Fixing a cracked tooth can be like figuring out the damage after a car accident. If you don’t have a professional check things out, what looks like a surface dent can actually turn out to be really serious. Since dental bone does not behave like other types of bone and cannot knit itself back together, a chip or a crack to the tooth is likely to get worse over time.

In the case of a cracked tooth, your repair expert is an endodontist. Endodontists are experts in saving natural teeth. They frequently see clients with a cracked tooth, and can use their dental specialty training to determine if additional intervention such as a root canal is needed before placing a crown on the tooth.

When Does A Cracked Tooth Need A Root Canal Before A Crown?

The main job of a dental crown is to provide structural support by acting as the new outer surface of a tooth. Before a crown is cemented into place, your endodontist will want to make sure the natural tooth underneath the crown is as healthy as possible. If there is any injury or infection in a tooth’s nerve pulp, a root canal can provide a healthy tooth underneath.

With a crack deep enough to damage the root pulp, a root canal will be needed to prevent further difficulty, possibly extraction. It can be difficult to tell from symptoms alone if you need a root canal before you get a crown placed on your cracked tooth. Some cracked teeth that need a root canal before the crown hurt a lot; some do not. Some teeth with large cracks do not have root/nerve damage, but some teeth with much smaller cracks may have infected nerve pulp that must be removed via a root canal.

It’s important to see your endodontist right away because there are some types of cracked tooth injuries that cannot be remedied with a root canal and a crown. If the crack in the tooth extends below the gum line, it’s highly likely that the tooth will need to be extracted.

“It’s vital to have an endodontist perform a careful evaluation of a cracked tooth – what you can see on the surface may not be an accurate picture of the entire situation,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “Our office can perform the diagnostic procedures needed to determine if a root canal is called for before a crown is placed on the tooth.”

Although advancements in technology and microsurgical techniques have made root canals more comfortable and less stressful, the procedure still requires significant investment of time, money, and care. Root canals aren’t inevitable, though – you can reduce your risk of needing one with targeted, proactive self-care.

The tips below can help you prevent a root canal. They focus on managing your risk of falling prey to the three major causes of root canals: tooth decay, infection, and injury. By diligently following these tips, you can greatly lower your chance of needing a root canal, or developing serious oral health problems.

Keeping Teeth Strong And Healthy: 5 Tips For Avoiding A Root Canal

1. Brush your teeth twice a day. A twice-daily toothbrushing routine is the first line of defense against tooth decay, a major contributor to the type of dental pulp infections that require a root canal to resolve. Use an American Dental Association (ADA) approved fluoride toothpaste on a soft-bristled toothbrush.
2. Floss your teeth once a day. This will amplify the effectiveness of brushing your teeth. Flossing cleans the 40 percent of tooth surfaces that cannot be reached by brushing.
3. Strengthen your teeth with calcium-rich foods. Dairy products such as milk, yogurt, and cheese provide calcium to protect and build tooth enamel. You can also get calcium by eating green leafy vegetables, including bok choy, Brussels sprouts, and kale.
4. Use care when you bite down. This tip applies any time you apply force with your teeth. Be careful eating foods like nuts or peanut brittle or hard pretzels. And if you use your “teeth as tools” to rip, tear, or clamp down on things – stop it!
5. Wear a mouthguard for sports or workouts. Use a mouthguard when playing ANY sport where a collision or fall is possible. Mouthguards should also be worn during fitness activities such as rock climbing, hiking, or even cycling. To best avoid dental injury that could lead to a root canal, get your mouthguard professionally fitted.

“Chances of needing a root canal can be minimized with proper planning and the right habits,” says Dr. Susan L. Wood, an endodontist at Phoenix Endodontic Group. “Visit your dentist for regular checkups and cleanings, and always let them know if you experience any discomfort or symptoms indicating you need a root canal.”

The benefits of a root canal treatment when you have a tooth that is infected or injured are significant. First and foremost, you keep your tooth. Root canals also effectively reduce tooth pain, decrease the chance that serious dental infection will spread to adjacent teeth, and prevent the loss of bone density in the jaw, a common after-effect of tooth loss.

