Frequently Asked Questions
Why do I need a root canal?
People who are experiencing a toothache know they need a root canal, but many people may not have any symptoms at all. They are told by their dentist that they need a root canal after an exam. If you have an inflamed nerve, then you most likely have pain with hot, cold, eating, or biting. You may even have a throbbing toothache all the time. A root canal is the procedure to treat this pain.
If you have no symptoms, then a dental exam can show the signs of your body reacting to the bacteria that are living in the space where the nerve use to be. It shows up as a dark spot on a dental x-ray picture and is sometimes referred to as infection. A root canal is the procedure to remove these bacteria and allow the bone to heal.
What is a root canal?
A root canal is performed to remove an inflamed nerve or bacteria that are living in the space where the nerve used to be, before it died. This space in the root(s) of the teeth is called the root canal. The procedure is performed using small files to gradually clean and widen the canal spaces. A disinfectant solution is used to remove any debris and kill the bacteria. Once the canals are cleaned and enlarged enough to fit filling material inside them, then they are filled with a natural rubber compound called gutta percha.
Why does my root canal need to be redone (Retreated)? Why did my root canal fail?
There are many reasons that a root canal can fail to heal or become reinfected and need to be redone. Most times there is either new decay (a cavity) or a leaking filling or crown on the tooth that lets new bacteria back into the root canal space. This new bacteria contaminates the old root canal filling material.
Sometimes a root canal never completely heals. Most times this due to the very complex anatomy inside of a tooth. It looks a lot like an upside down tree with the trunk being at the biting surface of the tooth and the branches spreading into the tooth roots. These branches can be so tiny that even our tiny files cannot reach them. These tiny places are wonderful places for bacteria to hide. Any bacteria that are left after the root canal treatment will contribute to a failed root canal. Often these bacteria can be removed by redoing the root canal, but sometimes a better approach is to do an apicoectomy, a minor surgery where we cut off these tiny branches in the root tip.
Sometimes a crack in the tooth causes a root canal to fail was well. These can be small cracks where it is still possible to save the tooth or big cracks where the tooth cannot be saved.
Can I eat after my root canal?
After a root canal, a temporary filling is placed in the hole that was made in the tooth to do the root canal. This keeps any food out of the tooth when you eat. It takes about 30 minutes for this filling to set up and harden. After that you can eat foods you are comfortable chewing on. Care should be used when eating hard foods until the tooth is restored with a stronger restoration like a filling or crown.
Will it hurt during or after my root canal?
You will be numb during your root canal, so you won’t feel any pain. You will still feel vibrations and work being done to the tooth, just like when you are having a filling done. After the root canal most people actually feel better! It is the root canal procedure that relieves the pain. However, anytime we poke around your tooth it can become tender or painful. Sometimes this pain doesn’t happen until 2 or 3 days after the root canal. When this happens people worry that their tooth is getting reinfected since it didn’t hurt before, but now 3 days later it is starting too. Just like when you pull a muscle in your back, it takes a few days for it to become sore. It just takes your body a few days to “ramp up” the pain. Studies show that about 3-7% of patients that have a root canal will have a “flare up;” which is a really painful tooth after the root canal. This is a small percentage of the patients.
The best treatment for pain is to use over the counter ibuprofen as directed on the bottle first. If you are still feeling pain, take Tylenol as directed on the bottle in addition to the ibuprofen. There are 2 main ways we feel pain. Ibuprofen works on one and Tylenol works on the other. When you take both, you block both. That relieves the pain for almost every patient. If you are still having discomfort, please call the office so that we can relieve your pain.
DO NOT take these medications if you have been instructed by any doctor to avoid them.
Do I really need a crown after the root canal?
YES! If it is back tooth, a molar or premolar, studies show that about 85% of these teeth will break and need to be extracted if no crown is placed on the tooth. The bottom line is if you are not going to do a crown, then don’t waste your money on the root canal.
Front teeth are different and may only need a filling. It depends on how much tooth structure is left or how badly broken the tooth is.
How successful is root canal treatment?
Root canal treatment is one of the most successful treatments in all of medicine. A root canal performed under the right conditions and by an experienced specialist can be as high as 95% successful according current studies. Root canal retreatments are a little less successful, but apicoectomies (root end surgery) are also about 94% successful.
Should I get a root canal or an extraction and replace the tooth with an implant?
Implants are wonderful restorations for replacing missing teeth. They have changed the way we do dentistry in many ways. Like many things in life, they are not a cure all. They work best to replace missing teeth or teeth that are not able to be saved. Many teeth can be saved with root canal treatment. Natural teeth are totally different than implants in how they function. You weren’t born with implants, so it’s best to keep your natural teeth as long as possible and use implants when no good option exists to save the tooth.
What is an apicoectomy (root end surgery)?
An apcioectomy is minor surgical procedure where the tip of root is removed from a failing root canal. The last few millimeters of a tooth root has the most branching of the blood vessels that supply the dental pulp. Much like a tree, these vessels branch into smaller and smaller branches. At the root end, many of these branches are so small that even our tiny instruments cannot reach them. These tiny branches make excellent hiding places for the bacteria that are causing the root canal to fail. By removing a few millimeters of the root end, we can remove these bacteria filled branches, just like pruning a tree by cutting off certain branches and leaving most of the tree intact.
The surgery involves making a small incision in the gum tissue and pulling it back to expose the bone and root tip. A small hole is made in the bone and about 3mm of the root tip is cut off. A small filling is prepared and placed in the end of the root. The gum tissue is then replaced and a few stiches are put in to hold the gum tissue in place while it heals. After 5-7 days, the stiches are removed.
While it may sound painful, nearly all patients describe the pain after surgery as minimal and usually only take a day or two of over the counter pain medication like ibuprofen or Tylenol.
What are the aftercare instructions following my surgery?
For the first 24 hours, do not use a hot pack on your face. You can apply a cold pack (20 minutes on, 20 minutes off) if you would like to help minimize swelling. You may have some swelling, especially in the morning after waking up. This will usually go down once you are out of bed and the fluid drains from your head. Minor bruising is also possible, but rare. You will experience some oozing of the incision for the first few days, but let us know immediately if the site bleeds for longer than 20 minutes. Resting and taking it easy for the first day will minimize bleeding. Do not do strenuous work or activities for the first 24-48 hours.
Do not pull your lip up to look at the surgery site as this could pull out your stiches!
Do not brush the area where the stiches are until you return and have them out. You can use warm salt water rinses starting after 24 hours to keep the area clean.
The best treatment for pain is to use over the counter ibuprofen as directed on the bottle first. If you are still feeling pain, take Tylenol as directed on the bottle in addition to the ibuprofen. There are 2 main ways we feel pain. Ibuprofen works on one and Tylenol works on the other. When you take both, you block both. That relieves the pain for almost every patient. If you are still having discomfort, please call the office so that we can relieve your pain.
DO NOT take these medications if you have been instructed by any doctor to avoid them.