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What should I know about root canals?

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May 02, 2012 by

What is root canal treatment?
Root canal treatment, also called endodontic treatment is a procedure that is performed on a tooth when the nerve becomes infected, injured, or has died away.   Root canals can also be done on a broken tooth in order to clear up any possible infection and properly build up the structure of the tooth. 
When cavities of cracks form on a tooth, they allow bacteria to enter the chamber of the tooth that is filled with nerves and blood vessels.   The nerves and blood vessels inside the tooth are known as the pulp, and once that becomes infected, it is necessary to remove the infected pulp in order to save the tooth.
The infection, or abscess, of the pulp can cause severe pain, swelling and sensitivity, though if the nerve has died in the tooth, or if the abscess is very small, no pain may observed.  
A root canal can save a tooth that would otherwise need to be extracted due to infection or structural damage.

If my tooth is broken or cracked, why would the dentist want to perform a root canal?

Once a tooth is broken, it is very easy for bacteria to infect the pulp.   Additionally, beyond the visible cracks and breakage of your tooth, there can be further microfractures or invisible cracks that can’t be seen which can further endanger your tooth.  A root canal procedure including a post/core buildup and crown can restore your tooth to proper structural strength, restore the cosmetic appearance, and prevent the need for extraction.

How is the root canal procedure done?
A root canal treatment is performed in the following steps:

  • X-rays of the tooth and an examination by your dentist is performed
  • The surrounding gums are numbed with a local anesthetic
  • A rubber dam is placed around the tooth to prevent bacteria from your mouth from entering the exposed chamber of the tooth
  • The dentist drills a hole into the tooth to expose the infected pulp
  • Using very small, specialized dental instruments, the dentist carefully cleans out the infected pulp of the tooth
  • After the infected pulp is removed, the dentist will sterilize the now empty canal and chamber of the tooth
  • The tooth is then filled and sealed with either a temporary or permanent filling
  • Is the procedure done at this point?
    Technically, the root canal treatment is finished, and any severe pain should be alleviated.  After the tooth is drilled into, the infected pulp of the tooth is removed and the root canal system cleaned and opened, the tooth will not have the same structural integrity as a normal tooth.  As such, it needs to be further restored with a post/core buildup and a crown in most cases.

    Tooth Restoration Following Root Canal Treatment
    After the root canal treatment is performed, it is necessary to build up the tooth in order to protect it and allow it to function normally.  For minor root canals, this can be done by simply putting a permanent filling in placed of the removed pulp.  For major root canals, and in most cases for molars, a crown is also necessary to build up the exterior of the tooth and provide it enough strength to chew normally without breaking.  If a significant amount of the inner chamber of the tooth was removed, a post is cemented into place that provides more adequate internal structure for the tooth.

    Most extensive root canal treatments, including restoration of the tooth require three components:
    • Root canal treatment to remove infected pulp from the tooth
    • Post/core buildup of the tooth for internal strength
    • A crown to provide external strength and allow for normal chewing/eating capacity and provide proper cosmetic appearance of the tooth
    How long should I plan my trip for?
    It depends on whether you want to have the root canal treatment only, or the root canal treatment and crown restoration.  If you have the root canal treatment only, you will need to visit a dentist back home for the permanent restoration.

    Root Canal Treatment Only
    The root canal treatment can usually be finished in one or two appointments.   However, there are exceptions to this.  If there is a large abscess or infection, it may be necessary to take antibiotics for several days before the root canal treatment can be started.  If you need a root canal and have an upcoming trip, many dentists recommend getting on antibiotics several days before you arrive to ensure the best chance of being able to commence treatment as soon as possible upon arrival.

    In cases where tooth infection is severe, and no antibiotics were started before arrival, 7-10 days are sometimes required to complete the root canal treatment.  It is very important that all sign of infection is gone before the tooth is permanently sealed, and sometimes a sanitizing/antibiotic solution needs to be left in the tooth for several days before the tooth can be sealed or restored.

    Root Canal Treatment + Restoration/Crown

    Once the root canal treatment is completed and the infection absent, the permanent restoration can take place.  A post/core buildup up of the tooth is then performed and impressions of the tooth are taken for the crown and sent to the dental laboratory.  The dental laboratory will need a several days to complete the crown, and then you would return to the dentist to have it cemented in place and for a final check up. 

    If an infected tooth requires only a minor root canal, and there is no severe infection, it usually takes about a week to finish the root canal treatment, post/core and the crown.  For more severe infections, especially if no antibiotics are taken prior to arrival, it may take up to two weeks to complete the whole process.
    In order to determine the amount of time recommended for your case, contact the clinic you are interested in visiting ahead of time for their recommended length of stay.  If you have dental records or x-rays that can be sent by email, this greatly increases the accuracy of the time estimated and procedures needed to restore your tooth.

    What should I know before I go?
    • Root canal treatments are difficult procedures, and when done improperly, can cause unnecessary pain, added time and expense, or even the loss of the tooth.   
    • Make sure that you visit an endodontist, or root canal specialist in order to ensure you receive the best treatment from an experienced, highly trained   professional.
    • Ask your local dentist or doctor about whether you should get on antibiotics prior to your trip.  This can save you significant time and travel expense in many cases.
    • Even if a clinic advertises a root canal treatment for very little money, make sure you get a quote for the whole procedure; the root canal treatment, post/core buildup, and the crown should be included in your price quote.
    • Beware of impossibly inexpensive root canals offered by rock-bottom priced dental clinic abroad.   A root canal procedure performed by a specialist may cost a bit more, but you will have a better result.
    • Consult with a patient coordinator from Dental Departures to make sure you are visiting a reputable clinic that has a highly qualified endodontist who will perform your treatment.

    If I need a root canal on a tooth that has a crown or a bridge on it, or a retreatment of a tooth that has had a root canal in the past, is this possible?

    Yes, this is possible, but these are more complicated procedures than a standard treatment.   If a tooth has an existing crown or bridge, the endodontist can sometimes drill through the existing crown and perform the procedure, but not in all cases.  It is not always possible to save the existing crown or bridgework, but an experienced endodontist can advise you of whether this is feasible.  
    Root canal re-treatments can be done, but are not always advisable, as they have a higher failure rate that initial treatments.  Your endodontist can advise you if retreatment is recommended for your case, or whether replacing the tooth is a better long term option.

    If I am in severe pain and/or have extreme swelling several days after a root canal, what should I do?
    Some swelling and soreness is normal following a root canal treatment, but severe pain or large swelling is abnormal and a sign that the treatment was not successful.    Root canal treatments do have a very high success rate when performed correctly; make sure you know who will be performing this treatment for you.   

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    This article is meant for information purposes only and is not intended to be dental advice or instructions for dental diagnosis or treatment. Please consult with your dentist or a qualified dental professional before starting or changing dental treatment