Endodontic treatment (a root canal) is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, faulty crowns, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.

During root canal treatment, the inflamed or infected pulp (connective tissue, nerve, and blood vessels in the center of the tooth and root) is removed and the inside of the tooth is carefully cleaned and disinfected, then filled and sealed with a rubber-like material called gutta-percha. Afterwards, the tooth is restored with a crown or filling for protection. After restoration, the tooth continues to function like any other tooth.

Patient comfort is the number one priority. Local anesthesia is provided in the area of treatment to ensure that no pain is felt during the entire treatment visit. Additional anti-anxiety measures can be taken such as the administration of oral agents and nitrous oxide if needed as well.

Most patients experience a small amount of post-operative discomfort after the procedure. Inflammation from the procedure can effectively be managed with over the counter anti-inflammatory medications such as Ibuprofen as well as prescription medications if needed. Some patients experience no pain following the procedure.

Most root canals can be completed in one visit. Depending on the tooth location and size, the procedure can take one or two hours in most cases. If the infection is large prior to receiving treatment, some treatments are completed in two visits with the application of medicine to reduce the infection between visits.

Depending on which tooth is treated and the amount of decayed tooth removed for treatment, a crown is often recommended following root canal therapy to help provide protection to the underlying tooth and establish a seal to prevent the ingress of bacteria inside the tooth in the future. Patients who need crowns will be referred back to their general dentists for this step.

If an existing crown is intact and in good condition, root canal therapy can be completed through the crown and then sealed with a small filling. If the crown is leaking bacteria or if there is a significant amount of decay beneath the crown, sometimes a crown will need to be removed to effectively clean the tooth and provide a clean sealed restoration. A new crown may then be fabricated.

We gather information for a complete medical and dental history. We take a radiograph of the area in question. Clinical tests are performed including vitality, percussion, palpation, probing, and biting to determine the health of the nerve of the tooth and surrounding bone. Then, we look at the radiograph(s) and test results to diagnose whether the tooth needs endodontic treatment.

Sometimes previously completed root canals can leak or canals in the root are missed during the first treatment. If infection persists or arises on an existing root canal, the previous root filling can be re-cleaned and sealed again. Once the root canal is re-done, the source of infection is removed to allow healing.

An apicoectomy is a procedure to remove a source of infection in a tooth that has had a root canal and has often undergone a re-treatment. Depending on which tooth, the tip of the root(s) is/are cleaned and a small filling is placed to seal the tooth from the bottom rather than from the top (root canals seal from the top). This procedure also preserves the tooth or crowned tooth; the procedure is completed at the tip of the root avoiding any removal of tooth structure in the top of the tooth.