Root canals might not sound too exciting, but can be really beneficial. After all, they’re not as bad as many think. We polled the industry and here are six replies from those in the know on when a root canal should be considered.
Ronald Goldstein, DDS
Dr. Ronald E. Goldstein is commonly referred to as the “father of modern cosmetic dentistry”. He is one of the managing partners of Goldstein, Garber and Salama (GG&S).
A root canal should be considered when a patient is having a throbbing pain localized to a specific tooth especially if the x-ray shows an abscess at the end of the or one of the roots. There also should be sufficient bone to continue supporting the tooth. However, if the crown of the tooth is severely damage and there is too little bone to continue supporting the tooth then extraction and replacement with an implant or a fixed bridge should be considered.
Some of the other reasons for having a root canal are as follows:
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- If a patient has had a full crown placed on the tooth that fractures at the gum line even if no pain (the pulp canal could have been receded into the root) then a root canal treatment followed by a post buildup of the underlying tooth structure can result in saving the patient’s tooth…and at times I have found it possible to even use the patient’s own previous crown that broke off, removing the remaining tooth structure inside the crown and retrofitting it with glass ionomer cement in order to save the patient’s tooth. This also holds true if the tooth itself has fractured and not enough tooth structure to build it up…then performing a root canal and post can also save the tooth after placing a crown on top of the post.
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- Acute tooth wear….sometimes the teeth have suffered so much from advanced wear (bruxism) to the extent they are worn down to the gum line and again, a root canal followed by post buildup (either direct or indirect) and then a full crown can build back the arch especially when multiple teeth are involved.
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- Traumatic injury….could be from an auto accident or even a fight where a person was severely injured in the fight with teeth knocked out…if the person or friend can find the knocked out teeth and get the person to a dentist within the hour it is possible to replace the teeth into the socket and bond them to each other as an interim procedure…later if the teeth require it then root canal therapy can be done. The safest place to keep the tooth until getting the patient to the dentist is in the actual patient’s mouth.
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- Patients who have medical problems and the physician will not allow surgery (required to place the implant)…then root canal therapy is the best option. Just did this last year with good results.
- Economics: Sometimes it is less expensive to save the actual tooth with a root canal rather than extraction and implant followed by a full crown.
Dr. Sarah Jebreil DDS AAACD
I am a celebrity cosmetic dentist and also referred to as the ‘Smile Whisperer.’
Root canals are a dreaded treatment by most, but usually the reason why they are so unpleasant is because they should have been done a while ago and the tooth is just angry. There are a multitude of reasons why a tooth may need a root canal but for general purposes I am going to break it down into 3 categories:
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- Color – A tooth you hit with a beer bottle back in college starts changing color and getting darker. Is it just in your head? Probably not. Teeth can endure injury and be fine years afterwards with no symptoms and then suddenly change color. The change in color is a tale-tell sign that the nerve has died and a root canal is needed.
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- Temperature – Cold sensitivity is normal on teeth, but cold sensitivity that makes you jump out of your chair or hold your cheek for 5 seconds is not normal. Extreme cold sensitivity is usually an indicator of a nerve that is dying and a root canal is needed. Sensitivity to hot is a definite indicator of nerve damage and treatment is needed.
- Pressure – Pain to biting and chewing can mean there is an underlying infection. Pressure and throbbing pain when you lay down is a definite sign that there is an infection going on and treatment is needed.
Whatever the cause maybe it is best to discuss with your doctor the risks, benefits and alternatives to root canal treatment prior to embarking on treatment.
Anya Brodsky
Dr. Anya Brodsky is an attentive, friendly, detail oriented family and cosmetic dentist practicing on the Upper West Side of Manhattan.
A root canal is primarily considered when there is evidence of an infection in a tooth. This can be an acute or longstanding infection. There are certain symptoms and tests that dentists use to determine the vitality and prognosis of a tooth.
We check a thermal response (hot and cold), a percussion response (tapping), an evaluation of pain and swelling, sometimes a response to electrical stimulation, and often check to see if there is a fracture in the tooth. It is important to also know the quality and duration of the symptoms. In addition x-ray radiographs and sometimes 3D imaging are useful.
Dr.Pallak Razdan
I’m an Indian Dentist passionate about spreading knowledge about the field of dentistry and helping people in need.
A root canal treatment is a fairly simple procedure that involves removing the infected blood supply from the tooth root, disinfecting, cleaning and shaping the root canals and filling them up with a strong filling material called gutta percha.
A root canal treatment is indicated in the following cases:
- A deep dental cavity that has exposed the pulp(blood supply)
- Dental abscess (infection)
- Loss of tooth structure
- Trauma to the tooth
- Tooth fracture
- An RCT is also performed on adjacent teeth when a bridge is being placed to substitute for a missing tooth.
Hope this helps. Do let me know if you have any other questions or topics you’d like covered.
Uju Mbamalu, DMD
Born in Nigeria, Dr. Uju moved to New York City at a young age and spent the remainder of her childhood in Harlem. She obtained her Bachelors of Science degree in Sociology from Vanderbilt University in Nashville, Tennessee.
A root canal is necessary to repair a tooth and prevent its extraction. Endodontists are dentists who specialize in these highly sensitive and skilled procedures, as they save teeth via root canal procedures and other surgeries relating to root canals. Root canals are most commonly required to repair deep tooth cavities, traumatic mouth injuries or damaged fillings. I can address each of these factors.
A cavity forms when bacteria latches onto the enamel (tooth surface) and causes a breakdown of that surface. Without restoration, the cavity can deepen until it reaches the most internal part of the tooth, also known as the pulp. When this occurs, the only option to save the tooth is to undergo a root canal procedure, followed by a permanent restoration or filling.
In the case of trauma or a physical injury to the mouth, teeth will either fracture outright, or they will be vulnerable to bacteria seeping in through minor cracks. These traumatic injuries also require root canals, and are very common with kids and teens who are active or play sports.
Lastly, when an old filling or restoration is compromised, that breakdown makes the tooth vulnerable to bacteria and can also expose the second layer of the tooth, known as dentin. Both scenarios necessitate a root canal procedure.
In general, I advise patients to be mindful of a few symptoms when assessing the overall health of their teeth. These include lingering pain (more than 5 seconds); sensitivities to hot, cold, sweet, citrus items; and pain while chewing. If a tooth is infected, patients may also notice a bubble or swelling around the gums, or even externally on the mouth or cheek. Anyone experiencing the above symptoms should contact an endodontist to adequately diagnose and recommended treatment solutions.
Dr. Robert Stanley’s professional career began as a Mechanical & Aerospace engineer.