FAQ

Do you have any of the following symptoms?

• Sensitivity to hot or cold that lingers
• Pain when chewing or biting
• Dull ache
• Spontaneous pain
• Pain that comes and goes
• Throbbing or pulsing pain
• Pain that wakes you up at night
• A bubble or pimple on your gum that when pressed may release pus or blood (most likely, not painful)
• Pain that persists four to six weeks following a filling or replacement of a filling
• Chronic pain and/or pressure that may extend to the ear, eye or neck
• A tooth that feels loose
• One tooth is distinctly and consistently more sensitive than the other teeth
• Your dentist has diagnosed the need for root canal therapy, either by clinical exam or x-ray

If you answered yes to any of the above, you might very well need a root canal. Please call and schedule for an evaluation.
Be aware not all teeth that ARE in need of root canal therapy will cause pain. It is possible to be pain-free and still need a root canal.

It is a branch of dentistry that deals with the cause, prevention, diagnosis and treatment of diseases of the human dental pulp and the surrounding tissues.

It is what we commonly know as the “nerve” of the tooth. It is a soft connective tissue that is highly vascularized (tiny blood and lymph vessels), and innervated (nerve fibers). It is located inside the dentin of the tooth in the pulp chamber. Its main function is formative, nutritive and sensory.

A dental specialist in the treatment of diseases and injuries to the dental pulp, root and surrounding tissues of the teeth. Endodontists receive a “certificate in Endodontics” after additional 2-3 years of training in an accredited program after dental school.

It is a generic name to any dentist who has performed a few years of advanced studies in a particular field of dentistry and has a certificate from an accredited dental school; hence, granting the name of specialist in Endodontics, or in Periodontics, or in Orthodontics.

ROOT CANAL is a “lay persons” term for Endodontic therapy or root canal therapy. Root canal therapy is necessary when the nerve inside the tooth becomes irreversibly damaged or infected. This is usually due to the entry of bacteria into the center most part of the tooth called the dental pulp (“nerve”). Root canal therapy involves the removal of the entire nerve system, as well as cleaning, shaping and filling 3-dimensionally the canal system with gutta-percha and a dental sealer.

Gutta-percha is the purified coagulated exudate from a tree, commonly called the “mazer wood” tree, of the Malaysian archipelagos. The substance is similar to that of the rubber tree, which is then processed to obtain the dental compound. This is the only ADA approved material to be used as a filling in root canals.

Your doctor will review your past dental and medical history. A dental x-ray will be taken even if you have one from your referring dentist. Different x-ray angles are necessary to reveal possible problems such as decay or an abscess. Also, a series of test, such as hot, cold, biting and percussion (tapping) can be performed on several teeth. Through these tests the dentist will attempt to reproduce your symptoms that will enable him/her to make a proper diagnosis and decide if you do, or do not, need a root canal.

The reason is bacterial contamination. Bacteria are a normal host present in the mouth and saliva, but when it gets inside the tooth and enters the pulp (through decay, or a fracture in the tooth, broken down old filling, or a gap between your tooth and an existing crown), then it becomes pathologic. The time frame for this to occur can vary significantly. Sometimes it is very fast and usually painful, but also, it could be a very slow process in which the patient is unaware and no pain is manifested until it is significantly advanced.

Usually not. With modern technology and local anesthetics, the procedure is usually much faster and more painless than it has ever been. A similar anesthetic, as the one used in the general dentist office, will be used for a root canal. The main difference is the quantity. A deeper level of anesthesia is necessary for this procedure to be painless. In many occasions, it can be a completely pain-free procedure. Painkillers are usually recommended for a few days after treatment, in order to control normal post-treatment discomfort.

Root canals can be done in one, two or multiple appointments, depending on the tooth, how many roots there are, the current conditions of the tooth, the accessibility to area, the canals, and time available. Each visit or appointment can take from under 1 hour, to over 2 hours.

An abscess is a localized collection of pus (infection) within a tissue or a confined space.

No. Some abscessed teeth can be pain free, those are most commonly found and diagnosed accidentally by a dentist, usually through a dental x-ray and exam. Whenever possible, the recommended treatment is a root canal.

