Endodontics specifically treats problems associated with the inside
of the tooth. To fully understand this, it helps to know
a little about the anatomy of a tooth. Every tooth is
covered on the outside by a very hard, white, material
called enamel. Inside of this is a deeper material
called dentin, also hard but less so than enamel.
At the center of the dentin is a hollow space than
extends from the "crown" end of the tooth, or the part
that you see in the mouth, all the way down to the
tips of the "Endo" is the Greek word for "inside",
and "odont" is Greek for tooth. Endodontic treats roots of
the tooth within your jaw. In this hollow space is living
tissue called the "dental pulp" containing blood
vessels and nerves. It is similar to most other
tissue in your body except that it is very sensitive
and is surrounded by the hard tissue of the tooth.
When you are very young, this tissue actually
forms the tooth around itself. Once your
tooth is fully formed, this tissue does not
play as active of a role but remains to give
you feedback on when you are biting too hard,
and when things are hot or cold etc. Since
this tissue is not critical to your
tooth during your adult life, the tooth can
actually survive almost unchanged without this tissue.
One characteristic of this tissue is that it has a somewhat
reduced ability to heal itself when it becomes injured. Your
blood is the primary source of cells involved in healing and
repairing inflammation and injury . Since the only way for
your blood supply to get to the tissue in your tooth is
through tiny openings in the end of the roots, inflammation
and increased pressure in this tissue are harder to correct.
The injuries that occur to this tissue from cavities,
deep fillings, cracks, and trauma tend to add up over a
lifetime, and can reach a point when the body can no longer
eliminate the inflammation. The inflammation then causes
pain and discomfort, and if left untreated, usually leads
to death of this tissue. Once the tissue dies, an
infection usually follows which can spread out the root
ends and cause a jaw infection or "abscess". Abscesses
are usually related to pain and swelling, but can exist
without any symptoms other than showing up on a dental
To solve this problem,
our Austin endodontist removes the
inflamed or infected tissue and cleans the hollow space
in the tooth to remove all remnants and bacteria present.
Once this space is emptied, cleansed, and shaped, it can
be filled with a biocompatible material to seal this
space from any entry of bacteria in the future.
How is the Treatment Accomplished?
An examination is accomplished prior to treatment to review your
clinical signs and symptoms and any relevant X-ray films. You
will go over your health history with our
Austin endodontist and the financial and
insurance arrangements for treatment will be discussed.
Even if you have been examined by your general dentist,
it will also need to be done by your endodontist,
for both legal and ethical reasons, as the provider
of your care. This examination is either accomplished
at a separate appointment before treatment is
scheduled, or in cases where your general dentist
feels certain about the nature of care needed, time
can be incorporated into the treatment appointment to
allow verification of diagnosis and completion of
information gathering without a separate visit.
Once the treatment phase has begun, the affected area
of your mouth is completely numbed with local anesthetic,
just like when you have a filling. A small opening is made
through the chewing surface of the tooth, filling, or crown,
to gain access to the hollow "pulp" space. Small
cleaning instruments are used to remove the contents of
this space and smooth and shape the internal walls.
Disinfecting solutions are used to help remove any bacteria
present. Once the endodontist is satisfied that the space is
clean, a filling material is inserted to completely seal the
internal space. The most common material used is a naturally
occurring product called "gutta percha", used because of
it's biocompatibility and ability to be softened and conform
to all of the internal shapes of the tooth. Once this cleaning
and filling has occurred, either your endodontist or your general
dentist will then place a filling material in the opening
created on the chewing surface of the tooth to strengthen
and seal the tooth structure. If the tooth does not already
have a crown, it is usually recommended that one be placed by
your general dentist to protect the tooth, since once the hollow
space has been enlarged and cleaned, the tooth is more
susceptible to cracking in future years. Where a crown already
exists on the tooth, the root canal procedure in most cases
does not damage the crown and a filling in the chewing surface
can seal and maintain the crown for many years. In some cases,
if a significant amount of tooth structure is missing or
damaged, a "post" or reinforcing rod is placed into part
of the hollow space created by the root canal treatment to
help reinforce the filling that will be placed. The decision
on whether or not a post is needed is made on a case by case basis.
This reinforcement with fillings and posts may be done by your
general dentist or your endodontist, depending on your general
Can I Expect Pain During or After the Treatment?
Rumors and stories abound about the "tortures" of root canal
therapy. Luckily these are just that: stories. In most
instances the treatment should be similar to a filling
appointment. With modern techniques and anesthetics, most
patients find the treatment no worse than an average dental
appointment, reporting that they are comfortable and pain
free during the appointment.
Teeth that are painful and troublesome before treatment are
likely to take a few days to heal and resolve after treatment.
It is not uncommon to have post-treatment mild discomfort
and biting soreness, but this is usually relieved by taking
over the counter or prescription medications that your
endodontist can prescribe. Some patients report that
following a root canal, their tooth feels slightly different
from the other teeth for some time, although not painful.
Will Any Further Root Canal Treatment Ever be Needed on a Treated Tooth?
If the internal space does not become contaminated in the future by new decay,
leaking fillings, or cracks, the root canal treatment can last a lifetime.
Studies show long term success with root canals to be 80-90% or better.
Besides the structural problems listed above that can recontaminate the
internal space, sometimes teeth have internal areas difficult to find
and access during treatment. Some roots can also have extra "canals" or
hollow spaces that are not expected and not found during the first
treatment. Some of these problems can cause a recurrence of pain or swelling
and a second treatment to re-open and search for causes is necessary.
If this is needed, the treatment is often similar to the first root
canal, but may require added care and time to get through metal fillings,
posts, and the previous root canal filling material.
What is Endodontic Surgery?
