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Endodontic Dentistry

How Do You Fix Infections INSIDE a Tooth?

Obviously this website isn’t about SAT vocab prep, but we’re still gonna answer that question with a word puzzle… If “Endo” means “inside” and “Dontic” is a fancy way of saying tooth, then Endodontic Dentistry must treat the inside of a tooth, right?  

Root canals are the most common type of endodontic treatment. A root canal cleans infection out of the inside pulp chamber and root canals.

Are Tooth Infections Really Such A Big Deal?

These infections are a big deal if you care about toothaches and bone health. Once an infection reaches the nerve deep inside tooth’s pulp chamber, it’s only a matter of time until the infection causes a blazing toothache and pushes its way down the roots and into the surrounding bone. These are the infections that swell the face and keep you up at night with throbbing pain.

If the infection is allowed to progress into the bone, it can spread bacteria throughout the body and endanger your heart and brain. What starts as a tiny tooth infection can become life-threatening if not treated. It may sound crazy, but abscessed teeth were once a leading cause of death and they still cause brain infections, sepsis and death today when not treated promptly. Endodontic infections are definitely serious business.

Root Canals: Relieving Toothaches One Root at a Time!

A root canal stops a toothache by removing dead, dying and decayed tissue from the tooth’s center and roots and cleaning out any infected and inflamed pulp material. No more infection. No more nerve. No more pain. The roots’ canals are then filled with a rubber-like material (called gutta percha) and the tooth is restored appropriately.

But Don’t Root Canals Compromise Teeth?

Great question. Can we answer with a question? Compromised compared to what?

Without the root canal, the tooth is a goner. So are you comparing the strength of the root canal tooth to that same tooth if left alone with its infection, OR are you comparing it to a healthy tooth that never had an infection?

When a tooth is badly infected, keeping it requires a root canal. Compared to an infected tooth or no tooth at all, a root canal tooth is strong and functional and can stay healthy for years. Compared to a healthy natural tooth, yes, root canal teeth fracture more easily.

Just like other natural teeth, root canal teeth need to be kept clean, and the filling or crown that seals the root canal needs to be carefully maintained to prevent future infections. Remember, the tooth can still decay and get re-infected. The fact that it has been root canaled once doesn’t mean that it cannot get infected again if bacteria gain access through a chip, wear spot, or poor hygiene.

Benefits of Root Canals:

  • You keep your natural tooth.
  • You preserve your gum tissue and bone around your tooth.
  • From a cost perspective, a root canal is generally less expensive than a new implant tooth.

Are There Any Alternatives to Root Canals? Yes.

Root canals are not the only way to treat infected teeth.

  1. Extractions: The least expensive way to fix an infected tooth is to extract it. Once the infected tooth is gone, the body can clear up any remaining infection with the help of antibiotics. This gets rid of the infection. However, missing teeth create cosmetic and functional problems of their own. Learn more about extractions here.
  2. Bridges: A bridge is actually an extraction followed by a bridge. Treating an infected tooth with an extraction and bridge eliminates the infection, solves any cosmetic issues and stops teeth from shifting. However, a bridge cannot stop bone loss at the missing tooth spot. Bridges can also be more expensive than a root canal and require drilling down the neighboring teeth. Whether or not a bridge is the best solution for you depends on your exact situation. Learn more about bridges here.
  3. Dental Implants: Like a bridge, an implant is placed after the infected tooth is pulled. Implants are typically a little more expensive than a root canal and crown. However, an implant can be more ideal than a root canal because it it is stronger and potentially much longer lasting. A dental implant treats the infection, solves cosmetic issues, stops shifting AND stops bone loss. Implants also have the advantage of never being able to get a cavity or decay. Teeth with root canals are still natural teeth and can still get cavities that lead to re-infection and tooth failure. Learn more about dental implants here.

It’s Just an Infection, So Why Don’t Antibiotics Work?

Toothaches are like the Terminator – “They’ll be BACK!” An antibiotic alone can make a toothache stop hurting, but it will not cure a toothache permanently. Why? A toothache infection has two parts: the infection inside the tooth and the infection in the surrounding bone and tissue.

The antibiotic gets to the infection riding in the blood. This means that the antibiotic can reach the bone and tissue around the tooth, but that it can’t really get inside the dead nerve. The pain will stop, but because the antibiotic can’t really penetrate the tooth with all that infection inside, the infection and the pain are going to come back.

Once a tooth has been infected inside, the infection must be cleaned out, either with a root canal or an extraction.

When No More Pain is a Bad Sign: 4 Stages of Infection

Most people assume that no more pain is ALWAYS a good thing – they assume that no more pain means that the infection is gone. Right? No. Sometimes this is wrong and that’s when it gets dangerous. When a terrible toothache magically “goes away on its own” without treatment, the pain has stopped because the nerve has died. In spite of the fact that the pain is gone, the infection is continuing to grow, spread and damage surrounding tissues. You can’t feel it anymore because the nerve, the body’s emergency warning system, is dead. To understand how this happens, you need to know about the four basic stages of tooth infection.

Stage 1: Bacteria take up residence on a tooth and produce acid that starts the decay process in the tooth’s enamel. The outside of the tooth is infected with dental caries.

