What are the different parts of a tooth?

Each tooth in your mouth is composed of an outer enamel layer which is the white part of your tooth that you can see. Inside the white part of the tooth is the bulk of the tooth which is known as the dentin. It is inside the dentin that there is a soft tissue known as the pulp of the tooth. This pulp is composed of nerves, which provide feeling and sensation in your tooth. The pulp further consists of arteries and veins which supply the blood supply and nutrients to your teeth. From this pulp, there are thin branches of the pulp that enter into the roots of the tooth, these are known as the root canals. Most molars have 3 or 4 root canals inside the roots of the tooth and most of your front teeth have 1 root canal.

Why do I have pain with this tooth?

The pulp and root canal system is naturally a sterile, bacteria free environment. When that bacteria free environment is contaminated by either a large cavity or a break/fracture of the tooth that penetrates into the pulp and root canal system that allows bacteria to enter and cause an infection in the tooth. This infection can result in a swelling of the pulp and root canal system which is perceived as pain. This swelling can be aggravated by hot or cold or relieved by hot and cold depending on the stage and severity of the infection – this aggravation is perceived as pain. The infection can also cause an abscess to form at the end of the root. When an abscess forms, pain is often felt when the patient bites down on that tooth or puts pressure on that tooth because the pressure is being placed on the abscess. The only way to relieve the pain is to eliminate the infection in the pulp and root canal system – endodontic treatment.

What is endodontic treatment (a.k.a. Root Canal Treatment) and why is it needed?

Endodontic treatment is the removal of the infected tissue in the pulp and root canal system from the infected tooth.

What is involved in the procedure?

Depending on the severity of the infection, endodontic treatment can be a one appointment or two appointment procedure. Local anesthetic is administered for that tooth and a rubber sheet is placed over the tooth in order to expose it only and keep the lips, tongue and other teeth out of the way during the procedure. The pulp and root canal system is accessed by entering the tooth through the top of the tooth with a small hole. This allows for the removal of the pulp tissue and the root canal system tissue. Different chemicals and disinfectants are used to clean out the pulp and root canal system at this time along with small files used by hand as well as by machine. If the endodontic treatment was assessed to require two visits, medication is often placed inside the tooth at this time and a temporary filling placed in the tooth. The second appointment is usually 7-10 days after the initial appointment at which time the temporary filling is removed and the root canal system is filled in with a chemical and rubber based material to prevent future contamination by bacteria. If the tooth is missing a significant amount of tooth structure, a post is often placed at this time in one or more of the root canals and then a filling is placed on top of the post. A crown is often advised on a root canal treated tooth because the tooth has been weakened by the removal of the pulp and root canal tissue as well as being weakened by the removed tooth structure during the procedure.

Risks and Complications of Endodontic Treatment:

Although the success rate of endodontic treatment is above 90%, there is always the possibility that the treatment may fail. This can occur for a number of reasons from a missed root canal not seen during initial treatment to a broken file or instrument in one of the root canals to a failure for no apparent reason. At this time, a referral to a specialist is often considered.

After Endodontic Treatment:

For 3-5 days after endodontic treatment patients often have a little sensitivity or discomfort commonly known as a flare-up. This is usually best controlled with anti-inflammatory medication which will be advised to you after your appointment.