A Dentist Explains Root Canals

Root canal. Many people cringe at these words. Frequently, they fear the procedure but, trust me—I'm a dentist—it sounds much worse than it is.

From the words, a lot of people believe we're taking out the root of their tooth. But that's not it. We're removing soft tissue inside the tooth's canal and then filling up the resulting empty space with a material that's compatible with the body's own tissues.

Called "pulp," this tissue includes a network of tiny blood vessels and nerves. It must be removed when it becomes inflamed or infected from deep decay, multiple dental procedures or injury. Many patients feel ear pain, throbbing or lingering sensitivity to heat and cold. Then they are referred to my office or sometimes they just show up on their own.

I feel around the tooth with my finger, tap it with an instrument, and apply heat and cold. Sometimes I use electric stimulation to check the nerve. I'm trying to duplicate what you've been feeling so I can judge what's going on in your tooth. If there's a twinge of pain during the tests, you're better off. That means the nerves are in good shape, and my work on your tooth may not have to be as extensive. I use X-rays to gauge the tooth's length.

Your dentist can do a root canal or refer you to an endodontist like me, depending on the severity of your problem and your dentist's comfort level with the procedure. An endodontist is a dentist with two to three years' additional training in endodontics (Greek for "inside the tooth") who is an American Dental Association and American Association for Endodontists certified specialist in Endodontics.

The American Association for Endodontists says dentists do more than 14 million root canals a year. That number is rising as people keep their teeth longer.

If you need a root canal, I use a local anesthetic to numb the area. Then I use instruments to open the tooth and extract the tiny "pulp," about two drops of spongy tissue. I clean and shape the inside of the tooth, fill it with biocompatible, a rubber-like material, and seal it. The procedure can take half an hour or multiple visits, depending on the problem. Sometimes, depending on how long the area around the root of the tooth has been infected, an additional surgical procedure is necessary, called an "apicoectomy," literally, removing a small piece of the very end of the root. This procedure allows me to really clean out any infection in the bone, if it's needed. I refer patients to their regular dentists for a crown or other restoration.

I might prescribe oral antibiotics whether an apicoectomy was done or not. Usually, all you'll need is over-the-counter pain medication. Your tooth may feel sensitive for a few days, but you shouldn't feel severe pain. If you do, call your dentist.

How can you avoid a root canal?

Good oral health care, including brushing and flossing, will help prevent the need for a root canal. Most root canals stem from deep decay brought on by bacteria that build up when people don't care for their teeth.

Have routine checkups at least once a year. If you lose a filling, see your dentist. And watch for trauma. Even an infant hitting you in the mouth can injure your teeth—leading to root canal.

Source: Eugene A. Pantera Jr., D.D.S., M.S., is assistant dean of dental continuing education and clinical associate professor of restorative dentistry at State University of New York at Buffalo's Dental School.