Root Canal – West Hills, CA
What is an Endodontist?
Endodontists are specialists who limit their practice to endodontics (root canal therapy, surgical and non surgical) - a branch of dentistry dealing with the soft inner tissue of teeth (called the pulp, which contains the nerve and blood vessels) and their surrounding structures.
The word "endodontic" comes from "endo" meaning inside and "odont" meaning tooth. Like many medical terms, it's Greek.
All dentists are trained in diagnosis and endodontic therapy, however, some teeth can be especially difficult to diagnose and treat.
In addition to dental school, endodontists undergo two or more years of postgraduate specialty training in the field of endodontics.
Endodontists perform the routine as well as highly complex root canal treatments such as retreatments, removing previously broken instruments or posts, treatment of the medically complex patients and surgical procedures.
Because endodontists limit their practice to practicing endodontics, the office design and equipment is specialized for just root canal treatments. Because of this, and the varying complexity of root canal treatments, many dentists like to refer certain root canal treatments to our office.
Although most of our patients are referred to us from the local dental community, we do accept self referred new patients or walk ins.
What is endodontic treatment?
Endodontics is a specialized field of dentistry that focuses on the research and treatment of blood vessels, nerve and tissues inside the roots of a tooth in an effort to relieve pain, swelling and infection inside the tooth and in the tissues surrounding the tooth.
When you look at one of your teeth in the mirror, what you see is the crown. The rest of the tooth, hidden beneath the gum line, is called the root.
The outer layer of the root is made up of a hard tissue substance called dentin, and the inside of the root is called the "root canal" which contains a pulp of soft tissue, blood vessels and nerves.
Bacteria can enter the “root canal” as a result of tooth decay, tooth fracture, gum disease or other problems, can severely damage the nerve. When this happens, the dentist/ endodontist removes the diseased pulp ( which contains the infected and inflamed nerve) to save the tooth and prevent further infection and inflammation, in the tooth and the surrounding jaw bone.
Endodontic treatment is a process that incorporates medicinal chemicals to clean the inner structure of a tooth and a physical cleansing technique to maintain the function and health of the tooth and bone supporting and surrounding it.
Once the nerve in a tooth has been affected, the only way to treat the tooth is to “remove the nerve” from within the root canal area of the tooth, thereby saving the tooth,
Removing the tooth completely, (i.e. extracting the tooth).
What are the signs and symptoms of needing a root canal?
Endodontic treatment is necessary when the pulp becomes inflamed or infected.
Symptoms of pulp damage include continuous spontaneous tooth pain, prolonged sensitivity to heat or cold, tooth discoloration, and swelling.
Occasionally, the tooth may have no symptoms, and the need for a root canal is discovered due to the way a tooth presents on an x ray.
Endodontic therapy is performed by removing the pulp tissue (which contains the tooth nerve), cleaning and chemically disinfecting the root canal space, and filling/sealing the space.
Why should I do a root canal/ endodontic therapy?
Once the nerve of a tooth has become irreversibly inflamed or infected, the only choiceto save the tooth at that point is root canal, (endodontic) therapy
If you do not wish to do root canal (endodontic) therapy, then the only alternative to root canal (endodontic) therapy is extraction of the tooth, i.e. taking the tooth out.
Do I feel pain during or after the root canal/ endodontic therapy?
Root canal (endodontic) therapy is usually performed to alleviate the pain of toothaches caused by pulpal (nerve tissue) inflammation or infection.
With profound local anesthetic numbing techniques, the majority of patients tell us that their root canal (endodontic) therapy was painless, or much better than they expected.
Usually for the first 3-4 days after treatment your tooth may feel sensitive, especially if there was pain or infection before the procedure. To help you through this period, the appropriate pain, anti inflammatory and antibiotic medications are prescribed for you.
You also receive the endodontists emergency phone number, to help with any concerns, should they arise post treatment.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that last more than a few days, call your endodontist.
How long does root canal therapy/ endodontic therapy take?
Typically, most root canal / endodontic treatments are performed in one appointment, ranging in time from around 30- 90 minutes, depending on the complexity of the tooth.
In some more inflamed and infected cases two appointments can be necessary.
Rarely, in severely complicated or calcified teeth, more than two appointments may be necessary.
Generally, root canal/ endodontic therapy, is about 85-90% successful, depending on the clinical studies published.
In those 10-15% of cases, a tooth may need endodontic retreatment, because symptoms present that can include pain, sensitivity or re-infection. These symptoms might occur months or even years after treatment.
If your tooth has not healed or new problems have surfaced, endodontic retreatment may be indicated to try and save the tooth.
Generally, endodontic retreatment enjoys a high probability of success.
Endodontic retreatment begins with removing restorative materials such as a crown or filling to allow access to the root canals.
