Root Canal Therapy

The cores of teeth have soft tissue called pulp. The pulp contains nerves, blood vessels, and other cells. This tissue at the core of the tooth is in the pulpal chamber and canal. The very bottom of the tooth where the blood vessels and nerves exit the root is called the apical constriction. The pulpal tissue is surrounded by hard tooth structure. When it gets too inflamed or irritated it will try to swell just like any other body tissue. The problem is that when it swells inside the tooth the tissue can’t expand and the pressure ends up closing the blood vessels that enter through the tiny canal entrance at the constriction and cuts off the blood flow. If this pressure persists over time the tissue in the tooth can die. Bacteria can infect this dead tissue and begin to invade the surrounding bone. The bone can become destroyed by this infection. Infections in the lower jaw can end up spreading towards the airway and can be fatal if not treated. Upper jaw teeth can get infections that can reach veins that communicate with the brain which can also be fatal. These occurrences are not common but they are risks you must know about if you delay treatment. Teeth in these situations can either be removed or in some instances can be saved with root canal therapy.

The goal of root canal therapy is to remove the dead or dying tissue and infection from the center of the tooth and do a filling that will keep bacteria out that reaches all the way through the canal to the constriction. This will allow the tooth to remain in the mouth without causing further infection. That is as long as it does not fail. Root canal therapy is not always successful. Sometimes there are extra canals not detected or that go off in directions that make it impossible to fill. Any unseen fracture in the root can also cause failure. Not all canals are round and if very oblong they can be quite difficult to adequately clean with the limits of the round files we use to remove tissues. It is recommended that Endodontist who are specialists do difficult root canals. I a root canal fails a specialist may recommend re-treatment. If the tooth is not savable it would be recommended to remove.

Pain management in these situations can be difficult. If the tooth is dead and the pain comes from the infection invading the bone, it is almost always relieved with an antibiotic. One must not delay root canal treatment after getting an antibiotic even if the pain goes completely away. The antibiotic only removes the infection from the bone but once stopped the infection can return and cause more problems. If the tooth is in the middle of dying, many times even prescription pain medication will not relive it adequately. In these instances the only thing that may relieve the pain is to start the root canal or have the tooth removed.

Most teeth after a root canal therapy have lost enough structural integrity that they need a crown in order to lower future fracture risk.