Frequently Asked Questions
WHY CAN'T MY REGULAR DENTIST DO THE ROOT CANAL?
Some dentists do the majority of root canal procedures needed by their patients and refer more involved cases to an endodontist. Other dentists refer the majority of their root canal cases believing that their patients will benefit from treatment in a specialty practice. Technology in every aspect of dentistry has changed dramatically and it is not feasible for a general office to purchase or utilize all of the technologies now available for every area of dentistry.
MY TOOTH QUIT HURTING. DO I STILL NEED A ROOT CANAL?
There are certain key symptoms--spontaneous pain, lingering cold and (usually) chewing sensitivity--that indicate the nerve tissue has undergone irreversible change. Once these symptoms have been present, the tooth will ultimately need root canal treatment, even if the symptoms temporarily resolve. So, if you have had one of these key symptoms, the answer is, unfortunately, yes, you will still need a root canal. On the other hand, many teeth we treat have had no symptoms at all and are diagnosed solely on the basis of radiographic changes.
IF THE PROBLEM IS INFECTION, WHY NOT TREAT IT WITH ANTIBIOTICS?
The logic of this common question makes perfect sense. The answer lies in the fact that once the nerve and blood supply in the tooth dies, there is a dead space left behind that becomes a perfect place for bacteria to grow. Antibiotics can only go where the blood supply takes them. Since the blood supply dies along with the dying nerve, an antibiotic is unable to get to the source of the infection inside the root. The purpose of a root canal procedure is to remove the bacteria within the root canal space that antibiotics are unable to get to and to then seal the space to prevent bacteria from taking up residence inside the root again.
WHY DO I NEED TO SCHEDULE A CONSULTATION. WHY CAN'T I JUST SCHEDULE AN APPOINTMENT TO START TREATMENT?
In some cases, you can. For some teeth, we can tell from the x-ray of your tooth if a root canal is needed and what type of treatment appointment to schedule. In these instances, we will utilize your first appointment to start treatment (unless you prefer a consultation anyway). For other teeth, it is not possible to tell which tooth is causing the pain or what type of treatment appointment is needed. In more than a few cases it has turned out that the problem tooth was not the one initially believed to be the cause of the pain. And in some instances, root canal treatment is simply not the best option. This cannot always be determined from an x-ray alone.
Like you, we'd prefer to simply schedule treatment, but there are often situations that require an evaluation and consultation. From a cost/time perspective, the evaluation fee does not even cover the hourly overhead costs. Likewise, it may mean lost time and money for you if you need to take time off from work. So it's a lose-lose proposition for both you and our office in terms of time and cost. But it's a win-win in terms of us providing, and you receiving, the best possible care.
HOW MAY VISITS ARE REQUIRED FOR ROOT CANAL TREATMENT?
Some teeth require one visit. Others require two (and occasionally more) visits. So the number of visits required for your last root canal or that of a friend who recently had root canal treatment is not a good guide for what is normal.
The need for one or several visits depends on many factors. The type and presence of symptoms, the presence of an abscess, the length, shape, and number of roots, the difficulty of the case, whether the canals are calcified, the presence of swelling, or the presence or possibility of fractures, are just some of the factors that determine this.
These factors can sometimes be evaluated from an x-ray but can sometimes only be determined by an in-office evaluation. Trying to schedule every root canal in one visit in a set amount of time is simply poor treatment.
IS ROOT CANAL TREATMENT PAINFUL?
The answer is no 99% of the time. In addition to taking great care to anesthetize slowly and gently, we anesthetize the tooth much more heavily than your dentist would for routine dentistry. For the vast majority of root canal procedures treated in our office, it is truly a non-painful experience. Most patients who have never had a root canal before are pleasantly surprised to find it is not the dreaded procedure they anticipated.
If you have had difficulty getting numb in the past or have had any bad past dental experience, please let us know so that we can ensure your treatment is comfortable. Please also refer to the section on Oral Sedation.
CAN I BE SEDATED FOR TREATMENT?
Sedation is available for treatment if desired. Please refer to the section on Oral Sedation.
SHOULD I EXPECT PAIN AFTER TREATMENT?
Over many years, we have found that about half of our patients tell us they felt little to nothing the day after treatment. The other half of the time we hear that the tooth was achy and sore to chewing for several days to a week. When it is sore, the discomfort most commonly peaks at 48-72 hours, then gradually subsides over the next several days. The use of an anti-inflammatory medication such as Ibuprofen (Motrin) helps to minimize this. You will be given two anti-inflammatory pain medications after each visit to have available if needed.
Occasionally a tooth can be significantly sore following treatment and take a week or two to subside. Fortunately, this is a minority of cases.
A High Tooth: If you find the treated tooth is hitting harder than your other teeth subsequent to treatment, please call the office. A simple adjustment can immediately reduce the discomfort of a high tooth.
DO I NEED ANTIBIOTICS AFTER TREATMENT?
Although antibiotics cannot take the place of root canal treatment, they are sometimes used during treatment to help your body more quickly resolve acute infection that has spread out of the root.
Antibiotics are only indicated when swelling or fever is present. Just as antibiotics are of no value for a cold, they are of no value for a toothache without swelling or fever. The majority of toothaches are due to inflammation of the nerve tissue. Antibiotics have no effect on inflammation just as they have no effect on the viruses that cause the common cold.
WILL I BE ABLE TO RETURN TO WORK THE NEXT DAY AFTER TREATMENT?
If you use oral sedation you would not be able to return to work that day as you would still be groggy. Without sedation, many people return to work after their appointment. With or without sedation, it would be very unusual not to be able to return to work the following day.
IS THERE AND ALTERNATIVE TO ROOT CANAL TREATMENT?
The only alternative to root canal treatment is extraction. Assuming the tooth will be replaced, the replacement options are a removable appliance (not usually desired or done for a single tooth), a bridge, or an implant. The usual method of replacing a single tooth is a bridge or implant--both of which are more costly than keeping the tooth with root canal treatment. But despite the greater cost, a bridge or implant is the best option in some cases.
Replacing the tooth with a removable appliance is a less expensive alternative but one that most patients find objectionable. Not replacing the tooth is, of course, the least expensive option initially, but often results in adverse effects on the opposing or adjacent teeth that may be more expensive to correct over time.
We will always discuss and explain fully your other options, their pros and cons, and their associated costs. Root canal treatment is not always the best option for every tooth and we will advise you of that in those situations.
IS A CROWN NEEDED AFTER ROOT CANAL TREATMENT? IS IT REALLY NECESSARY?
Although front teeth do not usually require a crown after root canal treatment, most back teeth need to be crowned ("capped") or run a high risk of fracture and tooth loss. A tooth that has had root canal treatment is usually already weakened due to large fillings or fractures and the root canal procedure adds to the weakened state if not followed up with a crown. If the tooth already has a crown on it, the existing crown does not usually need to be replaced.
I HEARD ABOUT A MOVIE CALLED "ROOT CAUSE" THAT SAID ROOT CANALS CAUSE CANCER AND HEART ATTACKS--ALONG WITH MOST OTHER HUMAN DISEASES. IS ROOT CANAL TREATMENT SAFE?
For anyone interested in this, see the very long answer under the Root Canal Myths section.