Root Canal Therapy

Root Canal Specialists Serving the Austin Area

 

Endodontics (endo- within, dontics- tooth) is the specialized branch of dentistry that deals with the diagnosis and treatment of diseases and injuries of the dental pulp (nerve). Root canal therapy is the most common method of treating diseases of the nerve, but occasionally a surgical procedure called an apicoectomy is required instead. The reason for needing a root canal is injury to the nerve, caused by such irritants as decay, deep fillings, orthodontics, crowns, periodontal disease, accidental trauma, developmental defects, etc.

The most common symptoms of a tooth needing a root canal are one or more of the following: pain brought on by heat or cold, pain to chewing or tapping pressure, swelling around a tooth, discoloration, and spontaneous toothache. Conducting tests to determine the presence of these symptoms, along with the examination of an x-ray are the only accurate means of diagnosing the necessity for root canal therapy. If none of the above symptoms are present and the x-ray looks normal, root canal therapy may not be necessary. Occasionally a tooth that displays no symptoms may be diagnosed solely from an x-ray as needing root canal therapy, but this is unusual. Endodontic symptoms usually come and go or rise and fall in intensity, making diagnosis accurate only if and when symptoms are present.

Root canal therapy consists of the removal of the dental pulp (nerve), followed by its replacement with a specialized filling material (gutta percha). A tooth with a well-placed root canal can usually be maintained for a lifetime once your regular dentist properly restores the tooth. If a root canal is not performed, the tooth almost always will be lost due to infection and loss of supporting bone. If an abscess (infection) in the bone is already present, a root canal will usually provide relief and help the bone return to a healthy condition. If a chronic (stubborn) abscess or cyst has formed, a surgical procedure (apicoectomy) may be needed later if root canal therapy alone does not eliminate the infection or cyst.

Root canals are usually accomplished in two appointments, but occasionally may be done in a single visit if favorable circumstances exist. The initial visit is spent conducting a thorough examination to determine if a root canal is needed, which tooth is the offending one, and what is the best method of treatment. The exam includes a health history, necessary x-rays, an oral examination, and, most importantly, any specific tests necessary to achieve a correct diagnosis of which tooth is causing the symptoms you wish eliminated. About half the time, the tooth actually causing the symptoms is different from the tooth your brain thinks is the offending one. This phenomenon is called “referred pain” and is very common in the diagnosis of oral pain. Each tooth must be accurately and thoroughly tested so as to avoid an incorrect diagnosis. There is a nominal fee for consultation and diagnosis. If you choose to begin a root canal today, the diagnosis fee is included in the root canal fee; otherwise, it is separate.

 
 
 

Our first goal is to accurately assess x-rays and symptoms to determine if a root canal is necessary. Radiographs (x-rays) must be taken and each suspicious tooth must be individually tested with heat, cold, pressure, chewing, etc., to determine which is the offending tooth. Referred pain (your brain thinking the pain is from one tooth when it is really from a different tooth) is common in the oral cavity. About half of our patients assume the pain is coming from a tooth different from the one actually causing the pain. Therefore, a correct diagnosis is our primary concern before beginning treatment.

After testing has identified the proper tooth, a local anesthetic is given to anesthetize the tooth. The amount and type of anesthetic required varies from patient to patient and from tooth to tooth. Please inform our staff if you have any allergies to medications, as this may impact which anesthetic we do use.

Once anesthetized (numb), a rubber dam is placed over the tooth to isolate it from the bacteria in your mouth. Any decay, old filling material or weak tooth structure is removed and a hole is made in the tooth surface to gain access to the nerve itself. (If the tooth has an existing crown on it, a small hole is drilled through the crown to accomplish the root canal and is refilled after treatment.)

Next, the nerve is removed using small files designed to follow the curved path of the canals within the root. The number of canals varies from one to four, but all canals must be cleaned of nerve tissue to the tip end (apex) of each root. Many endodontists remove only part of the nerve at the first visit (pulpotomy), but we take additional time to remove the entire nerve (pulpectomy). Once the nerve is removed, a long cylindrical void remains, similar in shape to the channel left in a ball-point pen when the refill is removed. A small piece of cotton moistened with a disinfectant is placed within the tooth to kill any bacteria that may be present. The hole that was drilled in the tooth is then filled with a temporary cement, sealing in the disinfectant until you return for the completion visit.

An appointment for the completion of the root canal will also be made at this time. Postponing the completion of your root canal risks the recurrence of pain and infection, and necessitates cleaning the tooth out again when the completion appointment is scheduled.

At the end of the first visit, you are given prescriptions for an antibiotic and a pain reliever, and instructed if and when to fill them. Most patients never need the medications, but they are available to you as a precaution. You are also given a handout explaining how rapidly each of your symptoms should subside, how soon you may eat on your tooth, and what foods to avoid.

Please allow approximately one hour of your time for treatment. Since some patients are more difficult to numb than others, the visit can vary in length from thirty minutes to one hour.

Symptom: Momentary sensitivity to hot or cold foods.

Possible problem: The sensitivity may be caused by a small decay, a loose filling or by minimal gum recession that exposes small areas of the root surface.

 
 

Symptom: Sharp pain when biting down on food.

Possible problem: There are several possible causes of this type of pain: decay, a loose filling or crack in the tooth. There may also be damage to the pulp tissue inside the tooth.

 
 

Symptom: Constant and severe pain and pressure, swelling of gum and sensitivity to touch.

Possible problem: A tooth may have become abscessed, causing an infection in the surrounding gingival tissue and bone.

 
 

Symptom: Dull ache and pressure in upper teeth and jaw.

Possible problem: The pain of a sinus headache is often felt in the face and teeth. Grinding of teeth, a condition known as bruxism, can also cause this type of ache.

Want more information? Read our "Common Questions"     
 
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