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Endodontics: What Happens at a Root Canal Appointment?

At the root canal treatment appointment, whether it is an emergency visit or a regularly scheduled visit, the patient will be cared for by various members of a trained and professional team. A primary goal of the dental team is to make certain that the patient is comfortable physically and emotionally during every stage of treatment. In addition to relieving tooth pain, if present, the goals of endodontic treatment are to eliminate endodontic disease and move the patient towards a state of health. With modern endodontic techniques, these goals can generally be achieved. Root canal treatment may take one or more visits to complete and usually progresses through the following stages:

1. The dentist reviews the findings and recommendations from the examination and consultation visit. If any additional radiographs are needed before starting treatment, they may be taken at this time.
2. The patient is typically given a local anesthetic. With newer techniques and devices, these anesthetics can usually be administered painlessly. The tooth can be made "profoundly" numb so that the patient is completely comfortable during treatment.
3. After achieving the required level of anesthesia, the dentist "isolates" the tooth using a "dental dam." This is a sheet of rubber material that fits over the tooth to be treated and forms a tight seal around it. The rubber dam serves to keep the saliva away from the area being treated and it also prevents the various disinfecting and cleaning solutions used during the procedure within the tooth from entering the mouth.
4. After the tooth has been isolated, the dentist prepares a window (an "access" opening) through the biting surface of the tooth in order to gain access into the diseased root canal space.
5. Once the access preparation is complete, the dentist begins to "clean" the root canal space by removing the diseased pulp tissue, bacteria, and related irritants. This is done using special solutions and small flexible instruments, called "files." The solutions penetrate and clean areas of the canal where the instruments cannot physically reach.
6. As the root canal system is being cleaned, it is also being "shaped." Shaping is the process of enlarging the root canal space in such a way that it can be thoroughly cleaned and subsequently filled and sealed. A root canal space that is not properly shaped may still harbor bacteria.
7. Following cleaning and shaping procedures, the root canal space is ideally filled and sealed in all its dimensions by a dentist. This is most commonly accomplished using a sealing cement in combination with a unique material called "gutta percha." Gutta percha is a special material that can be softened with heat and then pressure molded to precisely fill the root canal space.
8. Once the tooth is three-dimensionally sealed, it is generally "provisionalized" (temporarily restored) until a more long-lasting protective restoration can be placed. A protective restoration helps minimize the chances of future tooth fracture.

By Clifford J. Ruddle, DDS, in collaboration with Philip M. Smith, DDS

Root Canal Frequently Asked Questions

Q. Why would I need a root canal?

A. When the nerve of a tooth becomes irreversibly damaged -- due to decay, trauma, or a crack in the tooth -- you'll need root canal treatment.

Q. How can the dentist tell if I need a root canal?

A. Often nerve damage causes tooth pain, swelling and sensitivity to hot or cold. You may also notice that the tooth is becoming darker in color. Sometimes, it can only be diagnosed with an X-ray or other tests.

Q. What happens during a root canal?

A. During root canal treatment, the dentist cleans out the infected pulp tissue within the roots. After all the nerve has been removed, the canals are filled with a sealer.

Q. How long will it take?

A. Usually, root canal therapy takes one or two appointments for a front tooth (anterior), and two or three appointments for a back tooth (posterior). A tooth can have from one to four roots and all the roots must be treated.

Q. After the root canal is finished, will the tooth need more work?

A. The tooth is more brittle after a root canal and requires a permanent restoration. This could range from a simple tooth filling to a large build-up with posts and pins. If the tooth filling is large, the tooth may also need a dental crown to protect the tooth from breaking.

Q. Why not just take out the tooth?

A. It's usually healthier and less expensive to save the tooth with root canal treatment. Replacing an extracted tooth involves either expensive bridgework or a partial denture. If the tooth is extracted and not replaced, adjoining teeth can move into the empty space, creating even more problems.

Q. Will root canal treatment be painful?

A. Your tooth will be numb during the treatment. If your tooth was aching or sensitive prior to treatment, it may take a few days for the tooth to get back to feeling normal. You can take a mild painkiller during that time. If it's necessary, something stronger will be prescribed. If the tooth had been badly infected, you may need to take an antibiotic.

Q. How much will it a Root Canal cost?

A. The cost of root canal treatment usually depends on the number of canals which are infected and need treatment. There will be a separate charge for the restoration, which will vary from the cost of a simple filling to a crown. All expected treatment charges will be discussed with you before treatment.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.