What is a root canal treatment?
The first question we have to answer is, what is a root canal treatment? Because there is a broad range and variety of root canal treatments. To put it simply, a root canal treatment is where we go inside the tooth because it means that the tooth is either dying or has died, and an infection is beginning to form or is already present.
The term root canal actually describes the part of the tooth that is within the root itself. Imagine you have the top part of the tooth, and then you have the root. The canal in the root is actually the hole where the nerve enters into the tooth and gives feeling and life to that tooth.
A root canal is where we go inside the tooth, and we go down into the canal of the tooth and clean out that canal because the nerve has died. We clean it out with the hopes of preserving and saving that tooth itself. That, in short, is what a root canal is.
What are the signs that indicate the need for a root canal?
The number one sign that indicates a root canal is sensitivity to cold, sensitivity to sweets, and sensitivity to heat, especially. Each of those is going to tell you a different stage of the tooth, where it's at, and how it affects the nerve. The reason I say cold is the first step is because where we start to believe we need a root canal is when there's sensitivity to cold, and that cold lingers.
It's not uncommon that a tooth will be sensitive to cold. But when the cold hits the tooth, and it's sensitive, we want that cold feeling to go away immediately, like within 5 seconds. But when cold hits a tooth, and now it starts to throb or linger for several seconds or even minutes, that's where we're really starting to believe that something is communicating with the nerve, and the nerve is starting to be involved at this point.
The same thing can happen with sweets. A sweet sugar hits the tooth, it makes it really sensitive. If it goes away quickly, I'm not too worried about it, but if it lingers, now I'm getting worried. When it starts to progress to where heat is starting to bother the tooth, that means that the tooth is dying, and that is when we need to see you right away, because having sensitivity to heat is not common at all. When we do have sensitivity to heat, as I said, it means the tooth is dying, and that is one of the earliest signs of the need for a root canal.
What causes the need for a root canal?
What will cause the need for a root canal is a cracked tooth. That is one of the most common reasons. When a tooth is cracked just in the top part of the tooth, then we can still save the tooth with a root canal. But when that crack has gone on for too long, and the tooth goes unprotected, that crack in the top part of the tooth can start to progress down into the root. And when the crack gets down into the root, that's now called a vertical root fracture.
At that point, a root canal cannot save a vertical root fracture. That tooth now has to be pulled. So when a crack is in the top part of the tooth, and you need a root canal, that's when we need to get to it right away and get that tooth treated and protected so it does not continue down the root.
When is a tooth too late to get a root canal?
When a crack progresses down the root, it is now too late. Sometimes infections get so big that a root canal is not going to save the tooth. It's not going to get rid of that infection. Other times, a tooth cavity can become so big where maybe a root canal could have been used at one point, but now there's such little tooth structure remaining that a root canal cannot be used. So those are instances where a root canal no longer can save a tooth. Now the only option we have is pulling the tooth.
What happens during a root canal?
What happens during a root canal is that the first step is when we go into the tooth. Say it's because of a crack or because of tooth decay or because of a fracture, we go in, and we clean the tooth up first. When we're cleaning up the tooth, we want to protect the tooth. We put this rubber thing around the tooth. It's called a rubber dam. That rubber dam seals off the tooth because when we go in, and we're cleaning this, we don't want any bacteria from our saliva in our mouth to get into that tooth once we've cleaned it.
The research shows that the only successful way to have a root canal is with a rubber dam. If you have a root canal without a rubber dam, you will 100% of the time have a failure of that root canal, where the infection comes back.
Once we get the tooth isolated and clean, we clean up the top part first, and then we get into where the roots are and where the canals are. We start cleaning out each of the canals. What's very important when you're cleaning the canal is that we take dental X-rays and we have devices that tell us that we're at the tip of the root because you have to get down to the very tip of the root in order to properly clean a root canal.
Once you get to the tip of the root, it is very important to make sure that all infection is cleaned out. There are cleaning steps that we do that kill bacteria and kill infection. Depending on where the tooth was at the time the root canal was done, whether it was partially alive or fully dead, it will determine the way that root canal is done.
