What happens during a root canal?

DEAR DOCTOR K:

I have to have a root canal. What will happen during this procedure?

DEAR READER:

You brush your teeth twice a day, but you probably don’t know their inner workings. Every tooth has roots that anchor it to the jawbone. Inside the body of the tooth and inside its roots is a hollow central chamber, or canal. And inside that hollow chamber is an inner pulp containing a network of nerves, blood vessels and tissues. The pulp helps nourish your tooth. The nerves in the pulp are the reason that injury or damage near the pulp causes pain.

Pulp damage can cause a range of symptoms, including tooth sensitivity, pain, swelling or tenderness of the gums. Pulp damage can also cause cracked or discolored teeth, nerve death and infection.

Among the common causes of pulp damage are tooth decay and advanced gum disease, which can produce infection in and around the teeth. A bacterial infection in the pulp usually kills the nerves, and the infection can spread to the gum and mouth tissues and beyond.

Root canal therapy removes damaged or diseased pulp and seals off the inner chamber that normally contains it. This prevents the infection from spreading.

The process usually takes two to three office visits. During the first visit, the endodontist (a dentist who specializes in problems with dental pulp and nerves) will inject a local anesthetic. He or she will drill a hole in your tooth and remove the decayed or diseased pulp.

The endodontist will clean the root canal, removing bacteria, tooth fragments and tissue. An antiseptic (and sometimes also antibiotics) will be injected into the pulp chamber to kill remaining bacteria.

The root canal and pulp chamber will be dried, then filled with a permanent filling material. This material replaces the pulp. Below, I’ve put an illustration of how a root canal procedure is done.

How root canal therapy is done

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Root canal therapy is done to remove damaged pulp, clean the root canals from infection, and prevent further infection. The procedure usually requires two office visits. At the start of the process, the dentist drills a hole to get to the pulp: (A). After cleaning out the pulp chamber and root canals, the dentist fills the pulp chamber and root canals with a permanent filling material known as gutta-percha (B). Then he or she places a filling in the rest of the pulp chamber; this is sometimes called a “core buildup.” Finally, the dentist restores the treated tooth, often with a crown.

 

After the root canal treatment is complete, your dentist will place an amalgam (a filling) or composite restoration, a crown, or both on your tooth. This will protect and strengthen your tooth and help maintain its structure. Premolars and molars in particular should be crowned after root canal therapy to prevent the tooth from breaking.

The best way to keep pulp damage at bay is to brush your teeth and floss twice a day. And don’t forget regular visits to your dentist for more thorough cleanings.

I’ve had several root canals. Before my first one, I was very apprehensive. So many people (including plenty who’ve never had it) talk about root canal surgery as if it’s terribly painful. They say things like, “Seeing the Red Sox end up at the bottom of the division hurt me less than a root canal!”

In my experience, a root canal doesn’t hurt any more than other dental procedures. But seeing the Red Sox go from first to worst in one year, on the other hand — that really hurt.