Root Canal

Once upon a time, if you had a tooth with a diseased nerve, you'd probably lose that tooth. Today, with a special dental procedure called a root canal therapy you may save that tooth. Inside each tooth is the pulp which provides nutrients and nerves to the tooth, it runs like a thread down through the root. When the pulp is diseased or injured, the pulp tissue dies. If you don't remove it, your tooth gets infected and you could lose it. After the dentist removes the pulp, the root canal is cleaned and sealed off to protect it. Then your dentist places a crown over the tooth to help make it stronger.

Most of the time, a root canal is a relatively simple procedure with little or no discomfort involving one to three visits. Best of all, it can save your tooth and your smile!

What is the purpose of root canal treatment?

You could say that the purpose of root canal treatment is to create an end result where the tissues surrounding a tooth's root will maintain a healthy status despite the fact that the tooth's nerve has undergone degenerative changes. Specifically, we mean that the tissues surrounding a tooth's root are not affected by bacterial infection and/or irritating substances leaking from those inner aspects of the tooth originally occupied by the tooth's nerve tissue.

Possibly in more scientific terms, our bodies, as a defense mechanism, will initiate an "inflammation reaction" when irritants (such as those seeping out of a problematic tooth) have injured or destroyed body tissues. If incorporating the term "inflammation" into our description we would then say, root canal treatment is the treatment of the inner aspects of a tooth (whose nerve has undergone degenerative changes) so to provide an environment where the tissues surrounding a tooth's root are free of, and will likely to continue to be free of, the presence of inflammation.

How does root canal treatment accomplish this goal? In a nutshell, the process of root canal treatment first removes (as thoroughly as possible) bacteria, nerve tissue, the organic debris left over from the breakdown of nerve tissue, and bacterial toxins out from within the inner aspects of a tooth (the area originally occupied by the tooth's nerve tissue). All of these items either are or will produce the tissue irritants that can cause your body to activate an inflammation reaction.

Subsequently, once this space has been cleansed root canal treatment involves filling in and sealing off the interior of the tooth. This is done as a means of minimizing the possibility that bacteria will be able to re-colonize the inner aspects of the tooth or that the interior of the tooth can fill in with tissue fluid that could become stagnant and subsequently break down. (Either of these situations could produce a state of persistent inflammation in the bone that surrounds the tooth's root.) The seal also contains and encapsulates any debris that could not be fully removed during the cleaning aspect of the root canal treatment process so that it can't leak out and trigger an inflammation reaction.

Why go to all of this trouble? If you get an infection, say from bacteria entering a cut in your skin, your body will transport white blood cells to and from the area (by way of your blood vessels and lymphatic system) so to combat the bacteria that have caused the infection. In most cases your body will win the battle and kill off the offending bacteria.

The problem with teeth and infections (and likewise for tissue irritants in general) is that once a tooth's nerve tissue has started to degenerate and bacteria have taken up residence in the tooth's nerve area, there is no effective way for white blood cells to get at the bacteria to combat them. The dying nerve tissue's blood and lymphatic vessels that are normally used to transport white blood cells will have begun to degenerate too.

The net result of all of this is that the nerve space inside a tooth can provide a nice cozy cave-like location for bacteria to persist. It's a place where your body's defensive mechanisms can't effectively get at them. With this scenario, at best your body will only be able to cordon off the infection caused by the bacteria living inside your tooth. At worst, this bacterial infection will overwhelm your body's defense mechanisms and pain and swelling will ensue (an acute tooth abscess).

The idea of root canal treatment is that it provides the bulk of the clean up work for your body. It removes bacteria and tissue irritants that are present inside the tooth, especially those in the locations where your body would have the most trouble combating them. As an end result of its cleaning and sealing aspects, once root canal treatment has been completed it provides your body with an environment where its mechanisms are able to clear away any residual bacteria and tissue irritants that may still be present, thus allowing complete healing (resolution of the inflammation) to occur.

Are there any alternatives to having root canal treatment? If root canal therapy is indicated for a tooth there really is no alternative treatment other than an extraction. Root canal treatment deals with the inner aspects of a tooth unlike any other dental procedure. If it is required, no other dental work can suffice. If root canal treatment will not be a possibility for a tooth then it should be extracted.

Should you have an extraction rather than root canal treatment? The cost or simplicity of a tooth extraction might seem attractive in comparison to having root canal treatment performed but this solution might not be the easiest or least expensive treatment choice in the long run.

When a tooth is missing its neighboring teeth will tend to shift, sometimes significantly. This in turn can have a major impact on your dental health. Even the removal of a single tooth can lead to problems related to your chewing ability, problems with your jaw joint, and predispose the teeth that have shifted to problems also.

To avoid these complications, in most cases your dentist will probably recommend to you that you have any tooth that has been extracted replaced. Replacing a tooth which has been extracted with an artificial one (using either a dental bridge, removable partial, or implant) can easily cost as much (and usually more) than ideal treatment for your tooth beginning with root canal therapy.

Don't make the decision to have a tooth extracted quickly. First, make sure that you and your dentist have discussed and explored all of the benefits and detriments of all of the treatment options that are available. Timing your root canal treatment. In those cases where root canal therapy is needed it is always best to go ahead and make plans to have the treatment performed sooner rather than later. Sometimes, however, root canal treatment must be delayed because of scheduling conflicts, the need for other dental work, or else financial considerations. Delays such as these can usually be managed, at least to some degree. Often a dentist can perform the initial aspects of root canal treatment, the ones that can make it so your tooth feels better, and then schedule an appointment for you at a later date for the completion of the work.

You should not make a decision to delay root canal treatment unilaterally but instead discuss matters with your dentist. Any tooth that is in need of root canal treatment, but has not yet received it, is not predictable. A tooth could remain asymptomatic for an indefinite period of time or, at the other extreme, could abscess badly causing you pain and extensive swelling. Even in those cases where a tooth remains asymptomatic, the infection associated with the tooth could cause damage to the bone that surrounds it. Discuss matters with your dentist. Let them explain to you what they would consider a reasonable time frame for the treatment of your case.

The information provided on this Web page is general background information and should not be construed as CDC recommended practice or guidelines, except where official recommendation or guideline documents are specifically mentioned.