What is Root Canal Treatment?

Natural teeth are meant to last a lifetime.  Even if one of your teeth becomes injured or diseased, it can often be saved through a specialized dental procedure known as root canal (endodontic) treatment.  To help you understand when and why this procedure might be needed and how a damaged tooth can be saved, we have answered some of the most frequently asked questions about endodontic treatment.

Root canal treatment usually involves the removal of the tooth's pulp, a small thread-like tissue that was important for tooth development.  Once removed, it is replaced with materials that seal off the root canal from its supporting structures.  Years ago, diseased or injured teeth were often extracted.  Today, even if the pulp of one of your teeth become injured or infected, it often can be saved through rot canal (endodontic) treatment.  Endodontics is the area of dentistry concerned with the prevention, diagnosis and treatment of diseases or injuries to the dental pulp.

What is the dental pulp?

The pulp is the soft tissue that contains the blood vessels, nerves and connective tissue of the tooth.  It lies in a canal that runs through the center of the dentin - the hard tissue on the inside of the tooth that supports the outer layer of tooth enamel.  The crown (the portion if the tooth visible above the gums) contain the pulp chamber.  The pulp extends from this chamber down through the root canal to the tip of the root in the bone of the jaws.  Teeth have only one pulp chamber but may have more than one root and several root canals.

What happens if the pulp gets injured?

When the pulp is diseased or injured and unable to repair itself, it loses its vitality.  The most common causes of pulp death are a cracked tooth, a deep cavity, or traumatic injury to the tooth.  Bacteria and its products can leak into the pulp, eventually causing it to lose vitality.  If not treated with a root canal, an abscess can form at the end of the root, resulting in pain and swelling.

Why does the pulp need to be removed?

If the injured or diseased pulp is not removed, the tissues surrounding the root of the tooth can become infected, resulting in pain and swelling.  Even if there is no pain, certain substances released by bacteria can damage the bone that anchors the tooth in the jaw.  Without treatment, the tooth may have to be removed.

Why couldn't you just remove the tooth?

There are many disadvantages to losing a natural tooth.  When a tooth is removed and not replaced, the adjacent teeth may begin to shift from their normal position.  This may cause the teeth to become crooked or crowded, which decreases biting and chewing efficiency.  Crowded or crooked teeth may be more prone to gum disease because they are harder to keep clean than properly aligned teeth. A replacement tooth (an implant or bridge) is usually more expensive than endodontic treatment and can involve more extensive dental procedures on adjacent teeth.  A natural tooth is normally better than an artificial tooth.

What does treatment involve?

Treatment usually involves from one to three visits.  During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp.  The pulp chamber and root canal(s) are then cleaned, shaped, filled and sealed off from the bone surrounding the root.  In case of considerable tooth structure loss, a metal or plastic rod or post may be placed in the root canal for structural support, and a crown is usually placed over the tooth.

What material will be used for the crown?

Crowns are made from a number of materials.  Gold alloys or nonprecious alloys, porcelain or ceramic, acrylic or composite resin or combinations of these materials may be used.  The type of material used for the crown will depend on a number of factors including where the tooth is located in your mouth, the color of the tooth and the amount of natural tooth remaining.  Talk with your dentist about which option is suited to your situation.

How long will the restored tooth last?

As long as the root(s) of the treated tooth is nourished by the tissues around it, your tooth can remain healthy.  However, the tooth could still become decayed, so good oral hygiene at home and regular dental exams are necessary to help prevent both tooth decay and periodontal (gum) disease.

Here's how your tooth is saved through treatment:

• First, the tooth is isolated from the saliva with a dam (a rubber-like sheet placed around the tooth).  An opening is then made through the crown of the tooth into the pulp chamber.  Local anesthesia is usually given prior to this step so that you will be more comfortable during treatment.
• The pulp is then removed carefully from both the pulp chamber and the root canal(s).  The root canal(s) is cleaned, enlarged and shaped to a form that can be filled.
• Medication may be put in the pulp chamber and root canal(s) to help eliminate bacteria.
• A temporary filling will be placed in the crown opening to prevent saliva from getting into the chamber and root canals.  You might also be given antibiotics if infection is present and has spread beyond the ends of the root(s).
• During the next stage of treatment, the temporary filling is removed.  The root canal(s) are then filled and permanently sealed with a natural, biocompatible material, usually gutta-percha.
• In the final step, a crown made of porcelain or metal alloy is usually placed over the tooth to restore structure, function and appearances.  If an endodontist performs the root canal treatment, he or she will usually recommend that you return to your general dentist for the crown's preparation.

©1999 American Dental Association

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