There are some times where a root canal can be done in one step, or there are times where it needs to be done in two, three, or even more steps. The way we know how many steps it needs to be is, well, what was the level of disease in the tooth? How alive was the tooth at the time of doing the root canal? Like I said, was it dying or was it dead? The reason why that matters is because root canals often get a very bad rap. They say, "Oh, they're toxic. They're this. They're that." And part of the reason people say that is because root canals oftentimes are done incorrectly. And when they're done incorrectly, well, guess what? It is toxic. I agree with that. But when a root canal is done correctly, research shows it is not toxic. It's not going to cause cancer. Because that is a very big circulating thing right now, that's where we have to argue, well, was it done correctly to begin with? Imagine you take your car to the dealership and they put the wrong oil in. Is oil bad for your car? No. It keeps the car running. But if you put the wrong oil in, guess what? The car is going to break down. It's the same thing with the root canal. It works exactly the same kind of way.
Also, it's the medicine that you put into the root canal. I will be honest that in the past, there were medicines that were used that we found out to be toxic. But now, there have been so many more advancements, and there are so many even holistic things that we can put inside a tooth when we do the root canal that preserve the tooth and don't harm the body, and that actually strengthen the body. That's what we do in my practice. That's how I can safely perform a root canal. Once we know and confirm an infection has been fully cleaned out, the very last step is to seal off the roots, get the tooth protected, and then it's done. That's how we do a root canal in my practice.
What is the goal of a root canal?
The goal of a root canal is to preserve the tooth. What we hope is that we preserve that tooth long-term. Depending on how advanced the disease was or how much tooth is remaining, root canals will vary in the time that they last. There are many times where a root canal can last literally the entire length of a person's life. There are other times where it may not last as long because the disease was more advanced, but we at least bought some time for that tooth. In my practice, if I know a root canal is going to keep a tooth for 10 years, then I think it's worth it. But if I think a root canal is only going to save the tooth for a shorter period of time, then to me, it's not worth the investment. I'll explain the difference and I'll go through which one is the case. But more or less, like I said, time varies. My goal is always to get 10-plus years out of a root canal or the length of a person's life.
Do you always need a dental crown after a root canal?
Very often what follows a root canal is the need for a dental crown. It is going to be based on how much tooth structure is remaining when we do the root canal, as well as what area of the mouth that tooth is in. Very often, if I have a lot of good tooth structure on the front of the mouth and I do a root canal, I don't need a crown. I do the root canal, put a filling in, and I'm good. But the research shows that if it is a posterior tooth, which is a tooth in the back, those are our molars.
The research shows that within 6 months of doing a root canal on a molar that does not get a crown, the tooth will fracture. It's 6 months. That's not a long time. By year two, say a person fractures the tooth and still doesn't get it treated, that tooth is now being extracted. My goal is not to extract a tooth that you just had a root canal on. So we have to do a crown and protect that tooth. That way, you're not just wasting your money and getting this root canal procedure done, but you're actually preserving that investment and keeping that tooth around for a very long time.
Will a root canal be painful, and what anesthesia is used for the root canal procedure?
When we do this procedure, we want to make sure you are comfortable in the process. We will use some type of anesthesia, and there are different kinds. The most common kind is a local anesthetic, meaning we're going to numb the area up so you feel nothing. That way, when we do this procedure, it is a painless procedure. Very often, I have patients tell me, "Oh, I heard root canals are so painful." Well, it doesn't have to be. When done correctly and done by the right doctor, it is not painful at all.
Now, if you are in extreme pain when you need this root canal because you waited too long, then it might be a little painful, but you're already in pain. But even in those kinds of cases, we can still get you comfortable. There are other types of anesthesia where we maybe put you to sleep a little bit or maybe give you a medicine to really relax you. That's how we're going to use these different types of anesthesia to our advantage. That way, the process for you is painless and comfortable. That is my goal.
How safe is a root canal?
When a root canal is done correctly, it is extremely safe. The number one thing we have to verify is that we got rid of all the infection. There are a lot of ways that we can verify that. As a patient, we want it to be one and done. We just want it to be over with, right? It's uncomfortable. We don't want this. We don't want to come to the dentist. But what's so important for me is to make sure that, while I understand we want it to be done quickly and fast, at the same time, I want it to be done in a way that's not going to be detrimental to you long term. There are things that we can do to verify that disease is gone, and we take those precautions so that you can have a very safe and effective root canal, and this is not going to affect you or create problems long term for you.
How do I prepare for a root canal appointment?
Really, there's not much preparation needed. The number one thing I say is get in as soon as possible. The sooner, the better, because time will only do damage when you need a root canal. The way you prep for that is just, you know, come in, be relaxed, whatever you need to make things relaxing for you. That's really all the preparation needed. Also, if there are things that we can do to help you in that relaxation, let us know. How can you be more prepared? Well, make us prepared. Let us know what we can do to make you more comfortable because ultimately we want to take care of you, and we want it to be comfortable and painless throughout the process.
