Root canal treatment involves the mechanical debridement, disinfection, and filling of the hollow canal space within a tooth. Root canals are typically needed when the pulp tissue (nerve tissue) within the canal space becomes inflamed or infected. Some signs and symptoms we look for to help diagnose a root canal problem are: lingering or throbbing pain after exposure to cold or hot temperatures, spontaneous toothache or throbbing, pain to bite or tap on a tooth, swelling/bumps in the gum tissue over the root of a tooth, or evidence on an X-ray showing changes in the bone density around the tip or sides of a root. The pulp can become inflamed or infected for multiple reasons: deep decay encroaching or entering the pulp space, fractures or trauma to the tooth, deep restorations or the additive effect of multiple restorations being placed in a tooth over its lifespan.
After proper diagnosis, there are three main steps in the root canal process. First, an access opening is made through the top of the tooth structure to gain entry into the canal system. Next, endodontic files are used to debride and remove the inflamed or infected pulp tissue. After rinsing and disinfecting the canal space, filling material is placed in the canals to create a barrier to prevent oral bacteria from reinfecting the canal space and surrounding jaw bone. In many cases, root canals can be finished in one appointment although some teeth may need a medication temporarily sealed within the canal space for a short time (typically 1-2 weeks) prior to completing the treatment. After the root canal is finished, a temporary restoration is typically placed to seal the access opening in the top of the tooth and patients should return to their general dentist to have the final restoration and/or crown placed (usually within a couple weeks of finishing treatment). Back teeth, especially molars, are prone to developing cracks after a root canal is done so a crown is usually recommended to cover and protect the tooth from cracking. Front teeth do not take as much direct biting force and may not require a crown to be placed after root canal treatment.