A root canal procedure consists of removing part or all of the dental pulp (inner tissue of the teeth) to eliminate infections and preserve the natural tooth instead of extracting it.
The dental pulp is a soft tissue made up of blood vessels and nerve endings that are found under the dentin and tooth enamel. This is the part of the tooth that perceives stimuli and where sensitivity and pain occur.
Endodontics offers plenty of benefits for your long-term oral health by preserving natural teeth and avoiding further more complex treatments.
What is endodontics?
Endodontics or root canal is the procedure by which an endodontist removes the pulp of a tooth.
The space where the pulp is located is called the pulp chamber, it extends through the roots of the teeth forming the root canals that connect the pulp chamber with the tissues that surround the tooth.
Endodontics is performed to remove the diseased pulp and prevent the infection from spreading to other areas and causing more discomfort.
Once the pulp is removed, the endodontic specialist fills the root canals and pulp chamber with a biocompatible material to prevent bacteria from re-entering there.
Types of root canal treatments
Endodontics is classified into 3 types, depending on the tooth where the treatment is performed:
- Uniradicular endodontics: It is the one that is performed on incisor and canine teeth, these teeth only have one root and therefore, only one root canal.
- Biradicular endodontics: It is performed on molars and premolars that have two roots and two root canals.
- Multiradicular endodontics: It is performed on upper molars since these usually have three or more roots, each with its root canal.
When is a root canal treatment necessary?
Endodontic therapy becomes necessary when the dental pulp has an infection and causes pain or discomfort to the patient.
The main causes of pulpal injury that may require a root canal to preserve the natural tooth are:
- Dental fractures.
- Traumatisms (blows, even if there are no visible fractures).
- Dental abscesses.
- Tooth decay.
- Tooth sensitivity.
- Tooth erosion.
- Dental pain (can be constant or intermittent).
How to know if I need a root canal procedure
Initially, the diagnosis of pulpal inflammation is symptomatic. The most common symptoms are:
- Sudden onset pain.
- Hypersensitivity to cold and heat.
- Color changes in the tooth.
- Inflammation of the gum surrounding the affected tooth.
- Formation of dental abscesses.
But to ensure a correct diagnosis, the endodontist usually resorts to other methods such as pulp vitality tests, percussion tests, palpation, transillumination testing, and radiological studies.
Pulp vitality tests
Dental vitality or sensitivity tests allow for evaluating the response of the pulp to specific stimuli such as thermal (cold or heat), electrical, and mechanical.
In general, the cold test is the most used since it simply consists of applying cold to the affected tooth to see its reaction and determine if there is pulpal necrosis (death of the pulp).
Percussion test
This test consists of gently tapping the tooth with the handle of a dental instrument, to accurately locate the place where the pain or discomfort originates. This test allows the evaluation of the health of the periodontal ligament.
Transillumination test
It consists of illuminating the teeth from the lingual surface in a dimly lit room, in this way fissures, fractures, and even cavities that are not visible to the naked eye can be discovered.
Radiological studies
X-rays are essential in endodontic therapy, not only for diagnosis but also to establish an adequate treatment plan since it helps to identify the anatomical characteristics of each patient.
Step by step of a root canal treatment
- The endodontic specialist will do a thorough intraoral exam and will take the necessary radiographs to properly visualize the anatomy of the tooth.
- After planning the treatment, the specialist will apply sedation for the root canal procedure.
- The endodontist isolates the tooth by using a rubber dam to surround it so the root canals can be properly disinfected.
- The tooth’s crown is drilled to gain access to the nerve (pulp).
- The endodontist must determine the working length that corresponds to the distance from where the root canals begin to the root tip (apex). This is done with an apex locator.
- Preparation of the canals with endodontic files and disinfectants, the files are small endodontic instruments that are inserted into the canals and allow the progressive filing, gradually removing bacteria and infected tissue; The filing is interspersed with the irrigation of the ducts using disinfectant substances like sodium hypochlorite.
