Dental Questions: Why do teeth need root canals?

When most patients think of endodontics (root canal procedures), they usually assume it is being provided to treat an infection.  While the most common reason for a tooth to need a root canal is infection, there are a whole host of procedures and conditions that benefit from endodontic therapy. Take a look at this list of typical reasons that teeth need root canals!

Infection- Indeed, the most common reason most patients need root canals is from bacteria growing around the roots of the teeth. In the classic model of tooth infection, tooth decay spreads to the dental pulp, causing the tissue to become necrotic. This dying tissue becomes a food source for the bacteria, allowing them to flourish. A root canal treats these infections by removing the remaining tooth pulp, sterilizing the interior of the tooth and cutting off the bacterial food supply. 

Fractured Teeth- Fractured teeth are often impossible to see and difficult to diagnose. Many times it takes the imaging technology found at an endodontist's office to reveal the location and extent of the crack. Most fractured teeth are impossible to restore and require extraction. However, some smaller cracks can be rectified through a combination of a root canal and crown. 

Post Placement- If the top of a tooth is broken off at or near the gum line, placing a crown on the remaining structure is impossible. In certain occasions, a root canal procedure can be performed along with a post placement to save the tooth. A dental post is a metal or composite rod that extends from the root of the tooth to above the gum line, creating a new substructure for a crown to be fashioned. 

Trauma- Many times, dental trauma will cause the internal tooth pulp to recede or become necrotic. A clear sign of this is a tooth becoming darker or red-toned following injury. In order to preserve the tooth and minimize risk of infection, a root canal is often performed. After the root canal is finished, internal bleaching can be used to lighten the tooth back to a natural tone. 

We hope you found this article helpful! If you have any more questions about root canals, dental trauma or dental crowns, please give our office a call!

Dental Questions: What Does It Mean If My Face Is Swollen?

Dental abscesses start small but can have very serious effects.

A swollen face in relation to tooth discomfort means that the tooth has an abscess that has not found a way to drain on it’s own.  An abscess forms when the body has detected a bacterial infection and “walled off” the affected area, but cannot naturally eliminate it. The associated swelling signifies a serious infection that has caused inflammation of the facial tissues. This is a health emergency and requires antibiotics and drainage of the abscess. 

Root Canal Rumors

    If you search the web for “root canals” right now, chances are you will get two kinds of results: advertisements for local endodontists (root canal specialists) and articles on the dangers root canal treatment. Multiple pages will come up claiming endodontics are everything from toxic to cancer causing and even DNA altering. Is there any merit to these arguments? In this article, we hope to show you the truth behind root canals- a safe and remarkable treatment that has saved millions of teeth from extraction!

    Before we explain the controversy behind endodontics, we need to clarify how the procedure works in general. When a tooth becomes traumatized -be it from decay, physical force or extreme temperatures- the nerve tissue inside can become irritated and dies. This leaves behind a perfect space for bacteria to colonize and form an abscess. The abscess is a collection of bacteria that your immune system has contained and walled off, but cannot eliminate.

Notice the dark halo around the tooth root (where the arrow is pointing)? That is an abscess that will need to be treated with a root canal. 

A root canal tries to interrupt this process before the abscess leads to a dangerous systemic infection or damages the tooth beyond repair. Essentially, the inner tooth structure is cleaned, shaped and sterilized using very specific techniques. After the tooth is completely prepared, the roots are filled with a material called Gutta Percha. Gutta Percha is a natural rubber derived from tree sap that both seals the tooth and resists breakdown. After the endodontic treatment is completed, a crown is placed for increased rigidity and longevity.

A visual guide on how root canals are performed

    Many articles that criticize endodontic treatment quote studies that were performed by Dr. Weston Price in the 1920’s. His research indicated that bacteria from incompletely sealed root canals could spread out to the rest of the body and cause systemic problems like arthritis and cancer. These conclusions were quickly disproved, as his data was obtained using outdated and inaccurate scientific methods. Current research shows no correlation between root canal treatment and increased risk for any disease. It is important to remember that the end goal of endodontics is to lower the bacterial load from infection, so that your immune system can naturally eliminate any residual microorganisms. In this sense, endodontics seek to work with your body, not against it!

    Still, many internet blogs insist that root canals can cause cancer. A commonly quoted statistic is that 97% of terminal cancer patients have at least one root canaled tooth. First, it is unclear what scientific study this number actually originated from. Secondly, even if there is a correlation, there is no causation between root canals and cancer. It would be equally (in)valid to say that cancer causes root canals- a truly absurd notion. Finally, this statistic is almost certainly false. A 2013 study by the Journal of the American Medical Association found that patients with root canals actually had a 45% lower cancer risk (again, this describes correlation and not necessarily causation).

    Overall, we can see that the majority of the anti-root canal argument relies on 90 year old disproven research, conjecture and anecdotal evidence. In contrast, peer-reviewed scientific research on endodontic treatment has continuously demonstrated that root canal therapy is safe, effective and highly successful. If you have further questions on root canals and why they are great treatment options, please give our office a call. We are always excited to keep our patients informed and knowledgeable on the best practices in dentistry!

Specialist Spotlight- Southern California Endodontic Group

Dr. Pokras

Dr. Trnavsky

Dr Lazarou

Dr. Ghahraman

At Thousand Oaks Family Dentistry, we are proud of the network of skilled dental specialists we have created. Whether you are in our office or one of our associates’ offices, know that you will be treated with respect, kindness and experience. Today, we would like to highlight Southern California Endodontic Group, the office of Doctors Pokras, Trnavsky, Lazarou and Ghahraman.

