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.

How do I Know I Need 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 pain
  • Tenderness to touch or when chewing
  • Swelling around a tooth
  • A pimple-type formation in the tissue near the tooth
  • Sinus issues, especially in maxillary teeth

In some cases, however, 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 deep fillings without nerve tissue insulation prior to restoration, deep cavities, a crack or fracture of the tooth down to the nerve tissue or trauma to the tooth that cuts off circulation to the pulp tissue.

Where Does the Tooth Pain Come From?

Your pain can come from several sources. If you are experiencing sensitivity to cold, this usually means the nerve tissue has become inflamed, causing the nerve to become hyper sensitive. The pain will usually become greater as time passes. When the nerve dies, the sensation of cold will disappear, and the pain will disappear because there is nothing living in the tooth to transmit the pain signals to your brain. If bacteria, such as from a deep cavity, is present in the necrotic pulp tissue, you will feel pressure, with sensitivity to heat but relief with cold. Upper molars that have become necrotic can result in issues including recurrent sinus infections.

Why Don’t Antibiotics Fix the Problem?

Antibiotics can be used to control an infection, but your body delivers antibiotics to infection sites through your bloodstream. If a tooth has a dead nerve without blood flow, then, the effectiveness of antibiotics is limited. When patients can’t get an immediate root canal, however, we do prescribe antibiotics as a liquid bandage. This is not a long-term solution, and once the antibiotics run out, the infection can return and spread to 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 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.

When the infection has spread to the roots’ ends and caused bone loss around the roots, once the canal system is cleaned and sealed with a root canal, the body will regrow the bone into the area that previously had bone loss.

How Is a Root Canal Performed?

  1. 3-D imaging to visualize the internal anatomy of the tooth is completed prior to numbing the tooth.
  2. The dentist will administer local anesthesia to 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.
  5. The dentist will make a small access into the part of the tooth with the nerve tissue and 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 the inside of the tooth is completely disinfected, the tooth is sealed with a sealer and a soft material called gutta-percha.
  8. We will rebuild the tooth from the inside with a core buildup, typically using a crown over the tooth to prevent future fracture.

Why Do You Crown a Tooth After a Root Canal?

A tooth that has undergone a root canal has been hollowed out to remove the pulpal tissue, which weakens the tooth and makes it prone to fracture. Think of a crown as a football helmet placed over a tooth for protection from food and your other teeth. Crowns also produce a good coronal seal so bacteria does not reenter the interior tooth, necessitating an endodontic retreat.

What Should I Expect After a Root Canal?

Most patients report an immediate pain relief, though tooth sensitivity when biting is possible for up to seven days after a root canal. The sensation to cold will be completely absent. Your dentist will typically prescribe NSAIDs such as Motrin or Aleve after the procedure to reduce any inflammation and post-op pain. In rare instances, antibiotics are prescribed.

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

Root canals are more time-consuming for a number of reasons: They are a specialty service that require specialized instruments and skill to properly clean the inside of a tooth without damaging the bone around it. It does not matter what brand of file or technique dentists use to clean the inside of a tooth; if they fail to find all the canals, the root canal will fail.

Because the internal anatomy of a tooth can vary from person to, the number of canals in many teeth can vary. In some cases, one or two may be hidden in the tooth, or one canal may branch into two; 2-D imaging often fails to show these canals. Small-volume 3-D imaging (CBCT) has far surpassed 2-D imaging, with respect to endodontics, because 3-D imaging shows dentists everything inside the tooth free from radiographic distortion. In many cases, we find issues with other teeth around the affected teeth, too, that 2-D does not show. 3-D images also rule out the possibility of fractures and bone loss around the affected tooth, helping us determine if the tooth is restorable. In other words, can the crown of the tooth actually be repaired after the root canal? This service gives our patients peace of mind, knowing we located and cleaned everything in the 3-D image.

Below are some root canals that were completed by Dr. Binkowski and endodontically fixed by Dr. Binkowski. There are also several cases where 3-D imaging showed the tooth could not be restored before a root canal was started.

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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