Root Canal Therapy

A root canal is one of the most common dental procedures performed, well over 14 million every year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges.

At the center of your tooth is pulp. Pulp is a collection of blood vessels that helps to build the surrounding tooth. Infection of the pulp can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms of the infection can be identified as visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.

If you experience any of these symptoms, your dentist will most likely recommend non-surgical treatment to eliminate the diseased pulp. This injured pulp is removed and the root canal system is thoroughly cleaned and sealed. This therapy usually involves local anesthesia and may be completed in one or more visits depending on the treatment required. We use local anesthesia to eliminate discomfort. We also offer nitrous and oral sedation for those people who are very anxious with dental treatment.

 Endodontic Retreatment

With the appropriate care, your teeth that have had endodontic treatment will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal or pain may continue to exist. Sometimes, the pain may occur months or years after treatment. If so, Endodontic Retreatment may be needed.

Improper healing may be caused by:

• Curved or narrow canals were not treated during the initial treatment.
• Complicated canals went undetected during the initial treatment.
• The crown or restoration was not placed within the appropriate amount of time following the procedure.
• The crown or restoration did not prevent saliva from contaminating the inside of the tooth.

In some cases, new problems can influence a tooth that was successfully treated:

• New decay can expose a root canal filling material, causing infection.
• A cracked or loose filling or crown can expose the tooth to new infection.

Once retreatment has been selected as a solution to your problem, Dr. Castro will reopen your tooth to gain access to the root canal filling material. This restorative material will be removed to enable access to the root canal. Dr. Castro will now clean your canals and carefully examine the inside of the problematic tooth. Once cleaned, Dr. Castro will fill and seal the canals and place a temporary filling in the tooth.

At this point, you will need to return to your dentist as soon as possible in order to have a new crown or restoration placed on the tooth to restore full functionality.

Apicoectomy

Generally, a root canal is all that is needed to save teeth with an injured pulp from extraction. Occasionally, this non-surgical procedure will not be sufficient to heal the tooth and your endodontist will recommend surgery. Endodontic surgery can be used to locate fractures or hidden canals that do not appear on x-rays but still manifest pain in the tooth. Damaged root surfaces or the surrounding bone may also be treated with this procedure. The most common surgery used to save damaged teeth is an apicoectomy or root-end resection.

An incision is made in the gum tissue to expose the bone and surrounding inflamed tissue. The damaged tissue is removed along with the end of the root tip. A root-end filling is placed to prevent reinfection of the root and the gum is sutured. The bone naturally heals around the root over a period of months restoring full function.

Following the procedure, there may be some discomfort or slight swelling while the incision heals. This is normal for any surgical procedure. To alleviate any discomfort, an appropriate pain medication will be recommended.

Cracked Teeth

Cracked teeth demonstrate many types of symptoms, including pain when chewing, temperature sensitivities, or even the release of biting pressure. It is also common for pain to come and go, making it difficult to diagnose the cause of discomfort.

Chewing can cause movement of the cracked pieces of your tooth, and the pulp within the tooth becomes irritated. At the same time, when biting pressure is released, the crack can close quickly, resulting in sharp pain. Eventually, the pulp will become damaged and tooth will consistently hurt, even when you are not chewing. It is possible that cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the problematic tooth.

Types of Cracks

• Craze lines

These are tiny cracks that only affect the outer enamel of the tooth. These cracks are more common in adults. These types of cracks are superficial and are usually of no concern.

•  Fractured Cusp

When a cusp becomes weakened, a fracture may result. The cusp may break off or be removed by a dentist. A fractured cusp sometimes damages the pulp, so root canal may be necessary. Your dentist will usually restore the tooth with a full crown.

• Cracked Tooth

This type of crack extends from the chewing surface of the tooth and vertically migrates towards the root. In some cases, the crack may extend below the gum line. It is possible for the crack to extend further into the root. Damage to the pulp is commonplace. In this case, root canal treatment is usually necessary. A cracked tooth that is not treated will worsen, resulting in the loss of the tooth. Therefore, early detection is essential. 