The infection will continue its progress, extending from the confines of the dental pulp and involving the surrounding tissues, such as the root, the bone, the gums etc. A progressing infection could easily involve facial spaces and the patient would then start observing swelling of the face. Such condition could become life threatening if left unattended.

Cellulitis is a painful inflammatory process that spreads through the connective tissue and is characterized by swelling and edema. It is usually associated with a bacterial infection.

No, with all the new materials and modern technology used during the procedure, your tooth should not discolor after the treatment. If you have a tooth that has had a root canal and it has discolored, it is best to have your dentist take a look. It may be that germs (bacteria) have penetrated underneath the old filling, and it is time for a new one.

After the tooth is properly numbed, a rubber dam will be placed, and then the dentist will open a small cavity on the chewing surface (back tooth) or the back of the tooth (front tooth), to get into the nerve chamber. The nerve will be manually removed using small dental instruments called files. The canal(s) will then be completely cleansed using some hand an/or mechanical instruments, alternating with different irrigants. Once the canals are adequately shaped, then they will be filled with gutta-percha and an endodontic sealer. The small cavity on the tooth will then be closed with a temporary filling material.

Avoid chewing on the tooth. It will most likely feel very tender and sensitive to pressure or touch. There should not be any discomfort upon drinking hot or cold fluids. Follow any instructions given by your dentist in reference to drugs such as painkillers and anti-inflammatories. Any of these, or the combination of them, usually provide excellent results to alleviate the normal post-treatment discomfort. If your pain does not respond to the initial medicine, then you should call your dentist. Sometimes, there will be a need for stronger painkillers and/or antibiotics. Finally, once your tooth is pain free, you must see your general dentist who will complete the necessary dental reconstruction of the crown. This last item is very important and should happen as soon as possible after completion of the root canal.

Not always, today we are very conservative in determining the need for an antibiotic. It is usually determined by the dentist on an individual basis, per case, per tooth. Usually, if there are systemic signs and symptoms such as swelling, fever, generalized sense of malaise (ill feeling), and/or lymph node tenderness, then an antibiotic will be prescribed. The common toothache even when it is associated with a minor localized infection or abscess will not automatically require an antibiotic. Since a high number of cases will respond favorably to the dental treatment, antibiotics are not prescribed on a preventive basis.

In most cases the quantity and quality of pain will subside dramatically within the first 24-48 hours. Any sensitivity to cold, hot or even breathing air “in” will be gone after the first visit. Nevertheless, you will experience mild to moderate pain that will last for several days after treatment. This pain is usually relieved by taking over the counter medications such as aspirin, Advil, Motrin, or Aleve. Tylenol has been proven not to be as effective as aspirin, etc., because it does not have the anti-inflammatory component as these other medications. The most common complaint is tenderness to touch, bite, tapping or chewing on the tooth. It is recommended to refrain from any of the above until your tooth is permanently restored. You should realistically give yourself 2-4 weeks to fully recover.

It is not recommended to start chewing on the tooth immediately after the root canal treatment. Most times it will be very tender, but even if it is not painful to chew, you should avoid chewing on it until the crown of the tooth is properly restored (repaired) by your regular dentist. The sooner you see your regular dentist, the sooner to you will be able to restart normal function on the tooth.

Unless otherwise directed, you should see your regular dentist as soon as your treated tooth feels comfortable (about 2-4 weeks). It is very important to see your regular dentist at that time to have a permanent restoration (typically a crown) placed in order to protect the remaining tooth structure. Until the permanent restoration is in place, do not chew on the treated tooth.

If the remaining tooth structure is not properly and permanently covered and protected, your tooth could fracture and not be salvageable at all. The bacteria in saliva, as well as food debris, can go between the temporary filling and the tooth surface and contaminate the root canal treatment. This may cause treatment failure. If a re-infection occurs, often, another root canal treatment will need to be done (endodontic retreatment). If the damage is very extensive, extraction should be considered.

