Dental Questions: Does every tooth need a crown after a root canal?

As a rule of thumb, if you have a root canal performed on a tooth, you should expect to have a crown placed afterwards. Crowns help restore the structure and rigidity to a tooth after it has been "hollowed out" by the root canal process. In a few instances, a dentist may not recommend placing a crown on a tooth as part of definitive treatment. However, these cases are certainly the exception, and not the rule. 

To perform a root canal, an opening has to be created to access the nerve space within the tooth. This involves removing important structural components of the dental enamel, and thus rendering the tooth much more likely to fracture. A crown remedies this problem by creating a solid cap around the tooth that braces it against biting and chewing forces. Root canal treated teeth also frequently require buildups to replace lost tooth structure and posts to resist against lateral and shearing forces. The cost and time investment of these treatments need to be considered when you choose to have a root canal performed. Without them, the tooth has an much higher chance of breaking during normal use. 

In some cases, a dentist will not recommend placing a crown on a root canal treated tooth. Depending on how the patient bites and how much natural tooth structure remains, anterior (front) teeth do not always need crowns. Because they are not primary chewing teeth, the front teeth tend to deal with much less force than the canines, premolars or molars. Additionally, teeth opposing (biting into) dentures or teeth that have nothing to chew against may not need crowns after root canal treatment. In these instances, there is not enough force generated to put the weakened tooth at risk. 

In general, expect to need a crown placed as part of completing your root canal treatment. At Thousand Oaks Family Dentistry, we do our best to inform patients of their complete treatment needs- from start to finish. If you would like to learn more about root canals, crowns, fillings or cavities, please give our office a call!

Dental Questions: Are root canals painful?

If there was a ever a classic trope of bad dental experiences, it would certainly be the root canal. From cartoons to movies to TV shows, we are taught from a young age that root canals are the most painful of all dental procedures. Fortunately, this bad press is entirely undeserved. Root canal treatment offers relief from excruciating pain and a near instant improvement of symptomatic teeth!

For starters, a "root canal" is a dental procedure where the nerve inside the tooth is removed and replaced with sealing material. It is usually performed on a tooth with an infection (where the now-dead tissue is feeding bacteria) or with an inflamed nerve. In either circumstance, removing the internal nerve pulp and cleaning the inside of the tooth relieves symptoms of extreme pain and pressure. After performing a root canal, the tooth will most likely need a crown and/or post placement to add strength back to its structure. 

A root canal procedure will not be more painful than any other dental treatment. Endodontists (root canal specialists) require that the patient is completely numb so that there are no undue delays or interruptions to the root canal process. The most common complaint after receiving this therapy is a sore jaw from staying open for the duration of the procedure. In cases of extreme infection, some teeth may be difficult or impossible to fully anesthetize. In these cases, the endodontist may elect to use antibiotics or mild sedation to maximize the numbing effect. Either way, you will be completely comfortable for the entire appointment. 

If you have dental pain and think you might need a root canal, don't panic! Tooth pain comes from a number of different causes and requires a complete dental exam to diagnose. If you would like to schedule an appointment today, please give our office a call!

How Can I Soothe a Toothache?

Note: Never start taking any medication for the first time (even OTC products) without consulting a medical or dental professional first. Never exceed the prescribed dosing for a medication or use it in a method for which it was not designed. 

Toothaches always seem to spring up at the least convenient times. Often enough, they show up 6pm on a Friday before a long weekend. When you can't get to a dentist right away, what should you do about your pain? In this article, we hope to give you some direction (and comfort) in helping your dental woes.

The first thing to do with any type of dental pain is give your general dentist a call. Even after hours, every office should have a means of getting into contact with either your own dentist or one of their associates. An exception to this would be excruciating pain, possibly combined with swelling, fever and warmth around a tooth. In these instances, your first choice should be to head to an emergency room, as this can be the sign of a serious infection. 

Beyond getting into contact with a dental professional, there are a few steps you can take to reduce your symptoms. If the pain feels like it is coming from a tooth directly, we suggest taking an NSAID medication like ibuprofen (Advil). Most dental pain comes from pressure inside the tooth or bones, and is best treated by drugs (such as ibuprofen) with anti-inflammatory properties. We do not suggest taking any left over narcotics you may have on hand, as they are potentially harmful and will not stop the pain as effectively as an NSAID. 

If your pain feels like it is coming from your gums, try flossing gently to see if you can dislodge any stuck food (popcorn kernels are the worst offenders). Beyond this, we recommend rinsing with warm salt water to soothe inflamed tissue. Never try to apply Asprin, Advil or other medications directly to the gums. This will only irritate the tissue and create more pain. We also suggest staying away from topical toothache creams/gels, due to their lack of effectiveness and potentially dangerous side effects.

If your pain has a specific trigger, make note of it and try to avoid using your teeth in that manner. Knowing what causes the tooth to flare up can be an important factor in diagnosing the exact problem. If you would like to know more about toothaches, dental pain or gum pain, please give our office a call! 

Technology and Root Canals

If you need a root canal, chances are you will be referred to one of the wonderful endodontists in our specialist network. With today's advances in dental technology, root canals are quicker, safer and more predictable than ever before. In many instances, these new products and techniques have allowed specialists to save teeth that were one destined for extraction. Take a look!

For starters, a root canal is a procedure performed on a tooth with an active infection or dead nerves. An opening is made in the top of the tooth and the innermost layer, called the pulp chamber, is thoroughly cleaned. The nerve canals (which follow the length of the tooth roots) are cleaned and shaped as well and filled with a resilient rubber material. After the root canal is finished, you will typically have to return to our office to have a crown placed on the tooth. 

One of the most important aspects of dentistry is being able to properly visualize the problem you are trying to fix. This is particularly challenging in the field of root canals, where the root shape and location makes diagnosis and treatment difficult. Today, cone beam CT scans can make this process much more straight forward. In these images, tooth roots, nerve canals and possible fractures are visualized in three dimensions. The endodontist can then accurately predict how he will perform his procedure before starting. 

Another important advancement in visualization is the use of dental microscopes in endodontic offices. The canals within your teeth can be as small as half a millimeter and vary in location from tooth to tooth. The microscope allows for much more accurate treatment and minimizes the risk of missed canals.

In the actual treatment of root canals, many advances have been made in the art of cleaning out the inner tooth. Flexible metal files shape the canals with ease while ultrasonic cleaners eliminate any residual bacteria. New materials create a better seal between the rubber filler and tooth while fending off recurrent infections. All in all, the entire process is now much more streamlined.

These technologies have helped make performing the root canal easier, which in-turn makes the patient experience more enjoyable. At any endodontist's office, your comfort is the most important aspect of the treatment. If you would like to know more about root canals, why teeth need them and how they are performed, please give our office a call.

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!

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!

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!