized teeth to see if the pulp inside the teeth still lives. X-rays or other tests can determine this. If the pulp is alive, your dentist can perform a normal external bleaching of your teeth.

At times, discoloration may indicate an underlying problem in the teeth, such as irreversible damage or death to the pulp. Before any whitening treatments can occur, the pulp will need to be removed through a root canal procedure. Once you have healed, your dentist can perform internal bleaching of your teeth.

Internal Bleaching

Your dentist will begin by first making a small hole in the back of your tooth, to gain access to the pulp chamber. Extra debris will be rinsed away before your dentist adds a special cement that will prevent the whitening agent from reaching the roots. The whitening agent is then put into the space and sealed shut. You will need to come back to your dentist a few more times to repeat this procedure until you gain the tooth shade desired. Once the tooth has been whitened to your satisfaction, a dental restoration, such as a tooth-colored filling, is placed over the hole originally created in the tooth.

If you are unsatisfied with the discoloration of your teeth due to a trauma, talk to your dentist about your options. External bleaching may be enough to whiten your teeth, but if not, internal bleaching may be your best option to gain the bright, white smile you desire.

Drinking hot and cold beverages, eating sweet or acidic foods, brushing your teeth, breathing through your mouth, biting down—if any of these normal activities are causing you pain, you’re probably experiencing tooth sensitivity.

Tooth anatomy helps explain why teeth can become sensitive:

• Enamel covers the crown, the visible part of the tooth above the gum line. Enamel is composed primarily of minerals and is the hardest substance in the body. Intact enamel protects the vulnerable tissues inside the tooth.
• Cementum covers the roots of the tooth and, while quite strong, is more porous and softer than enamel.
• Dentin lies just beneath the outer enamel and cementum. It’s a softer tissue filled with microscopic tubules that are connected to the pulp. When damaged enamel or cementum expose part of the dentin layer, the tooth becomes sensitive to things like temperature, sugars and acids, and touch.
• Inside the tooth and protected by the dentin layer are the pulp chamber and root canals. These are filled with pulp, living tissue composed of nerves, blood vessels, and connective tissue. If the pulp is damaged, the blood vessels inside become inflamed, putting pressure on the nerves and causing pain. Infection can set in, destroying pulp tissue and spreading to the surrounding gums and bone.

What causes sensitivity?

Sensitivity is a symptom that the tooth is compromised. You should see your dentist promptly to discover the source of and treatment for your discomfort.

Tooth Decay

When a cavity is deep enough to penetrate the enamel and reach the dentin, sharp pain when eating certain foods, drinking hot or cold beverages, breathing through the mouth, or brushing can result. Sensitivity can also be a sign that a loose or broken filling needs replacement. Treating a cavity in its early stages or replacing a damaged filling right away prevents decay from reaching the inner pulp and endangering the tooth.

Infection

Once decay has reached the pulp, the tooth is vulnerable to infection. This infection can spread to bone and gum tissue. Because the inner pulp contains nerves, infected and inflamed pulp can be very painful. Root canal treatment is often necessary to save the tooth.

Trauma

A chip, crack, or fracture can damage tooth structure and expose dentin and pulp to bacteria. You should see your dentist immediately after any dental trauma. Crown, onlays, veneers, or other restorations can repair injured teeth and prevent further damage.

Gum Disease

Periodontitis causes the gums to pull away from the teeth, exposing portions of the cementum covering the roots. Cementum is softer than enamel, and more prone to sensitivity and decay. If you have periodontitis, your dentist can recommend treatment options, including antibiotics, deep cleanings, and/or gum surgery.

Acidic Erosion

Acids can erode tooth enamel, exposing the dentin underneath. Acidic foods should be enjoyed in moderation and eaten with meals. Sodas and energy drinks should be limited. Medical conditions such as acid reflux can be very damaging to enamel, especially on the back of the teeth, and should be treated by your physician. Enamel won’t grow back, but if you have suffered significant enamel erosion, your dentist might suggest fillings, crowns, bonding, or veneers.

Abrasive Erosion

Aggressive brushing and hard-bristled brushes can be so abrasive that they cause enamel erosion and gum recession. Use a soft bristled or electric toothbrush, and brush thoroughly but gently. Your dentist can recommend better brushing techniques and toothpastes which reduce sensitivity.

Tooth Grinding

Repetitive nightly grinding can put so much pressure on the teeth that the outer layer of enamel is worn away. Tiny cracks and fractures develop. Pulp inflammation can occur. A custom-fitted nightguard is a common treatment used to redistribute grinding pressures.

Malocclusion

Too much pressure on a tooth caused by an unbalanced bite can lead to worn or cracked teeth or pulp inflammation. Orthodontic treatment is often recommended to create a healthy, balanced bite.

Tooth sensitivity shouldn’t be ignored. Any unpleasant or painful sensation which persists should be evaluated by your dentist to determine the cause of your sensitivity and to create a treatment plan for a pain-free smile.