Root canal treatment (also referred to as root canal therapy or endodontic therapy) is made necessary when a cavity is allowed, through neglect, to reach all the way to this pulp. (Regular cleanings and checkups prevent and detect problems early) Sometimes deep restorations or trauma to a tooth may cause the nerve to be damaged to the point it needs root canal therapy, also. Once this occurs the pulp becomes infected, and can even extend through the root tip and begin to eat away at the surrounding bone (this is an abscess).
By the time the pulp is infected it must be treated, and cannot heal on its own. It can even weaken the entire immune system. This is dangerous, not to mention very painful. Symptoms that the pulp has become infected may include sensitivity to hot/cold or sweets, pain, swelling, pain to biting or pressure, and a bad taste in the mouth.
Sometimes, however, no symptoms are apparent and the person is unaware of any problem until a checkup. A root canal is then performed to clean out the infected tooth pulp, and disinfect the canals of the tooth. The only other treatment would be to extract the tooth. Once the infection is resolved, the canal(s) are filled in to prevent any further infection. Usually a core build-up and crown is recommended for restoring a tooth that has had root canal therapy.
With proper care, a tooth that has had endodontic treatment will last as long has your natural teeth. As sometimes happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
- Narrow or curved canals were not treated during the initial procedure.
- Complicated canal anatomy went undetected in the first procedure.
- The placement of the crown or other restoration was delayed following the endodontic treatment.
- The restoration did not prevent salivary contamination to the inside of the tooth.
In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:
- New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
- A loose, cracked or broken crown or filling can expose the tooth to new infection.
- A tooth sustains a fracture
The endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the doctors will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. The doctors will now clean your canals and carefully examine the inside of the problem tooth. After the doctor has cleaned the canal, they will fill and seal the canals and place a temporary filling in the tooth. You will then need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.
There are many surgical procedures that can be used to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy. The Endodontist removes the inflamed/infected tissue from the bone at the root of the tooth and removes the very end of the root as well. A small filling may be placed at the end of the root. The bone can then heal around the end of the root.
Cracked teeth may be the source of many types of problems, including pain when chewing, temperature sensitivity, or the release of biting pressure. It is also common for resulting pain to come and go, making it difficult to diagnose the cause.
Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.
Types of Cracks
Craze lines are tiny cracks that affect the outer enamel of your teeth. These cracks are very common in adult teeth. Craze lines are very shallow, cause no pain, and are usually of no concern beyond appearances.
When the pointed part of the chewing surface or your tooth becomes weakened, a fracture can result and may cause you pain. This weakened cusp may break off by itself or may need to be removed by your dentist. When this happens, the pain is usually relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your dentist will usually restore the tooth with a full crown.
This crack extends from the chewing surface of the tooth towards the root. Damage to the pulp is common and root canal treatment is frequently needed. Early diagnosis and treatment is important because a cracked tooth that is not treated will progressively worsen and eventually will result in the loss of the tooth.
A split tooth is usually the result of an untreated cracked tooth. The split tooth can be recognized by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. In some cases a portion of the tooth can be saved using endodontic and restorative treatment.
Vertical Root Fracture
Vertical root fractures begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may go unnoticed. These Cracks are often discovered when the surrounding bone and gum become infected. Treatment may involve endodontic surgery if a portion of the tooth can be saved by removal of the fractured root.