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Endodontics:  What is a Root Canal?

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What is a root canal?
A root canal is often used as a shortened term for root canal treatment.  Root canal treatment is a procedure to maintain or keep a tooth when the dental pulp has been damaged.

What is “dental pulp”?
The dental pulp is soft tissue within the tooth that contains nerve, blood vessels, and connective tissue.  It extends from the crown of the tooth (chamber) to the tip of the root (the root canal).
 
What damages the dental pulp?
The most common causes of damage to the pulp are dental caries (tooth decay), traumatic injuries, restorative treatment such as a filling and crown placement, coronal cracks and tooth fracture.  These problems can provide a pathway for germs (bacteria) to enter the pulp.  As the disease within the tooth progresses, bacteria and the necrotic tissue can leak out of the root and infec/inflame the bone and gum tissues.  This results in the destruction of the bone around the root and in some cases, abscess formation (swelling). 
 

Can I just leave it be?
If the infected/inflamed pulp is not removed, pain and swelling can result.  Without the root canal treatment, the tooth cannot be saved and may eventually have to be extracted (removed).
 

What will happen if I come for an appointment?
Your tooth will be examined, tested, and radiographs (x-rays) made to determine if root canal treatment is necessary.  You will be informed whether or not it is necessary to have a root canal treatment.  If it is deemed necessary, you will be informed of treatment options, alternatives and recommendations. 

Root canal treatment often involves multiple visits.  Between visits, the tooth will be sealed with a TEMPORARY filling.  If you do not return in a timely fashion, this could result in severe pain and losing the tooth regardless of the stage of your root canal treatment.  Please continue coming for your appointments until your root canal is completely finished and a permanent restoration has been placed.

 

Below are the general steps, if you elect to save your tooth by having the root canal treatment:

  1. An opening is made through the crown (top) of the tooth to expose the root canal system and canals.2014_Opening a Tooth_wj.png
  2. The dental pulp is removed.
  3. The length of the root is determined by placing an endodontic file(s) in the tooth and making a radiographic (x-ray) image.
  4. Cleaning and shaping the root canal is typically the longest process in a root canal treatment.  The pulp tissue and/or necrotic tissue remnants and bacteria are removed with endodontic hand and rotary files and rinsed with an antimicrobial solution.  An antiseptic dressing may be placed between visits to kill any remaining bacteria.
  5. Root canal filling (obutration) is done with gutta-percha and sealer to seal off the root canal system.
  6. A temporary or permanent filling is placed following the root canal treatment depending upon future plans for restoration.  If a temporary is placed, it should be replaced by a permanent restoration as soon as possible.
  7. A six month recall examination is recommended to assess healing.

 

Will it be painful?
There may be discomfort following the root canal treatment.  Over the counter medications such as acetaminophen, ibuprofen, or aspirin usually relieve discomfort.  Your provider will prescribe or recommend medication for pain and/or infection if appropriate.

If the pain lasts more than a few days, or if severe pain or swelling occurs, you should call your dental provider.

For emergencies after clinic hours, call the University of Iowa Hospitals and Clinics at (319) 356-1616 and ask for the endodontic resident on call.  If you are seen at the Hospital (UIHC) or outside the Dental College, there will be additional charges which you will be responsible for.

What is a “Permanent Restoration”?
A permanent restoration (silver filling, composite filling, or crown) is CRITICAL to the success of the root canal treatment because it helps to prevent bacterial contamination and tooth fracture.  The fee for a permanent restoration is not part of the fee for the root canal treatment and can be done by a general dentist or a different department within the dental college.  It is not necessary for an Endodontist to perform the permanent restoration but it is necessary for the root canal treatment to be successful.

Will I need to come back after I have the “Permanent Restoration”?
The root canal treatment, permanent filling, and/or crown are evaluated for healing at a recall appointment 6-12 months later at no charge.

Will everything be done and my tooth saved after the permanent restoration and my checkup appointment?
Good oral hygiene is necessary for all of your teeth.  Your restored tooth that received the root canal treatment has a better prognosis if you commit to good oral hygiene and regular dental checkups and cleanings.  The tooth is still susceptible to future dental problems.