So you need a root canal…

Decided to do another collaborative with a specialist … this time it’s all about dental pain and the hero that gets you out of it … your friendly Endodontist Dr Ari Gold of Metro Endodontics . Here are some common questions patients ask me … let’s see what our specialist will say … take it away Dr. Ari


Q. Why do I have pain and what causes swelling around the gums when a tooth needs a root canal?

Pain is generally caused by the contamination of the root canal space by bacteria. Those bacteria generally come from the patient’s own oral cavity and can enter the root canal space by way of a large cavity, leaking/broken filling, cracked tooth, and more. Once the bacteria enter the canal space, they will give off toxins that will damage the normal tissue that exists(also know as the dental pulp), and result in pain as a result. Swelling generally occurs when the initial infection of the pulp has spread out of the tooth and into the jaw bone and overlying gum tissues

Q. What exactly is a root canal anyway ?

The root canal space is present in each and every tooth and is composed of dental pulp, which is the tissue that built the tooth itself when we were children. If that canal space becomes contaminated, root canal therapy (also known as endodontic treatment) is performed to remove the damaged or infected pulp, along with the bacteria and the toxins they have produced from that space. This is performed using specialized, very small instruments as well as a variety of disinfecting solutions. The disinfected space is then closed with a biologically acceptable material that seal the space off, so no contaminents are allowed to re-enter that space.

Q. The pain went away on its own, even though my general dentist referred me to a specialist . Does that mean I don’t have to go?

It is quite common for initial pain from a damaged pulp to disappear, often after just 2 or 3 days. This does not mean a procedure is no longer necessary. If the pulp has in fact been contaminated, there can be a period of time where even though the pain has subsided, the bacterial contamination can quietly spread into what is often called a dental abscess, where one might experience both a reccurence of intense pain as well as swelling of the area.

Q. I would rather not have a root canal, I’m scared of the procedure and the price.

There is no need to fear a root canal procedure. Dentistry has advanced to a stage where endodontic treatment can be performed painlessly in almost every situation. For those that are extremely apprehensive, there are dentists or specialists who are qualified to sedate their patients to make their patients less anxious during the procedure. The price can vary between general dentists and specialists and will vary depending on the tooth being treated. Most often, root canal therapy is covered to some degree under the basic coverage of dental health plans. We recommend patients check their coverage before entering into any treatment such as this.

Q. Can every tooth be saved by a root canal? Under what circumstances might it be better to “just pull the tooth” ?

Not every tooth can be saved. For example, some teeth are so badly broken down, that there might be no way to properly restore a tooth after a root canal procedure. In other cases, there might be some advanced underlying periodontal disease which may adversely affect the long term prognosis of the tooth. In other cases a tooth may be found to be cracked deep into the root, which would also present a long term problem. These are just a few examples of teeth we would suggest extracting, rather than saving.

Q. Do I need to take antibiotics and if so when do I start taking and for how long ?

Antibiotics are generally not required for most endodontic procedures. However in some cases, antibiotics are necessary. For example, a tooth that is badly infected may need antibiotics to help the body heal the infection. Some patients with a history of cardiovascular surgery or joint replacement surgery will be asked to take antibiotics as a preventive measure. Your dentist will assess your medical and dental situation and tell you if you need antibiotics and for how long.

Q. How long does the procedure take ? How many appointments ?

This depends on many factors including the experience of the dentist performing the treatment, which tooth is actually being treated and the signs/symptoms of the tooth in question. Most endodontic procedures can probably be performed in either 1 or 2 visits

Q. How soon after completion of treatment do I need to get tooth permanently restored , and do all teeth need to be crowned after a root canal?

My rule of thumb in most cases is to get the tooth restored as quickly as possible after root canal therapy, but after the tooth has had at least a few days to settle. The reason is that most teeth requiring root canal treatment are either heavily restored or broken down, which means they are inherently weak. We do not realize how much force we are putting on our teeth when we bite, but it is more than enough to break a weak tooth. Most, but not all teeth require crowns after endodontic treatment. Again, this will depend on the strength/weakness of the tooth, as well as its position in the arch.

Q. I lost a tooth after doing a root canal when it broke in half a year later  . My dentist had recommended a crown to protect the tooth right away but I didn’t follow through with getting that done unfortunately. I’m not sure root canals work … was that my fault or the fault of the root canal?

There is no way to answer that question with certainty as all cases are different. However, as I stated in the previous question, teeth that require root canal therapy are often already broken down or heavily restored teeth, that are weaker than other teeth that would otherwise be able to withstand normal biting forces.

Q. After the procedure was done I still had a bit of discomfort for a couple of days  . Should I worry ?

It wasn’t too bad , certainly not like when the tooth was badly infected . But still I’m concerned , what does that mean ? It is normal to have sensitivity after root canal therapy. This is not considered a surgical procedure, but we are working deep into the tooth, and the surrounding structures can feel “bruised” for a day or 2 after.

Q. Are root canal procedures generally successful?

Root canal therapy, if done properly, has one of    the highest success rates of any dental procedure performed, with published success rates well over 90%.