Stage 2: Left untreated, the cavity decays through the tooth enamel and dentin to reach the nerve in the central pulp chamber. The tooth now has a large cavity and is sensitive but it’s not a full-on toothache.

Stage 3: This is the toothache stage. The infection is in full swing creating puss under intense pressure inside the tooth and on the nerve. The infection begins to seep out of the ends of the tooth roots creating an abscess and swelling in the jaw bone. Stage 3 infections hurt intensely with throbbing, untouchable pain. These are the toothaches that people dread.

Stage 4: The nerve dies from the pressure and infection and the bacteria and inflammation spread to the surrounding tissues. The pain stops because the mechanism responsible for transmitting pain is destroyed. Without a live nerve in the area, the body only stops feeling pain until the infection spreads to another nerve and the toothache comes back with a vengeance.

Key Factors for Successful Root Canals:

Talk about technique sensitive! In a root canal, the operating dentist is working in tooth roots that are just fractions of a millimeter wide at the tip. Infected and dead tissue must be completely cleaned in order for the root canal to be successful.

Four tips to help you protect yourself and get the best possible result:

  1. Choose a dentist with a microscope: All endodontic specialists have microscopes that they can use to magnify the inside of the tooth and get a detailed view of all the cracks and crannies. You don’t need to see a specialist to get a great root canal, but you shouldn’t compromise on technology. Ask if your dentist has a microscope.
  2. Choose a dentist with root canal experience or a mentor: The only way a dentist can build experience is by working on patients. Building experience is one thing. Risking patients’ health is another. When I was gaining root canal experience after dental school, I partnered with a more senior dentist who would coach me through root canals, helping me prevent mistakes and successfully navigate the challenging parts of the procedure. I was gaining experience while my patients benefited from my mentor’s expertise. Never feel embarrassed to ask about a dentist’s experience.
  3. Choose a dentist who is meticulous: Root canals are detailed work and you want a detailed dentist doing them. Root canals are not the job for anyone who “paints with a broad brush.” How do you find out if your dentist is detailed? Ask the staff when the dentist steps out. Ask them if the dentist is a perfectionist. Ask them if he pays attention to detail. You’ll be glad you did.
  4. Choose a dentist who knows his or her limits: I have lots of experience doing routine root canals. With the help of my microscope, I can even handle complex cases and save patients the extra expense and hassle of a specialist. However, I will not touch cases with oddly curved roots or suspected root fractures. I won’t retreat a tooth myself if I can’t figure out why it failed. I won’t perform endodontic surgery. Those things are outside my experience and are best left to someone who only does endodontic treatment all day long every day. Every dentist has limitations based on their equipment and their experience. A dentist who knows their limits is a dentist who puts patients first.

Broken Down Tooth? Root Canal + Post & Core to the Rescue!

Sometimes cavities decay so much that there isn’t enough healthy tooth left to support a crown. In these cases, often the only way to save the natural tooth is to perform a root canal, removing the nerve as well as all the decayed tooth so that the tooth can be fitted with a post & core that extends down the tooth roots and provides an anchor for a crown. Without proper support, crowns leak, loosen and fail leaving extraction as the only option. To place the crown on a severely decayed tooth without first performing a root canal and placing a post & core would be to invest money in a guaranteed failure.

What! How Can I Need Another Root Canal on the Same Tooth?

Sometimes a root canal tooth gets re-infected and needs another root canal treatment or “retreatment” to save it. An endodontic retreatment (or second root canal) goes over the inside of the tooth with the high powered microscope to insure that the tooth is crack-free, completely clean and properly re-filled.

Why would you need a second root canal? Well, like we mentioned above, root canal teeth are still natural teeth and all natural teeth can get infected.

  1. A tooth can get re-infected from the outside if it isn’t kept clean.
  2. A tooth may also get re-infected if trauma or wear causes cracks that allow bacteria to get inside the tooth.
  3. Root canals can fail if the infection or any live material was not completely removed during the first root canal due to hidden canals, tooth defects, calcified tooth roots or oddly curved tooth roots.
  4. Also, root canals done in foreign countries can be at a higher risk for failure. Dentists in other countries don’t always have access to in-office radiographs (x-rays) during the root canal. X-rays during root canal treatment are essential to guide the root canal treatment step-by-step and verify success. Many dentists in other countries also don’t have the necessary equipment to clean all the way to the tip of root or to properly pack gutta percha, the sealant material. These root canals inevitably fail at some point and require retreatment.

Endodontic Surgery: Healing Stubborn Bone Infections

Sometimes the bone around a tooth root remains stubbornly infected even after a root canal treatment. These “periapical” infections (“peri” – around, and “apical” – end of tooth, so periapical means “around the tip”) are normally taken care of by the immune system after a root canal. When they persist, endodontic surgery is sometimes needed. Endodontic surgery is micro-surgery that goes into the bone and removes the infected bone as well as the affected end of the tooth root. The tooth root is then re-sealed with a small filling to prevent infection from going up into the tooth. With the infected bone removed, the area can heal and will re-grow healthy bone around the tooth root. Endodontic surgery can also detect and treat root fractures and damaged root surfaces. It can also remove calcium build up from canals. Endodontic micro-surgery is possible thanks to advances in digital imaging and operating microscopes. These surgical procedures cannot be easily performed in developing countries or rural areas that lack the technology.

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