At Southern California Endodontic Group, an array of services are provided towards preserving infected or chronically inflamed teeth. Beyond root canals, their office can diagnose internal fractures in tooth roots, retreat failing root canals and more. The end result is relief from pain, removal of infection and a longer lifespan for a tooth that would otherwise need to be extracted.  

Pokras, Trnavsky, Lazarou and Ghahraman represent decades of experience in endodontic treatments with successful outcomes. Aside from clinical dentistry, they are active in local dental societies, academies and dental schools as lecturers and mentors. In the office, their expertise is backed by a number of leading technologies and instruments. Cone beam CT scans are used to visualize fractures, cracks and infections, while microscopes elucidate every tiny detail of the tooth’s inner structure. This combination of knowledge and technological power allow them to deliver fast, comfortable and long lasting treatments. 

Beyond technical abilities, Southern California Endodontic Group prides itself in creating a warm and familiar environment. From the front desk staff to the various amenities, their goal is to treat everyone who walks through the door like family. Patients feeling apprehensive about dental treatment will be met with a variety of comforts, from blankets to in-operatory TVs and even massaging chairs. In total, they want you to feel relaxed and comfortable for the entire duration of your appointment and beyond; Their office will often follow up with courtesy calls to make sure you are feeling great about the results of your treatment. 

We love working with So Cal Endo Group because of their combination of clinical success and caring atmosphere. Our patients are always impressed and satisfied with their treatment, resulting in a great all-around dental experience. If you would like to know more about Doctors Pokras, Trnavsky, Lazarou and Ghahraman or any other of our fantastic specialists, please give us a call.  We want our patients to know they are in good hands, whether with us or one of our specialists.

Root Canals

Root Canal- Likely the most feared of all procedures. The name alone brings up visions of pain, discomfort and dental woes. But what is a root canal? Why would you need one? What does it do? In this article, we will shed some light on the world of endodontics, dental subspecialty that encompasses root canals. Contrary to popular belief, you will find that this procedure is both comfortable and provides near instant pain relief!

A Diagram of the different parts of the tooth. 

Before explaining how a root canal works, it is important to understand the different parts of the tooth and what they do. There are three basic layers to all teeth- the enamel, the dentin and the nerve/pulp. The enamel is mostly inorganic (nonliving) material and gives the tooth its strength and rigidity (it’s the hardest material in the human body!). Dentin provides support to the enamel and contains a mix of living and nonliving materials. The innermost layer is the pulp chamber and nerve canal. This space contains innervation that provides information on biting pressure, temperature and pain to the central nervous system. It is mostly organic material and has has it’s own blood supply.

Different teeth will have different numbers of canals. The number varies between tooth types, arch location and even person to person. In general, teeth typically have between one and four canals, with posterior teeth having more than anteriors. On top of this, a tooth can have any number of accessory canals.These can range in size from easily visible to microscopic.

With this information in mind, let’s discuss root canals. In the most basic terms, a root canal is performed by removing the root/nerve from the tooth, cleaning out the now-empty space and filling it with a stable material. Why would we remove the nerve from a tooth? This is typically done because:

A) Long term decay, stress or fracture has aggravated the nerve and it is causing constant pain. This is what happening when patients come in with a “hot tooth.”

B) The aggravated nerve has now “died,” leaving a perfect alcove of organic material for bacteria to feed on. Here, patients might have very little feeling in the tooth and may notice a change in color to a grayish hue.

C) Bacteria have found the dead tissue and there is an active infection. The bacterial abscess can be seen on an X-Ray and the patient will feel soreness, swelling or even draining from the gum tissue.

Condition A will eventually progress to condition B and usually to condition C. Since active infections are both difficult to treat and potentially life threatening, we will usually treat dying nerves early-on and aggressively. Waiting can often lead to more pain and higher long term costs to our patients.

The actual root canal procedure is based on a simple ideology: If you remove the dying/dead nerve, you remove the source of pain and bacterial “food.” We start by getting you numb using standard dental anesthesia.  You should not be able to feel any part of this procedure, from start to finish. The tooth is then isolated using a dental dam to keep your saliva and the inner tooth completely separated. We access the tooth canal and begin clean out the canal. We use a system of specialized files to shape and clean the canal, along with a number of sterilizing irrigants to eliminate any bacteria. Once the canal is the right size and shape (confirmed via X-Ray), we fill it with a material called gutta percha. Modern gutta percha is engineered in a lab, and is extremely resistant to deterioration, infection or absorption.

Tooth Second from left- Before and after root canal. The gutta percha shows up bright white in the X-Ray, highlighting the shape of the canal.

Once the canal is filled, it is topped of with a filling to give the tooth structure. This final step may be done the same day as the canal filling or may be delayed to allow the tooth time to adjust to the procedure. Most of the time, the tooth will require a crown to give it long term structural stability and strength. Removing the nerve from teeth can make them more brittle, and the capping effect of a crown can help counteract this.

After the nerve is removed from the tooth, it physically cannot feel any more pain. The surrounding tissues can still feel tender, but the specific tooth will no longer have a way to relate sensory information to the brain. This is what makes root canals great at ending tooth pain permanently and instantly.

Overall, root canals are about 80% successful long term. They are an excellent way of buying time with a tooth that would otherwise need to be extracted and replaced with an implant or dentures. At our office, we evaluate root canals on a patient-to-patient basis. If we feel your specific case could benefit from the perspective of a specialist, we will refer you to an endodontist. These tooth canal experts bring a number of technologies to handle complex or difficult cases, including microscopes, CT Scanners and cutting edge materials.

If you have further questions on root canals or why we place them, please contact our office. We understand that this procedure seems intimidating, and will try our best to make it more manageable. As with any procedure provided at our office, we want you to be happy, pain-free, and satisfied with the end result!