What is a Root Canal?

People ask me all the time....

"So what exactly is a root canal"?

Well it's really not that complicated. 

Let's make it a little easier to understand shall we.

The inside of your teeth are hollow. 

There is a CANAL running through them like a 

canal that carries water.

The canals run down the entire length of the the ROOT.

The canals in your roots carry the nerves of the teeth. 

When the nerve dies, and/or becomes infected, it will cause

pain and/or infection. 

A root canal is simply going into the ROOT to clean out the CANAL. 

Thus ROOT CANAL. 

The picture here simplifies it really well. 

The tooth on the left has a cavity that has gotten down into the nerve.

After a root canal, the picture on the right, there is no longer a nerve in 

the canals. There is now a filling. 

No nerve .......... No pain. 

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What if your dental visit doesn't fix the problem?

Lets say that you go into a dentist office. 

You have a problem. 

The dentist preforms some type of procedure and

tells you that the problem should be fixed.

The problem is not fixed however, and you want to

know what to do next.

First off, dentistry is medicine. 

Medicine doesn't always work.

The birth of a baby, sadly, is not always successful. 

Fusing a spine doesn't always get rid of the pain.

A total hip replacement doesn't always restore full function.

The same is true in dentistry. 

So what then? If the treatment doesn't "work" is a patient then just out of luck?

What is the Doctor's obligation if things still aren't going well for the patient?

Here is a list of what I think a health care provider should do, IF

sufficient time has been given for the procedure to take effect and 

the desired results have not been achieved. 

#1 Re-Do the procedure.

#2 Offer the services of a specialist, if there is a specialist

that can offer an advanced alternative.

#3 Provide information and/or preform alternative procedures

that could give the same result but in a different manner.

Here is a case that was successful ...........

the second time around.

The tooth in the middle of the shot needed a root canal.

Here is the picture of the finished root canal. 

The White line down the middle of the tooth is the filling material.

The filling material is not all the way to the end of the tooth but

is within the 1.5mm margin of error that is allowable for this

type of procedure. "By the book", this should have worked.

It did not however, and the patient was still in a significant 

amount of pain.

The option that was then chosen was to Re-do the root canal. 

All of the old material was stripped out.

The inside of the tooth was prepared further down the root.

The new filling material is now all the way to the end of the root.

The result is that the patient is now feeling much better.

Now there is a chance that the Re-do wouldn't have worked either.

At that point we would have moved on to the other options.

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Failing Root Canal?

Root Canals are like any other medical procedure. 

Sometimes they don't work.

So what do you do then?

One option is an Apicoectomy.

If you have no idea what that is then you are not alone.

In this day and age of implants this procedure has fallen out of favor.

But it should still be a very viable option in some cases.

Here is an apicoectomy we did just this morning. 

The tooth in the middle of the screen has the root canal.

You can tell by the white line running down the center of the root.

The white line isn't to the end of the root, and that may have lead to 

the continuous pain and discomfort that this patient was feeling.

You can tell from this photo that the root looks much shorter.

We surgically removed it.

We then cleaned out the infected area, placed a bone graft, 

and threw in a few stitches.

This procedure should allow the patient to maintain her 

original tooth while also getting rid of her pain.

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Do I just have a cavity or do I need a Root Canal?

So your tooth hurts. 

But how do you know if its just a cavity that needs filling

or if it's progressed to something much more serious and 

needs to have a Root Canal Treatment preformed on it?

First thing is to determine when the tooth hurts.

Cavities typically hurt only on exposure to hot or cold temperature changes.

Teeth that need root canals will hurt on biting, hot, cold, and 

perhaps most importantly, they may start hurting for no reason at all.

If you are just reading a book and your tooth starts hurting, 

you may be in trouble.

Another indicator would be the presence of an abscess. 

An abscess is a little bump next to the tooth on the gums.

This is a sign that there may be infection and that a root canal 

may indeed be in your future.

These are all general guidelines.

No matter what, if you feel any discomfort in your teeth you should

seek professional advice as soon as possible.

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Threatening your kids when they don't brush.

This post is not meant to be a lecture on how to raise children.

And trust me when I tell you that I do my share of threatening.

"You won't get any desert if you don't eat your beans."

"You wont get to watch the movie if you don't finish your chores."

Etc.

Etc.

The threatening that I am talking about is threatening your children

that they will have to get stabbed in the mouth with a needle by

the horrible mean dentist if they do not brush their teeth.

You may laugh, but it happens ALL THE TIME.

Children come in to get one simple cavity filled and they are out of

control and crying before they even walk through the door.

Their parents have scared them so badly that just the site of me sends

them into a screaming fit.

This wouldn't be so bad if the parent would then help me calm them down.

But that, usually, does not happen.

The parent will sit out in the waiting room and say things like....

"You knew this was going to happen" or

"Okay, you have to go get your shots now" or

"Don't cry, I told you he would drill on you if you didn't brush"

Do any of you know how hard it is for me at that point?

Do any of you know how hard it is on the child at that point?

Not only is it hard right then but this kind of thing will build an emotional

wall in that child that may remain for the rest of their life.

Most people that hate to come to the dentist due to experiences

when they were little children.

Bottom line is this.

If you can't get your children to brush their teeth by saying please or by using some

other type of positive reinforcement that is fine. Threatening to cut off the

x-box is, in my mind, a fine thing to do.