Occasionally during endodontic treatment, calcifications or blockages prevent
the complete cleaning of the internal spaces. Also when retreatment of a previous
root canal is needed, some of the posts and dental work placed after the first
root canal can block access to the internal space in such a way that they
cannot be safely bypassed. In some cases bacteria on the external surface
of the root ends and in the jaw may not have been eliminated by the internal
root canal procedure and are resistant to your body's ability to eliminate
them. In these situations, an alternative approach to cleaning and sealing the
root end is considered. By making an incision in the gum tissue next to the
tooth, the gum can be moved aside and the root approached directly from the
side of the tooth. In this way, any infection around the root is cleaned and
the root end is sealed from the opposite end. The gum tissue is replaced in
it's original position with a few sutures or "stitches" and the area followed
over time for healing.
Cleaning or re-cleaning from the top of the tooth through the inside space is
always considered the preferred treatment because there is a better chance of
cleaning the entire length of the tooth. When this is not possible however,
the surgical approach discussed above still has a good chance of success.
The surgery itself is usually as easily tolerated as a conventional root canal
procedure. As with any surgery, some soreness and swelling may occur over
the first few days following the treatment. A more in depth discussion with
your endodontist can help you make the decision on which approach is
best suited for your individual case needs.
What are the Alternatives to Endodontic Treatment?
Once the pulp tissue has been shown to be irreversibly inflamed or infected,
there are few alternatives to a root canal procedure. Letting the tooth go
untreated involves continued pain and ultimately can lead to destruction of
bone from the infection and loss of the tooth. Extraction of the tooth is
always an alternative, but although it is less expensive on the short term,
the restoration of your complete bite can involve much more expensive
options than root canal therapy, such as replacing the tooth with a bridge
or an implant. Removing teeth and not replacing them can lead to crowding
and tipping of teeth and subsequently problems with how your teeth fit
together and function.
When is a Root Canal Not Indicated?
Although saving teeth is always the goal in dentistry, some problems can exist that cannot be solved with any current treatment. Some teeth have cracks than run through the entire tooth, and even with root canal therapy, problems will persist. Also if periodontal or "gum" disease is too advanced, the support is lost to this tooth and root canal therapy cannot be expected to improve on this situation. Some teeth are decayed or broken beyond a point that can reasonably be repaired. In all of these cases, extraction and replacement is the only predictable option. Correct diagnosis before treatment is part of making root canal therapy as successful as it is by eliminating the teeth that cannot be expected to respond to treatment.
Do I Need an Endodontist to Accomplish my Treatment?
All dentists are taught the techniques of root canal therapy in dental school, and depending on the school, accomplish between two and 20 root canals while in school. An endodontist has also completed an additional two to three years of advanced training beyond dental school focusing on just root canal therapies. In the specialty program, procedures beyond routine root canals are taught such as retreating previous root canals, treating difficult and complicated cases, and endodontic surgery. Because of this extra training, an endodontist is able to deliver treatment faster and more efficiently with a higher degree of predictability. Because of this expertise, specialist fees are customarily higher than root canal fees by general dentists.
Here at Omni, we arrange for your root canal treatment by an in house endodontist to give you the best and most successful outcome possible. When necessary, the endodontist has a surgical microscope available to aid in difficult cases.
Why would I need Endodontic Surgery?
Generally, a root canal is all that is needed to save teeth with injured pulps from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest as pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.
What is a root canal?
A root canal is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.
At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.
How is a root canal performed?
If you experience any of these symptoms, your dentist will most likely recommend non-surgical root canal treatment to eliminate the diseased pulp. The injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. Success for this type of treatment occurs in over 90% of cases. If your tooth is not amenable to endodontic treatment or the chance of success is unfavorable, you will be informed at the time of consultation or when a complication becomes evident during or after treatment. We use local anesthesia to eliminate discomfort. In addition, we will provide nitrous oxide sedation if indicated. You will be able to drive home after your treatment, and you probably will be comfortable returning to your normal routine.
What happens after treatment?
When your root canal treatment has been completed, a postoperative report will be sent to your restorative dentist. You should contact their office for a follow-up restoration within a few days of completion at our office. Your restorative dentist will decide what type of restoration is necessary to protect your tooth. It is unusual for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond. To prevent further decay, continue to practice good dental hygiene.
How much will it cost?
The cost associated with this procedure can vary depending on factors such as the severity of damage to the affected tooth and which tooth is affected. In general, endodontic treatment is much less expensive than tooth removal and replacement with an artificial tooth.
With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.
Improper healing may be caused by:
- Curved or narrow canals were not treated during the initial treatment.
- Complicated canals went undetected during the initial treatment.
- The crown or restoration was not placed within the appropriate amount of time following the procedure.
- The crown or restoration did not prevent saliva from contaminating the inside of the tooth.
In some cases, new problems can influence a tooth that was successfully treated:
- New decay can expose a root canal filling material, causing infection.
- A cracked or loose filling or crown can expose the tooth to new infection.
Once retreatment has been selected as a solution to your problem, the doctors will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctors will now clean your canals and carefully examine the inside of the problematic tooth. Once retreatment has been diagnosed as a solution to your problem, the doctors will reopen your tooth to gain access to the root canal filling material. The restorative material will be removed to enable access to the root canal. The doctors will now clean and disinfect the root canals and carefully examine the inside of the problematic tooth. Once cleaned, the doctors will fill and seal the canals and place a temporary filling in the tooth.
At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.
Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.
Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and the tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.
Types of Cracks
These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.
When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp rarely damages the pulp, so root canal is not necessary. Your dentist will usually restore the tooth with a full crown.
This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential.
A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.
Vertical Root Fracture
A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.