Root Canal Specialists Serving the Austin Area

Common questions about Root Canal Therapy

•	What is root canal therapy?
	It is the complete removal of the nerve followed by the filling of the remaining canal space with a natural rubber-like substance derived from the sap of a tropical tree.

•	How do I know if I need a root canal?
	Pain and/or infection are the usual symptoms caused by a tooth that needs a root canal, but occasionally an x-ray will show changes that mean a root canal is necessary.

•	How can we be sure which tooth is causing the pain and/or infection and whether the pain could be from a problem other than a tooth needing a root canal?
	We will conduct specific tests on the tooth in question as well as the teeth surrounding and above or below the one under suspicion. “Referred pain” can frequently fool your mind into thinking the offending tooth is different from the actual culprit.

•	How many visits does a root canal take?
	Usually two, but occasionally it may be accomplished in a single visit.

•	If I need a root canal, does it mean the nerve is abscessed?
	Not usually. Most teeth that need a root canal have a living nerve that is inflamed and causing pain from cold and/or heat. Other teeth have a nerve that has gone through and past the inflamed stage and has died and decomposed. The percentage of teeth with a dead nerve is actually in the minority. A nerve MUST die before it can become abscessed (infected) because the bacteria need a food source on which to thrive. A living nerve does not provide a food source like a decomposed one. When an abscess does occur, it is actually in the bone outside the root end, not inside the tooth. The decomposing nerve inside the tooth feeds the abscess outside the tooth. That is why removing the diseased nerve allows the infection (abscess) in the bone to heal.

•	What causes a nerve to become damaged or die?
	It may be from a cavity where the decay has penetrated the enamel and dentin and has reached the nerve. Once the nerve is exposed to the toxins and bacteria in the decay, the nerve becomes progressively irritated until symptoms occur (usually pain to cold or heat). If left untreated, the nerve will always die and decompose. Other causes of irritation to a nerve are: trauma, such as a blow; heat and vibration from the drill during routine dental procedures like fillings and crowns; advanced periodontal disease; rapid orthodontic movement, etc. The irritation causes inflammation and pressure inside the nerve canal (nerves at this stage hurt to cold and/or heat). If the pressure from the swelling inside the nerve is great enough, the flow of blood (and the oxygen it carries) to the nerve is interrupted and the nerve begins to die.

•	Why does a tooth hurt if the nerve is dead?
	A nerve that has died eventually causes severe irritation and pain from the bone just outside the root tip. If bacteria (circulating in the blood flow) settle in the area of damaged bone and gum, the bacteria multiply; spreading the infection and causing further bone damage and more pain. So, while the “dead” nerve inside the tooth is no longer causing pain, the nerves in the jawbone and in the living tissue outside the root tip cause pain. Usually this pain is from chewing pressure or from touch or tapping, and can become excruciating. The pain from the bone is called “an abscess” if bacteria are present, but can be just as painful when not infected.

•	Can I actually need a root canal without experiencing any pain presently?
	Yes. In one situation, you can have a living and fairly healthy nerve that has been reached by decay. Early in that process, there are no symptoms, but when the decay is removed by a dentist, the nerve is additionally irritated such that it will not survive and will eventually become painful. In the second situation, a nerve that has already died can actually remain painless for years. It can even cause the loss of bone around the root tips without pain. This situation is unusual and is detected by x-ray during a routine examination.

•	If I do a root canal, will my pain be gone immediately?
	It depends. If the pain you are experiencing is from heat or cold, the root canal will instantly remove all the discomfort. However, if your pain is caused by chewing on or touching your tooth, that pain will remain for awhile before subsiding. Pressure pain is from inflamed or infected bone, and once the dead or diseased nerve is removed, the bone needs time to heal before complete comfort returns.

•	If my tooth is painful to hot and/or cold, do I have to have a root canal?
	No. If you are willing to put up with the discomfort and inconvenience of the pain, you are welcome to do so as long as you can stand it. Eventually it usually worsens and forces you to do the root canal later, but if for some reason you choose to wait—that’s OK. Remember, however, teeth can become painful and infected at inconvenient times, making your life miserable when a dentist may not be available. Therefore, if you can afford to purchase the comfort, we recommend you consider it.

•	Is root canal therapy painful?
	Rarely. If the tooth can be made numb with a local anesthetic—the procedure will be painless. Rarely, a tooth is too infected or inflamed to be able to be made numb, so antibiotics and pain relievers are administered for a few days until the tooth improves and can be anesthetized. Once the tooth is numb, you feel pressure during treatment, but no pain. Some patients are difficult to anesthetize and may require more anesthetic than others to obtain complete anesthesia. When the numbness wears off, there may be some discomfort for a few days due to inflammation in the periodontal ligament and bone at the tip end of the root, created by removing the nerve.

•	Can a tooth survive without a nerve?
	Yes. The root surface (cementum) and the periodontal ligament (to which the bone attaches) are still alive and are still innervated by nerves and blood vessels. Thus, a tooth with a good root canal can usually (and about ninety-nine percent do) be maintained for the rest of your natural life.

•	Once the nerve is removed, what is the remaining canal(s) filled with?
	The best and preferred root canal filler is gutta percha, a natural rubber-like substance derived from the sap of a tropical tree. It shapes itself to fit inside the canal and seals off the hole in the root tip. It can also be easily removed if necessary. If the canals are not filled, the body will fill them itself—with a stagnant organic debris and bacteria, causing the bone outside the root to abscess and requiring the root canal to be started all over again.

•	Can a successful root canal be done on every tooth that might need one?
	No. Some teeth have roots so crooked or canals so narrow that the dentist cannot get his or her instruments to the tip of the root. If the nerve cannot be removed completely, the remaining tissue usually dies and becomes nutriment for bacteria and a subsequent abscess. Fortunately, this is seldom a problem.

•	What else can be done to save a tooth if a root canal cannot be accomplished or is not successful?
	When infection or pain persists or recurs after the completion of a root canal, a surgical procedure called an apicoectomy may save the tooth. The painful and/or infected root tips are approached by cutting through the gum and bone next to the tooth. The surgeon exposes the root tip, cuts it off to ensure removal of the source of the problem and then seals off the hole in the root tip with a filling material. This procedure is about ninety percent successful, but has its own risks. If surgery is too expensive or dangerous, an “intentional replant” may be tried. The tooth is carefully extracted, the root tips are cleaned and sealed in the hand, and then the tooth is replanted, all within a few minutes. The success rate of this procedure is about eighty percent.

•	Is it cheaper to pull the tooth and make a bridge?
	Usually not. A root canal followed by a crown is usually cheaper than an extraction and replacement.

•	Is it necessary to crown (cap) every tooth that has a root canal?
	Generally that is true, but not always. Ask your regular dentist for his or her recommendation. If you cannot afford a crown immediately after a root canal, the crown can be delayed until finances allow. Thus, the tooth can still be saved.