Also called endodontic (Greek for inside the tooth) treatment, this is the treatment of choice to repair a tooth that is badly decayed or becomes infected, and it has a 95% success rate.  The only alternative is to extract the tooth.  Saving a natural tooth is almost always the best option.  Contrary to popular belief, endodontic treatment is typically pain free because local anesthesia is used, and also, because when the pulp is necrotic/dead, it cannot generate nerve impulses to trigger pain.  A root canal is usually done to relieve the pain, but any discomfort is about the same as what you would experience for a filling.  The process includes:

  1. Access: An access hole is drilled through the crown to remove pulp and decayed tissue in the tooth’s core.
  2. Debridement: Canals inside the roots are cleaned with files of increasing diameter and debris flushed out, disinfected (and medicated if needed), and then its walls filed and flared to eliminate bacteria.
  3. Obturation: The new empty space is filled with a plastic, rubber-like material called gutta percha and a sealer, after which a filling or a crown is placed on top. If more structure is needed, a post may be placed inside the tooth.

It is very important not to postpone a root canal treatment.  When pulp and nerve tissue breaks down, bacteria and other decayed debris can cause an infection or an abscess (a pus-filled pocket) at the end of the roots, that can spread into the bone and cause bone loss.  Besides an abscess, an infection in the root canal of a tooth can cause:

  • Swelling that may spread to other areas of the face, neck, or head
  • Bone loss around the tip of the root
  • Drainage problems extending outward from the root. A hole can occur through the side of the tooth with drainage into the gums or through the cheek with drainage into the skin`

Sometimes there are no symptoms, but if you have a loose tooth, pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gum tissues, see your dentist right away.  As the infection progresses, these symptoms often disappear as the pulp dies. Your tooth then appears to have healed, but the infection has in fact spread through the root canal system.  If your tooth is infected, the pulp can’t heal by itself.  Antibiotics treat bacterial infections and are not effective in treating root canal infections.

Some of the reasons a tooth’s nerve and pulp can become irritated, inflamed, and infected are:

  • deep decay
  • repeated dental procedures on a tooth
  • large fillings
  • a crack or chip in the tooth
  • trauma to the face

There are many reasons why the pulp becomes infected, but it almost always goes unnoticed because it’s inside the tooth.  Moreover, dental pulp can be damaged by trauma even if the trauma didn’t cause any cracks in the tooth.  Sadly, often the first sign a person gets that the pulp has been infected is when pain occurs, sometimes severe.

When a tooth is extracted it must (or should) be replaced with a bridge, implant, or removable partial denture in order to restore chewing function and prevent adjacent teeth from shifting.  Not only are any of these treatments more expensive than a root canal procedure, but they require more treatment time and sometimes additional procedures to adjacent teeth (like preparation for crowns) and supporting tissues.

UNDERSTANDING THE TOOTH STRUCTURE

A tooth is made up of two main parts, crown and root. The crown is the top part of the tooth that’s visible in the mouth. The root extends into the bone of the jaw, anchoring the tooth in position.

Teeth also consist of:

  • Enamel – the hard outer coating *
  • Dentine – a hard (but softer than enamel) bone like tissue that supports the enamel and forms most of the tooth
  • Cementum – a hard material that coats the root’s surface
  • Dental pulp – the soft tissue at the center of the tooth containing blood vessels, nerves, and connective tissue.
  • Periodontal ligament — bundles of connective tissue fibers attached at one end to the cementum, and on the other end anchor the tooth root to the jaw (alveolar) bone.   These act as shock absorbers, allowing the tooth to withstand the forces of biting and chewing.
  • Accessory canal – smaller channels branching off from the main root canal, usually near the apex/root end, that supply blood vessels and nerves to the pulp.
  • Apical foramen – a tiny opening at the tip of the root, where blood vessels and nerves from surrounding outside tissue pass through into the tooth.

* Enamel is the hardest substance in the human body, even harder than bone.  It is the only tissue that has no living cells. Because it is not alive, it can’t repair itself from decay or damage.

The root canal system is the term used to describe the natural cavity within the center of the tooth that contains the dental pulp and extends from the crown of the tooth to the end of the root.  Teeth always have at least one root, and each root always has at least one root canal.  A single tooth can have one root for incisors and canines and up to four or more for molars, and the roots are frequently curved or bent.

Only before the tooth has emerged through the gums is the nerve vitally important to a tooth’s health and function.  Once a tooth is fully mature it can survive nicely without the pulp and nerve, because the tooth continues to be nourished by the tissues surrounding it.  The nerve’s only function is to provide the sensation of hot or cold. The presence or absence of a nerve will not affect the day-to-day functioning of the tooth, and after a root canal it can last a lifetime.

WHAT TO EXPECT AFTER THE ROOT CANAL

There may be some sensitivity for the first few days due to natural tissue inflammation, especially if there was pain or infection before the procedure. This can be easily controlled with OTC pain medication.

If the permanent filling and/or the crown is not yet in place (some dentists prefer to wait a week before sealing), it’s wise to minimize chewing on the tooth to help avoid recontamination of the interior of the tooth.  Also, before the finish work is done the tooth may be fragile and subject to breaking.  Avoid biting on hard food or objects before treatment is complete.

Good oral health care is recommended:  brush twice a day, floss at least once a day, and use an antiseptic mouthwash as you normally would and see your dentist as scheduled.  This is also good prevention against dental problems.  Limiting sugary food and giving up smoking likewise are preventive measures.  Saving a tooth with a root canal will help you maintain your confident smile, continue eating the foods you love, and limit the need for ongoing dental work.

If you are interested in root canals in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.