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Woman at the dentist's chair during a root canal

Root Canals 101: What Every Patient Should Know

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It is New Year’s Eve. You are celebrating with family or friends. All dental offices are closed and out of nowhere, the worst throbbing pain you have ever felt starts inside your mouth. A situation likened to Finagle’s law: “Anything that can go wrong, will—at the worst possible time”.

Sound familiar? You may need a root canal.

Has your dentist ever told you that you need a root canal? You are not alone. Root canals are used to save teeth. Millions of teeth are saved each year with root canals and will continue to be a very popular method of saving damaged teeth. This article will explain what root canals are and how they can save you from pain.

What is a root canal?

Root canals are one type of endodontic treatment. Let’s break it down:

“Endo”—Greek for “inside”

“Odont”—“Tooth”

The tooth is made up of three distinct layers: the outermost layer is the enamel, the part you can see. It is white and hard, almost porcelain-like. The second layer is the yellow dentin. It is soft and porous. There are small tubules going from the outmost to the innermost layer. Facing the innermost layer are the nerves and blood vessels, also known as the “pulp”. The pulp starts from the crown you can see inside your mouth all the way to the tip of the roots. The pulp of each tooth connects to a much larger set of nerves and blood vessels that help the tooth during development.

The pulp is very important during tooth development because it carries nutrients to the tooth. However, once the adult tooth has finished developing, the tooth does not need the pulp anymore to survive.

The tubules running throughout the second layer runs straight to the nerves. The tubes can act as a highway for many things including cold, hot, spicy, sweet and sour foods, cold air, and bacteria. When the tubules of dentin are exposed, these items can travel to the nerve causing a sharp pain. This is the characteristic “nerve pain” one might associate with teeth.

Tubules are exposed when you have lost the enamel, broken the tooth, worn down the tooth or have a cavity.

Stages of tooth pain:

1. Reversible Pulpitis: When the nerve is exposed to irritants such as bacteria or a fracture, the tooth can enter a stage of reversible pulpitis. This is the reversible inflammation of the nerve. At this stage, it is important to see your dentist to prevent it from progressing.
Signs: pain to hot, cold or when something stimulates the tooth but not spontaneous pain. A root canal may not be needed at this time

2. Irreversible pulpitisearly stages: The nerve is “dying”.
Signs: Excruciating pain, pain to biting, hot, cold, pressure, may be swelling. May radiate to your jaw and different areas of your mouth. Note: at this stage, the pain will be generalised, and you may not know which tooth it is coming from. A root canal will be needed at this time.

3. Irreversiblepulpitis late stages:
Signs: Excruciating pain and the same symptoms as Stage 2. The pain can now be pinpointed to one tooth.

4. Necrosis: This stage may happen over years and may be associated with NO symptoms. There may be pain to pressure on the tooth or sometimes a swelling. The nerve has died and is rotting.

Do I need a root canal if it does not hurt?

A necrotic or dead tooth can lie dormant for years without any pain. This is because the nerve has degenerated. So why would you still need a root canal? In place of the nerve, bacteria and pus will lie inside your tooth leading to a chronic low-grade infection. This can spread to the supporting tooth structures and cause bone loss. The tooth can flare up at any time. It is not healthy to leave bacteria roaming around inside your mouth. Left untreated and you could have a massive abscess.

Why would you need a root canal?

When the pulp inside the tooth becomes infected and inflamed, a root canal may be needed. Inflammation and infection can be caused by decay, repeated procedures on a tooth and cracked teeth. If left untreated, severe pain or a throbbing abscess can result.

Do I need a root canal? What are the signs?

To summarize: prolonged pain to hot, cold, sometimes even breathing in cold air. Tender to touch, swollen lymph nodes, a bubble on the gum or a bad taste in your mouth. Sometimes, you may have no symptoms. Everyone has a different pain threshold.

Can all my teeth be saved with root canals?

A dentist can save most teeth with root canals but there are some conditions in which it cannot be saved as when the tooth has a poor prognosis. These include but are not limited to:

  • Root canals cannot be reached
  • Root is fractured
  • Tooth is severely broken down
  • Tooth is severely mobile or not enough bone

When traditional root canal therapy cannot be done, an endodontic surgery can be done to save the tooth.

What does a root canal feel like?

The tooth is likely inflamed so the dentist will be very careful to give you additional freezing before starting the procedure. After that, you will feel very little. The dentist will remove the inflamed and infected pulp, and carefully clean the inside of the tooth, filling and sealing the space with a sterile material.

Can I go to work after?

Root canal procedures are completed to relieve toothaches. Modern techniques and solutions of anaesthetic are used, and most patients feel no pain during the procedure.

During the next few days, your tooth may feel like how a bruise would feel and especially if there was pain or infection before the root canal. A small amount of infection may flare up because the bacteria were disturbed. This can quickly be remedied by over the counter anti-inflammatories or prescription medications as needed. Follow your dentist’s instructions.

Afterwards, your tooth may feel slightly different to your other teeth as it heals.

Dr. Rosie Leigh
Dr. Rosie Leigh
Originally from Manchester, United Kingdom, Dr. Leigh moved to Toronto in 2004 with her family. She completed her Honours Bachelor of Science Degree in Neuroscience & Psychology at the University of Toronto during which time she also published research in neurolinguistics and heart & stroke. She was accepted to the University of Toronto dental program, from which she received her Doctor of Dental Surgery Degree. During her time in dental school she also conducted research in the field of craniofacial development and had the opportunity to present at the Hinman symposium in Memphis Tennessee.

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