The main causes for root canal therapy are infections, diseases that damage the pulp beyond repair, or severe trauma experienced by the tooth. Cavities that are not timely or properly treated can decay the tooth structure (enamel and dentin) and eventually result in pulp damage. Tooth trauma includes physical trauma as well as occasional pulp inflammation due to other dental procedures. In any case, if root canal therapy is not performed, infection will likely occur. This infection can consequently affect the bone around the tooth and in some cases the tooth may need to be extracted.
Symptoms for required root canal therapy include significant pain in a tooth when pressure is applied, high sensitivity to heat, prolonged sensitivity to cold, swelling around an affected tooth, discoloration of the tooth, and a broken tooth. In order to diagnose whether root canal treatment is needed, the dentist will take x-rays and may expose the tooth to hot or cold, examine surrounding tissue, and/or applying pressure to the tooth. Finally, if the results are still inconclusive, an electric pulp tester may be used.
Root canal therapy should be completed in one visit if there are no complications. Later office visits may be required to check on removed infections. The overall procedure involves two main steps. First is measuring which may involve anesthetics and possibly sedation. The dentist removes the top of the pulp through a hole in order to measure the canal itself. In the second step, the canal is measured through X-rays and/or an electric apex locator.
Next is a very important step of the procedure as the dentist must make sure to remove all of the diseased pulp tissue from the canals. Rinsed with an antiseptic solution, the canals will then be dried, condensed and sealed. Depending on the condition of the tooth, the dentist may at times chose to wait until the following visit to seal the tooth in which case a temporary filling is placed between visits. A full coverage crown is often the restoration of choice following root canal therapy to protect these teeth from fracture. Fracture of root canal treated teeth is common if the tooth is not restored immediately.
The patient may feel some post-operative discomfort so medications such as an antibiotic, anti-inflammatory and/or an analgesic may be prescribed. In the days following treatment, chewing with the treated tooth must be kept to a minimum but overall normal activities can be continued.
Here are some complications that may occur with root canal therapy:
1) The tooth may develop new infections if a canal is left untreated. This often happens when there is more than anticipated number of canals inside a tooth.
2) An unknown crack in the root of the tooth.
3) A poorly condensed root canal therapy can resulted in new bacteria entering the inner parts of the tooth causing recurrent infection.
4) Poor restoration can cause decay which over time can allow bacteria into the tooth.
Possible complications that can occur during the procedure include bacteria being pushed through the tips of the roots into surrounding tissue, perforation of the root with a filing instrument, or a file may break off inside the tooth.
All of these complications are rare. Overall, root canal therapy is a highly successful procedure with over a 95% success rate. With proper numbing of the tooth and surrounding areas, the procedure is completely pain free. Teeth that have been repaired can last a lifetime and with cosmetic crowns, the root canal is completely hidden.