Facts About Root Canal Treatment

Who performs endodontic treatment?

All dentists, including your general dentist, receive basic training in endodontic treatment in dental school. General dentists often refer patients needing endodontic treatment to endodontists.

Who is an "endodontist"?

An endodontist is a dentist with special training in diagnosing and treating problems associated with the inside of the tooth. They perform only endodontic procedures in their practices, since they are specialists. To become a specialist, they complete dental school and an additional two or more years of advanced training in endodontics, one of the nine specialties recognized by the American Dental Association.

Endodontists perform routine, as well as, difficult or complex endodontic procedures, including endodontic retreatment and endodontic surgery. These complex procedures are often required to treat root canals that have failed or have not healed completely. Specialized equipment such as operating microscopes and sounding devices are usually required. Ultrasonic instruments may also be used for post and core removal prior to endodontic retreatment.

Endodontists are also experienced in isolating and identifying the cause of oral, facial, and head and neck pain that has been difficult to diagnose. Patients with one or more of these problems are often referred to an endodontist when the diagnosis is complicated or difficult.

Why would I need an endodontic procedure?

Endodontic treatment is necessary when the pulp (the soft tissue inside the root canal) becomes inflamed or infected. The inflammation or infection can have a variety of causes including deep decay, repeated dental procedures, cracked or chipped teeth and teeth with specialized problems such as internal or external resorptions. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible evidence of decay, chips or fractures. If pulpal inflammation or infection is left untreated, it can cause pain or lead to abscess formation.

What are the signs of needing endodontic treatment?

Signs to look for include pain, prolonged sensitivity to hot or cold, tenderness to touch and/or chewing, discoloration of the tooth, swelling, drainage and tenderness in the lymph nodes, as well as nearby bone and gingival tissues. Interestingly, however, many teeth may be chronically infected or inflamed, but yet be symptom free.

How does endodontic treatment save the tooth?

The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the root canal space (the channel inside the root itself), then fills and seals the space. The endodontist will often restore or rebuild the tooth following endodontic treatment. In many instances, especially in the case of posterior teeth, you will need to return to your general dentist who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.

Will I feel pain during or after the procedure?

Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are completely comfortable during the procedure. For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your post-endodontic instruction sheet carefully (see patient information sheet section).

Your tooth may continue to feel slightly different from your other teeth for a period of time after the endodontic treatment is completed. This awareness will gradually subside over a period of several weeks or months. If you have severe pain or pressure, or pain that lasts more than a few days, call your endodontist.

How much will the procedure cost?

The cost varies depending on how complex the problem is and which tooth is affected. Molars are usually more difficult to treat; therefore, the fee is usually more. Most dental insurance policies provide coverage for endodontic treatment. Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and an appropriate restoration. With root canal treatment you save your natural teeth and it is less expensive.

Will the tooth need any special care or additional treatment after endodontic treatment?

Your endodontist will often restore or rebuild the tooth following endodontic treatment. This procedure is usually done in the same visit as the root canal. The post-endodontic restoration is considered to be just as important as the endodontic procedure itself, since it will insure the structural integrity or the tooth and prevent further infection via salivary invasion or leakage (see patient information sheet section). If your tooth requires a crown, especially if it is a posterior tooth, you should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular dental check-ups and cleanings.

Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure (endodontic retreatment) can save the tooth.

What causes an endodontically treated tooth to need additional treatment?

New trauma, fractures, secondary decay, or a cracked or broken filling can cause a new infection in your tooth. In some cases, the endodontist may be able to isolate and treat an additional ramification (secondary canal) that could not be located or treated during the initial procedure.

Can all teeth be treated endodontically?

Most teeth can be treated endodontically. Occasionally, a tooth cannot be saved because the root canal is inaccessible, the root is severely fractured, the tooth has inadequate bony support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save even those teeth previously considered hopeless. When endodontic treatment is not been effective, endodontic surgery may be able to save the tooth.