Endodontic therapy, also known as a root canal, is a relatively painless treatment which aims at clearing infection as well as protecting the tooth from subsequent infections.
When a tooth is cracked or has a deep cavity, bacteria can enter the pulp tissue and germs can cause infection. If left untreated, an abscess may form. If the infected tissue is not removed, pain and swelling can result.
This not only puts your jawbones at risk for injury, but it is also detrimental to your overall health. Without the proper treatment, your tooth may have to be removed.
Teeth that require endodontic therapy are not always painful. However, signs you may need a root canal include:
Root canal treatment involves one to three visits during which your endodontist removes the affected tissue. After the tissue is removed, the interior of the tooth will be cleaned and sealed.
Finally, the tooth is filled with a dental composite. If your tooth had extensive decay, your doctor may suggest placing a crown to strengthen and protect the tooth from breakage. As long as you continue to care for your teeth and gums with regular brushing, flossing, and checkups, your restored tooth can last a lifetime.
Most teeth can be saved by endodontic therapy. However, tooth extraction may be necessary if:
Endodontic therapy is intended to help save your tooth from extraction. Missing teeth can make you self-conscious, affect your ability to bite and chew, cause other healthy teeth to shift, and have a negative impact on your overall health. By choosing to receive endodontic therapy, you are choosing to keep your smile healthy and beautiful for years to come.
Endodontic surgery can help save your tooth in a variety of situations. The benefit of choosing endodontic surgery could be a healthy, functioning, natural tooth for the rest of your life.
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 not heal or may become infected. A 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.
Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. Your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
Surgery may be used as a diagnostic tool if you have persistent symptoms but no identifiable problems appear on your X-ray. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
Surgery may also be performed to treat damaged root surfaces or surrounding bone.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called an apicoectomy, or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.
In this procedure, the endodontist opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end of the root is also removed. A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gums to help the tissue heal properly. Over a period of months, the bone heals around the end of the root.
In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
Other surgeries endodontists might perform when needed include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires in detail and answer any questions you may have about your recommended treatment plan.
Usually, the only alternative to endodontic surgery is extraction of the tooth. 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. No matter how effective modern artificial tooth replacements are, nothing is as good as your natural tooth.
Whenever possible, it is always best to save your natural tooth. Retreated teeth can function well for years, and even for a lifetime.
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial endodontic therapy (root canal treatment) for a variety of reasons. If the infection did not heal properly, placement of the crown or other restoration was delayed, or new decay has formed, you may need endodontic retreatment in order to save your tooth.
First, your endodontist will discuss your treatment options with you. If you and your endodontist choose retreatment, your endodontist will reopen your tooth to gain access to the root canal filling material. Removal of restoration and filling material allows access to blocked canals.
After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.
Your endodontist will clean the canals, seal them, and place a filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery.
After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.
Because we live longer and more stressful lives today, we are exposing our teeth to many more years of potentially damaging habits such as clenching, grinding, and chewing on hard objects.
These habits make our teeth more susceptible to cracks. Your endodontist may treat a cracked tooth to prevent further damage to the tooth structure and tissue.
Cracked teeth do not always show any visible signs of damage, but may present a variety of symptoms, including erratic pain when you chew with them, and pain or sensitivity to heat and cold. In many cases, the pain may come and go, making it difficult for your doctor to locate the source.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp becomes 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 where it can no longer heal itself. The tooth will not only hurt during chewing, it may also become sensitive to extreme temperatures. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks will lead to infection of the pulp tissue, even spreading to the bone and gum tissue that surround the tooth.
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent 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 are of no concern beyond appearance.
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 have to be removed by the endodontist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.
Some cracks extend from the chewing surface of the tooth vertically toward the root. A cracked tooth may not be completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp.
Your dentist will restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, which requires extraction.
A split tooth is often the result of 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 cannot be saved intact. The position and extent of the crack, however, will determine whether a part 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 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 until the surrounding bone and gum become infected. Treatment may entail extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.
While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.
Early diagnosis is important. Even with high magnification and special lighting, it can be challenging to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, and eventually result in the loss of the tooth. Early diagnosis and treatment are essential to saving these teeth.