There are few procedures that make people more nervous than a “root canal”. Let’s face it – they have a bad rep. The good news is they are not as bad as you may have heard.
Root canal treatment has been around for centuries. In fact, even in the 2nd or 3rd centuries BC, Roman doctors were placing copper wire into teeth to relieve pain and pressure. The following 1600 or so years saw adventurous individuals taking pity on their fellow man by drilling holes into teeth and covering them with gold or asbestos. In the 1800’s endodontics hit its stride, the rubber dam was developed, electric pulp vitality testing was invented, and many new methods and medications were being used to treat the tissues within teeth – including cauterization, lead foil, formalin, arsenic, cloves, and – thankfully – gutta percha!
The early 1900’s saw x-rays being used for the first time by dentists. Local anesthetics (freezing!) were heralded into being in 1910, and, 40 years later, manufacturers began to standardize the instruments used for root canal treatments.
Today the methods and materials for performing root canals are better than they have ever been. Thankfully we have access to great local anesthetics. So now, from a patient perspective, a root canal treatment is one of the most boring procedures. Sometimes an infection can make the tissues too acidic for anesthetics to work, but for the majority of patients, full and deep anesthesia is predictably achievable; this makes root canals no worse than a large filling.
So what is a root canal treatment anyway? It can be summarized in three terms: Clean, Fill, and Protect!
When a tooth is infected, or irreversibly inflamed, the only way to calm or prevent pain and further infection is to remove the dead and dying tissues inside the tooth. Generally there are three types of tissue inside the tooth: nerve, blood vessels, connective tissue. All three need to be removed.
We do this by creating a small hole through the biting surface of the tooth, using small files by hand or with a handpiece (i.e. drill) to remove the tissues down to the end or apex of the root tips. Among the back teeth, there are often 2 to 4 roots depending on the tooth. During the cleaning process, we use an irrigant liquid (bleach or EDTA) to dissolve the remaining tissues and to kill remaining bacteria. We also take x-rays to verify the length of the roots. The cleaning of the roots is generally completed over one appointment.
The next appointment usually consists of filling the now clean canals with an orange rubber substance called gutta percha and a biocompatible sealer. This material can be heated to mold to the intricacies of the canal system, and a series of pluggers are used to press the gutta percha into those intricacies. Between appointments and after the filling appointment it can be normal to have some tenderness; it should go away as the tooth and bone heal.
The final step is to replace the filling in the small opening and to have a crown placed on the tooth. The crown protects the very dry brittle root canaled tooth from breaking – about 50% of root canaled molars will break within 5 years if not protected by a crown.
Thanks for reading!
Dr. Jack Gordon