The previous root canal fillings are removed. The root canals are then cleaned, shaped, and chemically disinfected with medications placed into the canal.
After the canals are cleaned, shaped and chemically disinfected, the dentist/endodontist fills and seals the root canals. The tooth is then restored with a temporary filling, which your general dentist will replace with a permanent filling or a crown, depending on the circumstances.
What is endodontic surgery ( surgical endodontics or apicoectomy)?
Endodontic surgery is usually the last attempt that can be made to save a tooth, that would otherwise need an extraction.
When certain resistant teeth fail to heal after root canal / endodontic therapy, or are difficult to treat non surgically, or continuously present symptoms, endodontic surgery is indicated.
Usually you can discuss the circumstances with the endodontist under which you may need surgery.
Endodontic surgery can be performed under local anesthetics, or sedation (light to moderate sleep dentistry).
Most patients report the procedure being comfortable, or cannot remember it, in the case where they have been sedated.
Appropriate pain, antibiotics and anti inflammatory medications are prescribed to help you get through the immediate post treatment period.
When endodontic surgery is indicated, the success rate is again somewhere between 80-90% depending on the clinical studies.
Usually, a tooth that has undergone a root canal can last the rest of your life, and never need further endodontic treatment. However, in a few cases, a tooth may fail to heal. The tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
Will I be able to drive home after endodontic surgery?
Usually if you had the procedure under local anesthesia, you can drive home.
If the procedure was performed under sedation, then you will need someone to drive you home.
These issues can be discussed in the office before endodontic surgery is performed.
When can I return to work, or my normal activities?
Most patients return to work or other routine activities the next day. Individual recovery times can be discussed at the appointment.
What are the alternatives to endodontic surgery?
Usually, the only alternative to surgery is extraction of the tooth.
Typically the extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting.
If the tooth is not replaced after extraction, we have seen the adjacent teeth shift , or the opposing teeth over erupt into the space, which can lead to “bite” and temporomandibular joint (TMJ) problems.
This can lead to joint pain and headaches in many cases.
Because tooth replacement procedures, require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most cost-effective option for maintaining your oral health.
No matter how effective modern tooth replacements are - and they can be very effective - generally nothing is as good as a natural tooth.
What is cracked tooth and what causes pain in a cracked tooth?
When the outer part of the tooth has a crack, the chewing can cause movement of the pieces, which causes the crack to open slightly, and the pulp can become irritated.
When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain.
Irritation of the dental pulp can be repeated many times by chewing.
Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes.
In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.
Types of cracks in teeth.
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and severity of the crack.
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and usually require no treatment.
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved.
If the cusp fractures and the nerve is not affected, root canal (endodontic) treatment is usually not needed. The tooth will usually be restored by your dentist with a full crown.
If the cusp fractures at a deeper level, in closer proximity to the pulp (nerve) of the tooth, you will usually need root canal (endodontic) therapy.
Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.
A cracked tooth that is not treated will progressively get worse, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth can never be saved intact.
The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.
Vertical Root Fracture
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment usually involves extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractures root.
Will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will never heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.
The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen.
Once treated, most cracked teeth continue to function and provide years of comfortable chewing.
Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.
Traumatic Dental Injuries
Injuries to the mouth can cause teeth to be pushed back into their sockets.
Your endodontist or general dentist may reposition and stabilize your tooth.
Root canal treatment is usually started within a few weeks of the injury and a medication will be placed inside the tooth. Eventually, a permanent root canal filling will be placed.
Sometimes a tooth may be pushed partially out of the socket.
Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary.
Sometimes, if the pulp becomes damaged or infected, root canal treatment will be required.
If an injury causes a tooth to be completely knocked out of your mouth immediate treatment is indicated, because the longer the tooth is out of the mouth, the lower the chances of success in saving the tooth.
If this happens to you or a child, keep the tooth moist. If possible, put it back into the socket.
If you cannot put the tooth back into the socket, then put the tooth in milk or a glass of water (add a little salt.), and get to the dentist/endondontist as soon as possible
A tooth can usually be saved if it remains moist.
Your Endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored, may influence the type of treatment you receive.
What happens if a child’s tooth is not fully developed?
An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:
This procedure encourages the root to continue development as the pulp is healed.
Pulp tissue is covered with medication to encourage root growth.
Usually the apex of the root (tip) will continue to close as the child gets older. In turn, the walls of the root canal will thicken.
If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.
Here, the unhealthy pulp is removed.
Medication into the root to help a hard tissue form near the root tip. In many cases we create this barrier using a material called MTA.
This hardened tissue provides a barrier for the root canal filling.
At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures.
Therefore it is important to have the tooth properly restored by your dentist.