With all these advantages, the longer a root canal treatment can contribute to preserving a natural tooth, the better. The lifespan of a root canal treatment can vary considerably, depending on the circumstances. Here are several important factors that can play a role in how long your root canal treatment may last.

Factors Impacting Root Canal Success

1. Which tooth needs the root canal? The position of the compromised natural tooth will influence how complex the root canal procedure will be. Front teeth typically have only a single tooth root. Your molars, on the other hand, have two or even three root canals to be cleaned and filled, and will require a crown to protect the natural tooth afterward.

2. How bad is the damage to the tooth? Severe tooth decay or a crack or chip in a tooth can lead to inflammation or infection so bad that an abscess forms. If the outer structure of the tooth is still intact, there is a better chance that a root canal will last longer.

3. Who will perform the root canal? Endodontists are specialists in saving natural teeth. Surveys indicate that endodontists perform, on average, 25 root canals a week; general dentists average far fewer. One study found that 98 percent of root canals done by endodontists are successful, along with 90 percent done by general practitioners.

4. Will additional treatment be needed? The overall health of the tooth impacts whether a root canal is the best treatment. If the structure of the tooth itself is weak, a post and core procedure may be performed after the root canal to help anchor the crown and hold the natural tooth together.

5. Are you motivated to take care of your natural teeth? Patient involvement in the root canal process is critical to ensuring its long-term success. Contact your practitioner if you have unusual postoperative pain or if your temporary crown falls out; get the crown for the treated tooth promptly; and contact your dentist or endodontist if you have symptoms indicating tooth root infection at any point.

Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group, says, “Root canals can preserve natural teeth for years or even decades – and for some, they can last a lifetime. Our practice can instruct you in all the ways you can ensure your root-canal treated tooth stays healthy for as long as possible.” 

It seems that our schedules continue to get busier these days and are full of activities that need to be accomplished, particularly this time of year. If you are dealing with the challenge of an infected or injured tooth, you may wonder if you really have to schedule a dental appointment to place a permanent crown over a tooth that’s been treated with a root canal. There’s so much else to do!

You may ask,“Can’t I wait until early next year to schedule my crown appointment?” The short answer to that question is NO. Here are a few reasons why you should schedule your follow up appointment to receive your crown within one to three weeks after your root canal.

Reasons Why You Should Not Delay Getting A Crown After Root Canal Treatment

1. A longer wait means a longer period of being extra careful. Many of the instructions you receive after your root canal – especially the ones related to eating soft, bland foods – are designed to protect the temporary crown. If you wait longer to get a crown, you will have to continue that regimen.
2. Until a final restoration (crown) is placed, your tooth remains at risk of further damage. A root canal-treated tooth can be more brittle after the procedure, and a permanent crown is needed to prevent future damage.
3. Your tooth may suffer extra sensitivity without a crown. Some teeth treated by root canals can become more sensitive to heat or cold. Permanent crowns reduce this effect.
4. The longer you wait, the more likely you are to have the temporary crown fall out. Your temporary crown is not secured to your tooth in the same way a permanent crown is. If it falls off, the chances that you will experience increased pain or reinfection can skyrocket, as can cost. Such situations often result in unplanned emergency trips to the dentist.
5. A permanent crown gives your natural tooth the best shot at long-term survival. A study published in the May 2020 Journal of Endodontics reported that natural teeth treated with a permanent crown restoration have a survival rate of more than 90 percent over nine years. The extra layer of outer protection provided by the crown safeguards the interior protection offered by the root canal.

“Having a root canal is the first step to rescuing a compromised natural tooth,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “Having a permanent crown placed over that tooth within one to three weeks ensures a much higher level of certainty that your tooth repair will last a lifetime.”

If you’ve been referred to a Phoenix endodontist and have never seen one before, you might wonder what services they provide. Endodontics is recognized as an official specialty field for dentists by the American Dental Association. Endodontists attend two to three years of additional training after graduating from dental school. During their post-graduate training, they receive instruction in advanced microsurgical techniques and learn the latest in effective pain management methods.

Here’s a quick look at the types of procedures Phoenix Endodontic Group performs as part of their mission to save natural teeth whenever possible.

