Your tooth is made up of two parts, the crown and the root. The crown is the part of the tooth you see outside the gums. It provides a chewing surface. The root is under the gums in the bone, and supports the crown. The root has a space inside that runs the length of the tooth. Inside this space, blood vessels and nerve tissue make up the pulp of the tooth. Pulp develops and nourishes the entire tooth. Bone around the root also provides nourishment.
Root canal therapy treats the damaged pulp of a tooth. It is also called endodontic therapy (endo = inside; odon = tooth). The most common cause of pulp damage is severe decay or a tooth fracture that exposes the pulp to bacteria in the mouth. Bacteria cause infection. Injury such as a blow or crack, a cracked or deep filling, or repeated filling of a tooth can also damage pulp. Periodontal (gum) disease or orthodontic treatment (straightening teeth by braces) may also harm pulp, but this is a rare occurrence.
First, the dentist will examine your mouth and teeth and do some tests. X-rays are also necessary. This determines the extent of damage to the pulp. At first, a damaged or diseased pulp is usually sensitive to hot, cold or both. The tooth has a spontaneous or prolonged toothache. Later, infection of inflamed pulp may swell the jawbone and gum. At this point, dental treatment is urgently needed.
Root canal therapy involves removing damaged pulp through an opening made in the crown. The pulp space is cleaned so that bacteria and toxins in the root canal can be removed. Once cleaned and shaped, the pulp space is filled with non-reactive materials. Although the pulp is removed, the tooth remains alive, comfortable, and nourished by surrounding gums and bone.
Sometimes root canal work can be done in one appointment, but often two or three visits are needed. A temporary filling is placed in the opening of the tooth to protect it between appointments. If there is an abscess or infection that has spread to the bone, medication may be placed in the canal spaces and an antibiotic prescribed.
With modern anesthetics, root canal therapy usually involves little or no discomfort. Severe pain is not common and can be controlled. Often the worst pain occurs before treatment. Root canal therapy usually provides immediate relief.
A tooth (particularly a front tooth) can discolour if a blow injures the pulp. A dentist can easily treat this by internally bleaching the tooth back to its natural colour using special chemicals. Alternatively, the tooth can be crowned with a life-like material to hide the discoloration.
The cost of a root canal procedure will vary depending on the type of tooth and severity of the problem. Molars that have three or four calcified, fine or tortuous canals are more difficult to treat, and so usually cost more. However, a root canal is usually less expensive than removing a tooth and replacing it with an artificial one.
Although removing a tooth is much simpler than root canal therapy, often it is not the best solution. Once a tooth is removed, something should be done to fill the empty space.
Replacing the missing tooth is one alternative. This can be done with an implant tooth, a fixed bridge (a false tooth attached to adjacent teeth) or a removable partial denture. Extensive treatment is needed to attach a bridge to adjacent teeth. Nearby teeth also carry an increased load to make up for the missing tooth. Stress is placed on both the pulp and tooth surface of supporting teeth.
Alternatives to a fixed bridge include a removable partial denture or a dental implant. To replace a single tooth, a removable partial denture usually does not work as well as a permanent bridge. A single tooth implant is a surgical procedure to the bone. It is much more costly than a root canal and may require up to six months to complete. Implants may not be suitable for everyone. There is no real substitute for your own tooth, which is more efficient at chewing and biting than an artificial tooth.
Sometimes a tooth cannot be saved by a root canal. The procedure can only be done if the canals in the tooth root are accessible and can be properly cleaned and sealed. As well, the tooth must have enough healthy gum and bone support.
Many general dentists will do routine and relatively easy root canals. Complicated or emergency cases are often referred to dental specialists called endodontists. They are certified by the provincial dental governing college to perform all aspects of root canal procedures. All dentists receive some training in root canal therapy in dental school. However, endodontists have two or three years of post-graduate training and pass national endodontic board examinations.
Endodontists see patients referred by general dentists. After root canal therapy is complete, the patient returns to the dentist for final restoration of the tooth. Working together in your best interests, your general dentist and the endodontist can achieve the best outcome.
If your dentist says that you need a root canal, be assured this is the best way to try to save your tooth.