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Pulp, a collection of blood vessels at the center of the tooth, helps to build the surrounding tooth. Pulp infection can be caused by trauma to the tooth, deep decay, cracks and chips, or repeated dental procedures. Symptoms are visible injury or swelling of the tooth, sensitivity to temperature or pain in the tooth and gums.

More than 15 million root canal treatments are performed every year, making it one of the most common dental procedures. This simple treatment can save a natural tooth and prevent the need for replacement with an artificial tooth. It is necessary when a tooth’s pulp becomes inflamed by deep decay, trauma, fractures or repeated dental procedures. The typical symptoms are tooth pain, sensitivity to heat or cold, swelling and tenderness in the adjacent gums, discoloration of the tooth and development of an abscess.

After the endodontist takes a digital x-ray of the tooth, the tooth will be tested for pain from biting, palpitation, percussion and cold and heat sensitivity and assessed for mobility and surrounding gum tissue health.

The endodontist will numb the tooth with a local anesthetic and place a small protective sheet called a “dental dam” over the area to isolate the tooth from the surrounding area to keep it clean and free of saliva during the procedure. Then the endodontist makes an opening in the crown of the tooth and uses small instruments to clean and shape the pulp chamber and root canals to prepare the canal for filling.

Cleaned spaces are filled with a biocompatible material with an adhesive cement to seal the root canals, and a temporary filling is used to close the opening. The endodontist may use a post inside the tooth if it cannot hold the restoration in place. You can drive home and resume your normal routine, returning to the endodontist to have a crown or other restoration placed on the tooth and then to have a follow-up appointment. 

Dislodged Teeth

Injuries to the mouth can dislodge teeth, pushing them back into their sockets. An endodontist or general dentist can reposition and stabilize your tooth initially, prior to starting root Canal treatment a few weeks later. A medication is placed inside the tooth, followed by a permanent root canal filling. When a tooth is pushed partially out of the socket, an endodontist or general dentist may reposition and stabilize it. If the pulp remains healthy, then no other treatment is necessary, but root canal treatment is required if the pulp becomes damaged or infected. Otherwise, there can be infection of the tooth, root system or surrounding tissue, inadequate hygiene because of an inability to properly clean the dislodged tooth and the gums and loss of the tooth.

When an injury causes a tooth to be completely knocked out, it is important to be treated immediately. Keep the tooth moist and try to put it back into its socket. A tooth can be saved if it remains moist, even in a glass of milk or water with a pinch of salt. The endodontist may start a root canal treatment based upon the stage of root development, the length of time the tooth was out of the mouth and the way it was stored.

Injured immature teeth may need one of the following procedures to improve the chances of being saved:

In this procedure, which encourages the root to continue development as the pulp is healed, soft tissue is covered with medication. The tip of the root (apex) closes as the child gets older, and the walls of the root canal 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.

Unhealthy pulp is removed by placing medication into the root to help a hard tissue form near the root tip, providing a barrier for the root canal filling. Because the root canal walls will not continue to develop, the tooth will be susceptible to fractures, necessitating restoration.

While most teeth that have had a root canal and get proper care will last as long as other natural teeth, some teeth that have received endodontic treatment experience failure to heal or continuing pain months or years after treatment. That may require another endodontic procedure called retreatment.

Reasons for improper healing may be:

• Complicated canals undetected during the first treatment
• Narrow or curved canals not treated during the first treatment
• A crown or other restoration not placed at the right time after the first treatment
• Contamination from saliva inside the mouth not prevented by the restoration or crown
• New decay exposing the root canal filling material to bacteria, causing a new infection in the tooth
• A cracked or broken crown, or a loose filling, exposing the tooth to new infection 

Sometimes a partial crack (fissure) extends into the dentin but is too small to appear on an x-ray. It may extend to or through the pulp of the tooth or under the gum, causing pain when chewing, temperature sensitivities or the release of biting pressure. If untreated, it can lead to severe pain, pulp infection, abscess or tooth loss.

The endodontist will examine the cracked tooth will be examined by the dentist. A bite test may confirm the diagnosis. Root canal therapy can be the solution if pain continues after stabilization of the crown restoration.