• Split Tooth

 A split tooth is usually the result of an untreated cracked tooth. It can be identified by a crack with distinct segments. This type of tooth can never be saved intact. Yet, the position and extent of the problem will dictate whether any portion of the tooth can be saved. Sometimes, endodontic retreatment by the doctors and restoration by your dentist can be used to save a portion of the tooth.

• Vertical Root Fracture

 A vertical root fracture begins at the root and extends towards the chewing surface of the tooth. Unfortunately, they show minimal symptoms and may go unnoticed. Treatment involves endodontic surgery if a portion of the tooth can be saved by removal of the fractured root. Otherwise the tooth will have to be extracted.

Traumatic Injuries

• Dislodged Teeth

Injuries to the mouth can cause teeth to be pushed back into their sockets. Your endodontist or general dentist may reposition and stabilize your tooth. Root canal treatment is usually started within a few weeks of the injury and a medication, such as calcium hydroxide, will be placed inside the tooth. Eventually, a permanent root canal filling will be implanted.

Sometimes a tooth may be pushed partially out of the socket. Again, your endodontist or general dentist may reposition and stabilize your tooth. If the pulp remains healthy, then no other treatment is necessary. Yet, if the pulp becomes damaged or infected, root canal treatment will be required.

• Avulsed Teeth

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you are treated immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist.

You can even put the tooth in milk or a glass of water (add a pinch of salt.) Your Endodontist may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored, may influence the type of treatment you receive.

Injuries in children

An injured immature tooth may need one of the following procedures to improve the chances of saving the tooth:

• Apexogenesis

This procedure encourages the root to continue development as the pulp is healed. Soft tissue is covered with medication to encourage growth. The tip of the root (apex) will continue to close as the child gets older. In turn, the walls of the root canal will thicken. If the pulp heals, no additional treatment will be necessary. The more mature the root becomes, the better the chance to save the tooth.

• Apexification

In this case, the unhealthy pulp is removed. The doctors place medication into the root to help a hard tissue form near the root tip. This hardened tissue provides a barrier for the root canal filling. At this point, the root canal walls will not continue to develop, making the tooth susceptible to fractures. So it is important to have the tooth properly restored by your dentist.

Sedation

Sedation Dentistry Options

Several different types of sedation range from: 

• minimal sedation (you are awake, but feel relaxed, with little to no anxiety)
• moderate sedation (you are awake, but deeply relaxed and you may not remember the procedure later)
• deep sedation (you are on the edge of consciousness or lightly asleep, but can be easily awakened)
• general anesthesia (you are completely unconscious)

Types of sedation are:

Inhaled sedation

This is the type of sedation most people are familiar with. “Laughing gas” or nitrous oxide is inhaled through a mask placed over the nose. You will not lose consciousness or go to sleep; you will simply feel much more relaxed throughout the procedure. Nitrous oxide is quite safe, and the dentist is able to adjust the amount of gas you receive throughout the procedure.

Plus, since it is a gas, most patients recover very quickly after the gas is removed and most will be able to drive themselves home after an appointment. Nitrous oxide is safe and effective; however, insurance typically does not cover this additional procedure and patients will have to pay out of pocket.

Oral sedation

Oral sedation ranges from minimal to moderate sedation, depending on how much medicine is prescribed before the appointment. Typically, patients will take one pill the night before the procedure and one or two pills an hour or so before your appointment. The pills are usually Valium or a similar oral sedative and will make you very drowsy. Some patients might even fall lightly asleep during their appointment, though they will be easy to wake with a shake.

Since an oral sedative causes drowsiness, patients who choose this method of sedation should always arrange transportation to and from our office. They may even want a friend, family member or caretaker on hand for a few hours to make sure they make it safely home into bed for a nice nap.

General anesthesia

This type of dental sedation will cause the patient to be unconscious throughout the procedure. Patients cannot be woken easily while the medicine is in effect. They will likely need another medicine to wake them, or will need several hours for the anesthesia to wear off.

This type of sedation is offered by our anesthesiologist and is for patients with extreme dental anxiety, who would like to be "put to sleep". This type of sedation requires our anesthesiologist to monitor vital signs during the procedure.