What will it feel like after a root canal?
The majority of the time, there is zero pain. Occasionally, we might have a little bit of soreness, but it's very minimal, like something Tylenol or Advil can take care of.
Very rarely, but once every so often, we can have a hyper reaction where we get more pain. That's the worst situation. If that ever happens, you call me right away and let me know. Then what we do is give you some medication that's stronger that helps calm that down immediately. It's very easy to treat when that happens. I just need to know. The majority of the time, probably 99% of the time, people are either left with no discomfort at all or have mild discomfort, just some soreness. Maybe 1% of the time, we have someone who ends up with more pain. But like I said, we can easily handle and treat that, and that's where you just need to call me and let me know and we address that right away.
Will I still have sensitivity after a root canal?
The answer should be no. Now again, it depends on how bad the infection was and how much pain we were in before. What I typically see is if we had a lot of pain before, then we pretty much calm down 70% of that pain. So if we were a 10 out of 10, we're now maybe a 3 out of 10 afterward. But that will get better with each passing day. That's very important for us to know if you are experiencing that because there are things we can do to help speed that up. That way, you can have comfort right away because ultimately, there should be zero sensitivity or pain following a root canal.
If I have sensitivity, how long will it last?
Sensitivity will happen during recovery, but only for a couple of days. Usually, there's zero downtime and zero recovery for a root canal. If we need downtime or something, then again, I need to know. Prepare me, let me know, because I want to make sure I address that. There really should not be any downtime, and sensitivity at max should last just a couple of days, maybe like 3 days at most.
What is the best way to recover after a root canal?
The best way to recover after we do have a root canal is to take some Advil. Advil is an anti-inflammatory medication. Like I said, if we need a root canal because we've had pain, there might be some inflammation from the procedure or even because of the original pain. Advil is going to help calm down that pain. That way you're just going to have a fast recovery. That's something you can do afterward.
Ice also helps. If the area is a little sore, just put some ice on the outside. That will help calm down some of the inflammation. If we're sore from being open for a long time because the procedure can take a few hours sometimes, then we can do some heat as well. All those things are things you can do to help with your overall comfort after you have a root canal procedure.
Should I get a root canal or pull the tooth and do a dental implant?
Oftentimes, when you are presented with the need for a root canal, sometimes there is also the option of pulling the tooth and doing an implant instead. I typically default to saving a person's tooth because that's their natural tooth. There is going to be nothing better than their natural tooth. With that said, it all comes down to a judgment call. How long do I think this tooth is going to last? If I don't think the tooth is going to last but a couple years, then I'm probably going to elect not to do the root canal, for that tooth to be pulled, and to do an implant because ultimately I want you to get the most out of your investment.
A dental implant has the chance of lasting a person's lifetime. Why do I not automatically default to an implant? It's because even with implants, things can go wrong sometimes. That's why we always want to do the most conservative treatment, which is the root canal. But if it's not going to be something that's going to last a long time, then we would default to an implant. That would be kind of situations that we would look at. Also, how much tooth structure is remaining? There are so many factors that go into it, but those are some of the ways that we look at when we are going to choose an implant over a root canal or a root canal over an implant.
Why is a dental crown recommended after a root canal?
A dental crown is recommended when really either there's not a lot of tooth structure remaining, there's a big crack in the tooth, or it's a posterior tooth, a tooth in the back, our molars. Those are going to be times that we recommend a crown because ultimately, we're going to do the root canal, and we want to preserve the structure of the tooth. That is super important. How do we preserve that tooth? It's with a crown. What that crown does is it covers the tooth and keeps either a crack or the tooth shielded and protected because the crown is going to be stronger than our natural tooth. That's how a crown protects the tooth, and that's why oftentimes a crown is needed whenever a root canal is performed and done.
How much does a root canal cost?
The cost of a root canal is going to vary by type of root canal, as well as the extension of how invasive, how extensive the infection is that is now warranting the need for this root canal. I would say it varies by severity. It could range from being a few hundred all the way to being a few thousand. I'd say the most expensive root canal is, say, $2,000. Like I said, it can vary from a few hundred to $2,000. What makes it get so expensive? Like I said, it's the severity. The longer you wait on something, the more severe it's going to be, which means the more time it's going to take, the more materials, the more treatment, and more time with you in the chair. That's why it's always best to treat things at the smallest and earliest stage. That way, you can save yourself a lot of money in the long run.
How can I learn more about root canals or scheduling an exam at Inspire Dental?
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