Endodontic (Root Canal) Treatment
So, during your exam it was determined that you had a tooth in which the pulp (nerve) of the tooth was having a problem, what do you do now? Keep in mind that problem may or may not include pain and that there are many reasons a nerve may become compromised, including caries (decay), history of trauma, a cracked tooth, a previous restoration, a periodontal problem or an anachoretic infection. Often times it hurt at some point, maybe even having a gumboil rise up but then the pain went away when the gumboil “popped”. Part of the discussion during the exam and treatment planning process included the discussion of options and the consequences of each choice. When faced with an abscessed or necrotic (dead) tooth, the choices are to extract the tooth or have endodontic (root canal) treatment which allows keeping the tooth as long as it was determined that it is restorable. Root canals are generally going to be done early in treatment, especially if you are in pain. They certainly need to be done before restoring the tooth, as you don’t want to put an access hole in a brand new restoration. The rest of this discussion is about having the root canal. Many people associate root canals with pain. With today’s anesthetics and techniques, there isn’t much of a reason for that, though a severely infected tooth can require more anesthetic to get fully numb and that is true if you decided to extract it as well. Once you are numb, a rubber dam will be placed over the tooth to isolate it and keep saliva from further contaminating the tooth once the root canal gets started. An access opening will be placed and then using very small instruments all of the nerve and blood vessels will be removed from within the tooth, the canals will be thoroughly cleaned, shaped and disinfected. The canals will then be sealed, usually with a rubber like material called gutta percha. A temporary restoration will generally be placed until a final restoration is done, most usually being a crown. Don’t make the mistake of thinking that once the root canal is done and you are out of pain, that the tooth is fine. Remember, it only has a temporary restoration in it at that point. Restoring it is a separate procedure. You might wonder if the expense of a root canal and crown are worth it. Keep in mind that the alternative was an extraction. Replacing a missing tooth with either a bridge or implant is most usually more expensive than the root canal and crown and nothing is ever as good as your own tooth. If you can’t afford a root canal and crown and have multiple missing teeth already, you might consider the extraction and have a removable partial denture made which would likely be less expensive and replace multiple teeth, but it is the least natural in both looks and function and it is removable, allowing food to get under it.