Hi, I'm Dr. Ramya Narayanan from Strong Roots Dental. I have my colleague Dr. Saloni Trivedi with me today. We are going to be answering some of the most commonly asked questions about root canals today.
What is a root canal?
A root canal is essentially a procedure where we remove your current nerve due to different reasons, such as a big cavity or sensitivity, which are things we'll get into. Essentially, we're removing your nerve and replacing it with a biocompatible material. It takes away the sensation from the tooth, but it's still your natural tooth. So that's one of the last resorts to save your tooth in your mouth.
What are possible signs and symptoms I need a root canal?
One of the symptoms patients can have is pain. If the patient comes in complaining of pain, we take X-rays, elicit certain responses, and do some tests in the office to ensure that it is nerve pain, which means the nerve in the tooth is dying or degenerating. That would be one of the reasons for a root canal. But sometimes the patient may not have any pain, but the decay on the X-ray might be very, very close to the nerve. Good for the patient that they don't have pain, but sometimes it can act against them because they may not come to a dentist if they are not in pain. So, please go to your dentist every six months to make sure this is caught in a timely fashion.
Should I see a dentist or an endodontist for a root canal?
That's a good question. Both dentists and endodontists are trained in doing root canals. An endodontist is a dentist who goes to more schooling specifically for root canals. When you first see your dentist for that initial consult, they will decide whether they think it's a simple root canal that they will take care of or if the anatomy of your tooth or root is a little more complex, they will refer you over to the endodontist, who has more experience managing those complicated cases.
Is it okay to delay root canal treatment?
Absolutely not. If your dentist recommends that you need a root canal, it's probably for one of the reasons I mentioned before: the decay is very close to the nerve, so it's very time-sensitive. If you're in pain, I assume you would act right away. But sometimes you may need a root canal, and you are not in pain. Please do yourself a favor and do not delay this because, as I said, a root canal is one of the last resorts to save the tooth in your mouth.
How painful is the root canal?
The only part of the root canal that you may feel is the portion where you're getting numb, that tiny pinch of the needle. Once that kicks in, you shouldn't feel the rest. Once the root canal procedure is done, the nerve is gone, so the tooth can't really have much sensitivity anymore. The only thing that could be sore for a day or two is the gums. I know it's one of the most commonly used statements that a root canal is the most painful procedure in dentistry. I'd say it's right and wrong. It can be painful if the tooth is infected. Generally, if the tooth is infected and the patient comes in with pain, the dentist would not jump into doing the root canal the same day. We would put you on antibiotics to get that pain under control, and once that pain is under control, and when you come in and get numb, you're not going to feel anything during the procedure.
What is the process for a root canal?
When you come in and if your dentist decides that a root canal is the best procedure for you, you would come back to see the dentist and get numbed. The process involves removing the existing dying or degenerated nerve and filling it with a biocompatible material. Sometimes, or rather most of the time, the root canal is done in one visit, but if the tooth is very infected or if you are getting a re-root canal, which means you had a root canal in the past and there is some kind of secondary infection, then that can become a two-visit procedure.
What happens if you leave a root canal without a crown?
That's a great question. A root canal, as we were saying, does take out the nerve and the nerve supply from the tooth. If we're doing it, it's necessary, but that is a consequence of it, which means that it leaves the tooth a little more brittle and weak. However, it's a very easy solution if you put a crown over it, which covers the tooth 360 degrees. Now all the biting forces are going on the crown and not on the tooth, which protects it from breaking and fracturing. So, to answer the question, if you leave it without a crown, you're prone to more breakage and fracture.
What are the alternative options to a root canal?
As I have said before, a root canal is one of the last resorts to save a tooth in the patient's mouth. If, for whatever reason, the patient decides that they do not want to save that tooth, then the next option or the alternative option would be an extraction, followed by an implant. Ideally, once you take the tooth out, you want to restore that missing tooth for many reasons. There are many reasons to do so.
What is better, a root canal or an implant?
That question depends on what we're looking at—how much tooth is left, how much of it is decayed. It's something that we can't just answer overall; it has to be evaluated based on what the tooth looks like. But we'll pick what is best for your tooth in that situation. Simplistically, trying to have your own tooth in your mouth would be one of the best scenarios. However, it depends on how long it's going to last in your mouth. Whatever we decide to do for the patient has to be in the best interest of the patient, which also means it has to last in the patient's mouth for a minimum of 10 years. If we feel it's not going to be that way, then the next best alternative will be suggested.
What causes a gum boil after a root canal? How do you treat it?
A gum boil typically means an abscess, which indicates some kind of secondary infection after a root canal. There could be several reasons for it. It could be like one of the reasons you mentioned before: after a root canal, there is no crown, leading to a fracture that can cause leakage and seepage, causing secondary infection. Sometimes, due to the complexity of the anatomy of the tooth, there might be some small, minor accessory canals that could have been missed, leading again to leakage and seepage and causing secondary infection. In a nutshell, any kind of secondary infection can cause a gum boil. Most of the time, patients do not feel the occurrence of a secondary infection because the nerve is already taken out, so it can act against you. That's exactly why we say it's important to go back to your dentist every six months for a routine checkup so any of these issues can be caught in a timely fashion.
What are the reasons for a root canal infection?
Root canals are good and they're done, but they can get reinfected like anything else in the mouth. All the more reason to come every six months and get it checked. Some of the reasons, like we talked about, can be some of those missed canals or complicated anatomy. Leaving a tooth without a crown can cause things to get inside and reinfect it. But it doesn't mean we lose hope. If you come back to the dentist, we can always evaluate what can be done, whether it's treating that root canal again or finding some other alternative.
How common is tooth fracture after a root canal?
It's pretty common, which is why we recommend a crown over it. It also depends on the position of the tooth in the patient's mouth. If it's a back tooth where it's taking up much of the biting or chewing forces, it's essential to get a crown over it to prevent fracture or breakage. However, if the patient is young and, for some reason, needs a root canal on a front tooth and the bite is such that the tooth is not hitting the opposing tooth, we may not recommend a crown right away for fear of breakage. But we have the patient come back regularly to ensure the tooth is fine. If the tooth starts changing color, at that point, we recommend a crown or veneer.
Are root canals safe?
Yes, root canals are safe. The material we use is a researched and tested biocompatible material, so it's definitely safe. If possible, it's always advised to keep your natural tooth and not replace it with anything else.
Does bone grow back after a root canal?
It does. There is a time period within which it can happen. Generally, after a root canal, it takes about four to six months for the bone to grow back. When they come back for their six-month recall and we take an X-ray, we often see that the bone has regenerated around the root canal tooth. However, sometimes it's not 100% regenerated, which could be because there is some amount of infection left behind, or it could be scar tissue. In either case, your general dentist or endodontist is the best person to take a look and decide what needs to be done next.
Are root canals covered by dental insurance?
That's a good question. It definitely depends on your insurance. Most insurances cover at least a portion of the root canal. If you're looking for that exact number, my best advice would be to come into the office and work that out with the financial coordinator.
I hope we've been able to answer most of your questions regarding root canals. In case of any further questions, please don't hesitate to call us at Strong Roots Dental.