The single most important benefit of root canal therapy is that you keep your tooth. Extraction may lead to other dental problems. For instance, drifting of teeth, bite problems, TMJ pain, and the need to treat adjacent teeth that do not otherwise need dental treatment in order to restore the missing tooth.

Root canal treatment has a high degree of success if done properly by a trained skilled professional. The success of root canal therapy is equally dependent upon the technical skill of the doctor, as well as the follow through of the patient, to have the tooth immediately restored.

Sensitivity to hot and/or cold, which persists, usually indicates that the nerve of the tooth is irreversibly inflamed. The indicated treatment is Root Canal Therapy. Immediate attention by your dentist or Endodontist is necessary to prevent severe pain and abscess.

Resorption is a physiologic or pathologic condition associated with loss of bone, cementum and/or dentin. There are different types of resorption such as external, internal, inflammatory, replacement and surface. Its etiology is unknown, even though it commonly is associated with trauma.
EXTERNAL: a pathologic process that initiates from the periodontium affecting the external surface of the tooth. Can be further classified by location: cervical, lateral or apical. Or type: surface, inflammatory or replacement.
INTERNAL: a pathologic condition that initiates within the pulp causing loss of dentin and sometimes, cementum. It may or may not perforate the external root surface.
INFLAMMATORY: a pathologic loss of bone, cementum and dentin in the root.
REPLACEMENT: Also known as ankylosis, it is a pathologic loss of cementum, dentin and periodontal ligament with simultaneous ingrowth and fusion of bone to the tooth surface. A loss of the physiologic mobility is common.
SURFACE: a physiologic condition causing small surface defects in the cementum and dentin that are usually self-repaired by deposition of new cementum in the defect.

This is an endodontic micro-surgical procedure for a tooth that has had a root canal. The purpose is to remove persistent infection at the end of a root and seal the root end to prevent reentry of bacteria. This procedure also provides the opportunity to detect possible root fractures.

The purpose of a rubber dam is to protect the patient from swallowing the small instruments used during root canal treatment and to keep the tooth clean and dry during the procedure. It is for medical/legal reasons that a rubber dam is used for patient safety.

Retreatment is a term used to describe a procedure when a root canal has to be redone. The reason for retreatment is because germs or bacteria in the mouth have reentered the tooth, usually due to decay. A patient may experience pain to biting or swelling. Sometimes, a patient may have no symptoms and your dentist sees something on the x-ray that shows a root canal has not healed and advises a patient to see a root canal specialist for an evaluation.

This procedure is used to lighten a darkly discolored tooth. There are two very different types of bleaching, internal and external:
INTERNAL: Non-vital (Internal) bleaching is performed in teeth that have had root canal therapy. A chemical oxidizing agent is placed within the coronal portion of a tooth to remove tooth discoloration. It may be performed at the dentist’s office in one or more appointments, depending upon the discoloration of the tooth. When bleach crystals are place inside the tooth and after then removed after a period of time, the procedure is known as “chair side bleach.” Another method is when bleach crystals are placed inside the tooth and are left for several days inside the tooth. This is called “walking bleach.” An Endodontist commonly performs these procedures.
EXTERNAL: Vital (External) bleaching is a similar procedure performed by a general dentist on the outside of a tooth or teeth with vital pulps. Teeth that have not had root canal therapy. There are different methods for this procedure, such as lasers, or chemical agents (30% hydrogen peroxide and urea peroxide). The procedure often involves taking an impression of your teeth and the fabrication of a tray that will hold the bleaching agent. The patient wears this tray several hours each day or at night while sleeping. Other methods do not involve trays, but rather bleaching strips.

The numbness will last for several hours after your treatment. It is best to avoid chewing until the local anesthesia has completely disappeared to prevent accidentally biting your lip, cheek, or tongue. It is okay to drink or to use a straw to have liquids after treatment.

Yes. Most patients return to work after root canal treatment. They may keep a light schedule and plan to get rest during the days that follow treatment.

A tooth that has had a root canal is not “dead”. It is still considered a “live” or vital part of your body. There are nerve endings that are present in the jawbone underneath the tooth, as well as nerves that attach from the jawbone to the tooth. This is why there is still feeling in a tooth that has had root canal therapy.