Just don't tell them how horrifying it will be to see the dentist.

It will makes things that much worse now, and later on down the road as well.

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Do I need a crown on my tooth?

Every instance is different but here is a tooth with multiple problems

that did not end up needing a crown.

The filling is experiencing some break down around the edges

and a case could be made to replace it.

What gives this tooth the added need to be worked on

is the hole that you can see in the bottom left of the tooth.

This tooth for sure needs a makeover now.

Our filing material of choice is the newer white filling material. 

It wears great, looks great, and polishes very well.

Not all teeth like this can be fixed without the use of a crown but

this one did and the patient was very happy.

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How do I know if the dentist did a good job?

When you are involved in purchasing goods and services, how

do you know that the good or service is of high quality?

Well a good piece of advice is to do your homework.

Before you go to buy a car you can read up on reviews

of different makes and models. Read reports on the durabilty

of the cars you are looking at. Ask people who have that

same type of car. 

Before you get a message find out what to expect. How long
will it be. Is the message therapist a male or female.
How much will it cost? Will I be soar afterwards?

This very same line of logic should be used when going to the dentist.
What procedure are you having done?
Will it be done in one visit or will it take multiple visits?
Will I be hurting after, and if so, for how long?
What should the X-ray look like?

Here is an example of a root canal that we did yesterday.

Before

After

After the patient was done with this procedure we showed her both of these
pictures and explained what it all meant.
If she had read up about root canals before hand she would have known
what to look for and could have asked questions.
This would ensure that she was satisfied with the work done.

Moral of the story?
Plan ahead.
Study what is going to be done.
Ask questions.
Ask to see before and after pictures.
Become educated.

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Root Canal 101

Okay so what exactly occurs during a root canal procedure?

Here are 3 pictures to show you exactly what happens.

First you come in with a tooth that is hurting.

After all the proper determinations are made as to which tooth and why

a root canal procedure may be started.

The black space in the middle of the tooth is where the nerve lives.

We need to gain access to that space to remove the nerve tissue.

The long white object jutting out of the tooth is referred to as a file. 

We use files to clean, shape, and gauge length of the inside of the tooth.

After much cleaning, shaping, rinsing, medicating, etc. etc. the space that

used to house the nerve now houses a ruberized material.

The hope now is that the tooth will no longer be capable of  sending

signals to the brain that are interpreted as pain.

The tooth then can either have a filling placed into the hole used to 

access the nerve chamber or a crown could be placed.

You and your dentist will need to discuss what options are best for you.

Now, obviously this is the ideal, and complications can make root canals

more difficult to complete. But hopefully things go smoothly and you

are out of pain relatively quickly after the procedure is complete.

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How do I know if I need a Root Canal?

Teeth are like any other part of the body.

Sometime they may have a funny little pain here or there.

Sometimes these pains may come one minute and then are gone the next.

Sometimes however, the pains come and stick around for a while.

So how do you know if your tooth is in real trouble or just having

a little irritation that will go away quickly?

Well, there are 3 questions that we typically ask people to 

determine the extent of their tooth trouble.

#1 Does your tooth hurt with hot and cold temperature change?

#2 Does your tooth hurt to chew on?

#3 Does your tooth hurt when you are just sitting

around doing nothing (reading, watching T.V., etc.?)

If you answered yes to all 3 of these then you, more then likely, 

need to have a root canal.

However, if you answered yes to only 1 of the questions then

perhaps it will be a little easier of a fix.

No matter what it is always a good idea to have a dentist chekc

out your teeth if you think something is going wrong.

Implant continued.

We were back with our good buddy Collinn today.

I changed the spelling of his name to protect his innocence. 

Collinn had a root canal that failed (not mine :) )

The dark area at the end of the tooth denotes infection 

originating from the failing root canal.

This is the site after the extraction occurred. 

The area was also cleaned of infection 

and a bone graft was placed.

Here is a picture of the implant that was placed 

about 4 weeks after the extraction took place. 

the top of the implant is right at the bone level

and the infected area looks to be healing nicely.

After 6 weeks (this morning) the abutment (top of the implant) was placed.

This part is what what the new crown will sit on.

 Things are going swimmingly.

Within 2 weeks we will have the final crown in place

and Collinn will be back to is good old self.

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What's on the inside of my tooth?

Your teeth are hollow.

The hollow chamber contains the blood vessels 

and nerves that give your teeth, life.

A root canal is simply the process of accessing this

chamber and scrubbing it clean of all its contents

so that it can't cause you anymore pain.

This is the inside of a molar. 

We were almost completed with a root canal when

I decided to snap this picture.

Since this is an upper molar it has 3 roots on it.

Typically each root has one canal in it.

After the inside has been scrubbed clean the

canals are then filled with a rubberized material.

The hole we make to access the nerve chamber is then

filled with a typical filling material used to fill cavities.

The pink stuff you can see inside the tooth

is the rubberized material that has already

been placed down into the canals.

Here is a X-Ray of the molar before we worked on it.

Notice in the teeth that there is a black line down the center, 

that is the hollow space where the nerves reside.

Now instead of black lines you can see white lines.

Those white lines are the rubberized material.

If all goes well this tooth will no longer cause the patient any more trouble.

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