- Dental canals are filled or sealed using dental gutta-percha, a thermoplastic material, in combination with sealing cement.
- Finally, the dental crown is restored, this can be done with resins, porcelain inlays, or a prosthetic crown, this will depend on the extent of the damage to the natural crown of the tooth.
What is laser endodontics?
Laser endodontics uses laser-emission technologies to disinfect and debride the root canal in a more efficient way than the traditional method, this increases the success rate of the root canal treatment.
Root canal treatment aftercare
During a root canal recovery, it is normal for the patient to experience some sensitivity and discomfort in the area, however, this should only last a couple of days.
It is advisable to take an over-the-counter pain reliever after the intervention, in most cases, the endodontist will prescribe one.
In general, no special care is needed, other than avoiding excessive chewing in the area of the root canal treatment while the discomfort disappears.
Complications of root canal treatment
As in any treatment, there is the possibility of complications after a root canal treatment, the most frequent are:
- Endodontic failure due to incorrect sealing of the root canals.
- Long-term side effects such as dental fractures or changes in the color of the tooth.
- Sinusitis.
- Tooth pain does not go away after root canal treatment.
- Chronic infection, since in some cases, endodontics alone is not enough to eliminate the infection.
- Abscess after root canal treatment.
- Bad breath after root canal treatment.
- Fracture of endodontic files within root canals.
Benefits of root canal therapy
The main benefit is that the pain and discomfort will disappear permanently, the infectious process will be over and it won’t be spreading to other areas, improving overall health.
An endodontic treatment will allow you to preserve your natural teeth and will prevent the need for other dental procedures that might be more expensive and complicated.
Alternatives to root canal treatment
Endodontics is the last treatment option to preserve the natural tooth in the mouth. There are no other treatments that can do this.
However, in cases where this is not an option, it is best to extract the diseased tooth and then replace it with a dental implant.
Average root canal treatment cost without insurance
The price of a root canal cost around $600 and $1.500 without insurance, but most insurance companies cover up to 50% or 60% of the cost.
Frequently asked questions about endodontics
What to eat after a root canal procedure?
It is important to keep a soft diet at least for the first 48 hours and slowly start incorporating harder food as the discomfort disappears, you can opt for soups, smoothies, yogurt, mashed potatoes, eggs, soft fruits like bananas, etc.
You should avoid hot and spicy foods, and chewy food for a while.
Does endodontics hurt?
No, the treatment is carried out under local anesthesia, the patient should not experience any type of pain during the procedure, although it is normal that in the days after the intervention they experience discomfort in the area.
How long does an endodontic treatment take?
Thanks to the advanced endodontics and the new instruments available, it is possible to perform a root canal in a single session that can last approximately 1 hour and a half. In some cases, the endodontist could divide the procedure into two sessions for the patient’s comfort.
How many times can a root canal be performed?
Root canals are usually only done once on each tooth, but if the first treatment fails, retreatment of the same tooth can be done.
How long should I wait to eat after a root canal procedure?
You must wait until the effect of anesthesia disappears completely, it is also recommended that you eat soft things and avoid chewing toward the root canal treatment site.
What’s the minimum age for root canal treatment?
Dentists will advise you to wait until after age 12 or after the apex completes its formation, but in some cases of severe damage, younger kids can get a partial endodontic treatment, it is called pulpotomy and it is performed by a pediatric dentist.
References
- Van Nieuwenhuysen, J. P., & Leprince, J. G. (2023). What ultimately matters in root canal treatment success and tooth preservation: A 25-year cohort study. International Endodontic Journal, 56(5), 544-557. https://doi.org/10.1111/iej.13895
- Burns, L. E., Kim, J., Wu, Y., Alzwaideh, R., McGowan, R., & Sigurdsson, A. (2022). Outcomes of primary root canal therapy: An updated systematic review of longitudinal clinical studies published between 2003 and 2020. International Endodontic Journal, 55(7), 714-731. https://doi.org/10.1111/iej.13736