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