Root Canal - The Root of the Problem

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By Dr. David Leader

Sometimes, lunch with friends can seem like a pop quiz to a dentist. This is especially true when the topic of conversation turns to root canal treatment. Funny that people know so little about a treatment that is provided more than 24 million times a year (according to the American Association of Endodontists' Web site).

Root canal treatment is the removal of tissue and debris from the inside of a tooth's root and filling the space with an inert material to prevent infection or re-infection. While there have been many improvements to the technique in recent years, the theory, practice and reasons for root canal treatment have remained unchanged for many decades. The majority of reasons that a tooth may require this treatment are infection, trauma and the treatment of misaligned teeth.

Bacteria from decay that grows close to the dental pulp, the soft inner part of a tooth, may infect the pulp. This infection can become an abscess. People feel the effect of this infection as sensitivity to cold that lingers for more than several seconds after the cold stimulus is removed, or uncomfortable pressure near the root of a tooth, or even in pain that is referred to another tooth, the eye or ear on the same side as the infected tooth.

Force suddenly applied to a tooth from a fall, a sports injury or a car accident may move the tooth and damage its blood supply causing death of the pulp in the short term or even many years later. Wearing a sports mouth guard can prevent this type of injury. Misaligned teeth may require root canal treatment to allow the dentist to dramatically change their position with crowns or caps.

Root canal treatment may be performed by general dentists, pedodontists (dentists who specialize in the treatment of children) and endodontists (dentists who specialize in root canal treatment). While patients may expect the same quality treatment from all providers, some providers have a higher level of training and experience and will choose to treat cases that are more complicated.

To treat the root canal of a tooth a hole is made into the root canal system. Then drills and long, slender files are used along with chemical agents to carefully clean and shape the canal system. Measurements must be taken at various times during the procedure to determine the exact length of each canal. When the canal is clean and dry it may be filled. The filling is usually a combination of rubber and cement or sealer. Other materials found in root canal treatment, today, may include titanium, composite and plastic.

Root canal treatment is more than 95 percent effective. Failure may be caused by a fracture of the tooth, inability to completely clean the canal system or breakage of an instrument within the canal. The tooth can be re-infected if the canal is not completely cleaned or if the tooth is not sealed with a permanent filling and a crown (when necessary). Endodontically treated teeth are still subject to the ravages of tooth decay and periodontal disease even if they have a crown.

Most endodontically treated teeth require crowns to restore most of their strength; some only need a filling. Your dentist will recommend the best treatment for your tooth. Usually, when the restoration (crown or filling) is completed the tooth feels normal. After some years, some people forget that any of their teeth had root canal treatment or which teeth were treated.

Root canal treatment is expensive and does not always work (about 5 percent of cases fail and some teeth cannot be treated). Should you and your dentist decide that you must make a choice other than root canal treatment, your treatment would begin with extraction of the affected tooth. The missing tooth would be replaced. A removable device, a denture, may be used to replace one or more teeth. A bridge may be fixed to teeth on either side of the space that the missing tooth had occupied. My personal choice to replace one or more of my teeth would be a dental implant-supported crown. An implant-supported crown looks and feels just like the tooth it replaces.

Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.