An In-Depth Look at Root Canals

By Dr. Binkowski

If you’re researching root canals, chances are that you’re experiencing moderate to severe dental pain. Don’t let your fears and apprehensions of root canals keep you from seeking treatment. Find all the answers to your questions below, and call Story City Dental to set up an appointment to discuss the procedure and your needs further.

What Is a Root Canal?

When nerve tissue inside a tooth becomes irritated, infected or necrotic, a root canal provides the solution. A dentist will remove the inflamed nerve or infection from inside the tooth, relieving patients of pain and/or other symptoms.

What Are the Typical Signs That Indicate a Person Needs a Root Canal?

The symptoms of an irritated, infected or necrotic nerve within a tooth vary greatly.  Typical signs include one of the following or combinations of the following:

  • Sensitivity to cold or a sensitivity to cold with lingering
  • Tender to touch/chewing
  • Swelling around a tooth
  • A pimple-type formation in the tissue near the tooth
  • Sinus issues (especially in maxillary teeth)

But in some cases, there are no symptoms, and your affected nerve will be discovered with a routine dental exam.

What Causes Tooth Nerve Issues?

There are many things that can cause an irritated, infected or necrotic nerve, including placement of a deep filling without insulating the nerve tissue prior to restoration, deep cavities, a crack or outright fracture of the tooth down to the nerve tissue, or trauma to the tooth cutting off circulation to the pulp tissue.

Where Does the Tooth Pain Come From?

Depending on the symptom, your pain can come from several sources. If you are experiencing sensitivity to cold, this usually means that the nerve tissue has become inflamed, causing the nerve to become hyper sensitive. Depending on what caused the nerve to become inflamed, the pain will usually become greater and greater as time passes. When the nerve actually dies, the sensation of cold will disappear and the pain to some extent will disappear simply due to the fact that there is nothing living in the tooth to transmit the pain signals to your brain. If bacteria is present in the necrotic pulp tissue, such as from a deep cavity, the pain that usually arises from this will be a pressure pain, with sensitivity to heat but relief with cold. Sinus issues from upper molars that have become necrotic include but are not limited to recurrent sinus infections on the related side.

Why Don’t Antibiotics Fix the Problem?

Antibiotics can be used to control an infection. Your body delivers antibiotics to infection sites through your bloodstream, which limits their effectiveness with regards to a tooth that has a dead nerve without bloodflow.

When I have patients who can’t immediately get a root canal, I do prescribe antibiotics more or less as a “liquid bandage.” I’d like to stress, this is not a long-term solution. Once the antibiotics run out, the source of infection will resume the course it was on, and the infection could spread to other surrounding areas.

How Does a Root Canal “Save the Tooth”?

The blood vessels that nourish the tooth and the blood vessels that nourish the ligaments holding the tooth to your bone are independent of one another. Therefore, by cleaning, shaping and sealing inside the tooth, we simply remove the infection without affecting the ligament holding the tooth in the bone. This allows us to keep a tooth that you would otherwise need pulled.

Even in cases where the infection has spread to the end of the roots and has caused bone loss around the roots, once the canal system is cleaned and sealed with a root canal, the body will re-grow the bone into the area that previously had bone loss.

How Is a Root Canal Performed?

  1. 3D imaging of the tooth is completed prior to getting the tooth numb to visualize internal anatomy of the tooth.
  2. Your dentist administers local anesthesia to profoundly numb the tooth.
  3. A rubber dam is placed over the tooth to isolate it from the rest of the mouth.
  4. If the root canal is required due to deep cavities, the cavities are removed prior to making a small access into the area of the tooth where the nerve tissue is.
  5. Once your dentist gains access to the inside of the tooth, he will use small files to debride the roots.
  6. Very dilute bleach rinses and disinfects the inside of the pulp chamber and canals to remove all biological materials.
  7. Once complete disinfection of the inside of the tooth is achieved, the tooth is sealed with a sealer and a soft material called gutta percha.
  8. From here the tooth can be rebuilt from the inside with a core buildup. A crown is typically placed over the tooth to prevent future fracture.

Why Do You Crown a Tooth After a Root Canal?

A tooth with a root canal has essentially been hollowed out to remove the pulpal tissue, and as such it has become weakened and prone to fracture. Think of a crown as a football helmet that is placed over the tooth for protection from oncoming food, your other teeth, etc. The second function of the crown it to produce a good “coronal seal,” so that bacteria does not re-enter the interior tooth, necessitating an endodontic retreat.

What Should I Expect After a Root Canal?

Tooth sensitivity when biting is possible for up to seven days afterwards, however, the sensation to cold will be completely absent. Your dentist will typically prescribe you some NSAIDs (such as Motrin or Aleve) post operatively to reduce the inflammation that may arise and significantly reduce any possible post-op pain. In rare instances antibiotics are prescribed but are more often not necessary. Most patients report an immediate relief from their pain.

Why Do We Use 3D imaging prior to starting a root canal?

Root canals, being a specialty service, are more time-consuming due the specialized instruments needed and the greater value of clinical intuition that is required to properly clean the inside of a tooth without damaging the bone around it. It does not matter what brand of file or technique a dentist uses to clean the inside of a tooth; if they fail to find all the canals, a missed canal will cause a failure of the root canal.

Internal anatomy of a tooth can vary from person to person and because of this, the number of canals in many teeth can vary. In some cases one or two of the canals may be hidden in the tooth, or one canal may branch into two. In most of these cases 2D imaging is inadequate at showing this. Small volume 3D imaging (CBCT) has far surpassed 2D imaging with respect to endodontics as it shows dentists everything inside the tooth free from radiographic distortion. In many cases we find issues with other teeth around the affected teeth that 2D does not show. The second primary function of the 3D images is to rule out the possibility of fractures and bone loss around the affected tooth, which helps us to determine if the tooth is restorable (can the crown of the tooth actually be repaired after the root canal).  This service gives our patients piece of mind knowing that we located everything in the 3D image and cleaned it out.

Below are some initial root canals that were completed by Dr. Binkowski, some root canal cases that were endodontically retreated — fixed — by Dr. Binkowski, and several cases where 3D imaging showed the tooth could not be restored even before a root canal was started. 3D imaging, as with all endodontic cases at Story City Dental was used as a starting point prior to numbing the patient.

Completed root canal of upper 2nd molar
3D image left, intra oral picture of completed treatment right
Could not be restored

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