Procedures Performed By Phoenix Endodontists

1. Root canals and root canal retreatments. Root canals are frequently how patients first meet an endodontist. The procedure preserves natural teeth by cleaning infection out of a tooth’s root canal, and replacing the nerve pulp inside of a tooth with biocompatible material. A crown is placed over the treated tooth to protect it. Root canal retreatments can fix things that go wrong with an initial root canal, such as new decay entering the tooth or the tooth being further fractured.
2. Endodontic surgeries. Root canals, which are a non-surgical procedure, are typically very effective at treating a tooth threatened by infection or structural damage. Some cases require more intensive treatment. An apicoectomy is a surgery that treats damaged root surfaces or persistent infections in the bone surrounding the tooth. Recovery time for endodontic surgeries, just as for root canals, is usually brief. Postoperative discomfort is usually mild and easily remedied.
3. Dental trauma treatment. Your Phoenix endodontist can help save a damaged tooth, but you must act quickly. Regardless of the level of damage to a tooth – from a small chip or crack to a tooth that’s been knocked out of your mouth – you need a full examination of your teeth and gums to determine the next steps to be taken. An endodontist has equipment, dental training, and experience to preserve a damaged tooth; they can determine if a root canal or another procedure is the best one to protect and preserve the structure of your tooth.
4. Dental implants. More and more Phoenix endodontists are providing dental implant services for patients. The reasoning? All dentists receive training related to dental implants in dental school, with many endodontists receiving additional training in the placement of implants, as well. Endodontists are uniquely positioned to determine if a natural tooth can be saved. If a tooth cannot be saved, your endodontist can play a key role in the replacement of it.

“Phoenix Endodontic Group endodontists work closely with general dentists from across the Valley of the Sun to provide the best treatment results for all our patients,” says Dr. Susan L. Wood, of the Phoenix Endodontic Group. “Together, we can diagnose, collaborate, and treat dental challenges, so each patient experiences the most positive outcome for their case.”

While persistent pain is a common sign that a tooth is in trouble and may need root canal treatment, it isn’t the only indicator. If your tooth doesn’t hurt but you have other symptoms, you shouldn’t ignore the problem until it DOES.

To understand why pain should not be your only indicator to check with your endodontist to see if you need a root canal, let’s look at how dental professionals assess a potential root canal case.

You May Need A Root Canal – Whether You’re In Pain Or Not!

When you go to the endodontist to be evaluated for a root canal, they will take x-rays of your teeth, as well as examine your mouth and gums carefully, performing tests to determine if your tooth’s nerve pulp is damaged. They will ask you questions about symptoms you may be experiencing. Some conditions that will definitely get their attention include:

1. Swollen gums. Often, waste products from a tooth with dying or dead pulp will build up near the affected tooth, causing tenderness and swelling in your gums. The swelling doesn’t have to be constant to be of concern.
2. Gum boils. This term refers to a small pimple-like pocket of pus that can form on the gum near the affected tooth. If the boil drains into your mouth, you may experience an unpleasant taste in your mouth or bad breath.
3. An individually darkened or discolored tooth. A tooth that is noticeably darker than those around it can signal that the tooth has experienced some sort of trauma or damage. While not every darkened tooth needs a root canal treatment, discoloration frequently prompts investigation to clarify what is going on inside the roots of the tooth.
4. Tooth mobility. If an individual tooth feels loose, your endodontist will want to evaluate the cause. A loose tooth can be caused by acidic waste products from an infection softening the bone around that tooth’s root.
5. A chip or crack in the tooth. Even if it isn’t causing pain yet, chips and cracks in the enamel of a tooth can let in infection, allowing damage to the nerve pulp that can only be treated with a root canal.

“Tooth pain can indicate a variety of dental conditions best treated with prompt intervention,” says Dr. Susan L. Wood, who practices with the Phoenix Endodontic Group. “However, pain is not the only or even sometimes the most reliable signal that something needs attention. Your endodontist has the equipment and the experience to evaluate your symptoms and discuss whether a root canal or another type of procedure is needed to return your mouth and gums to full health.”

For many years, comedians have regularly used the term “root canal” to capture any painful experience. The jokes weren’t funny to anyone who actually needed a root canal – fear of pain was sometimes enough to keep them from getting badly needed care.

Today’s root canals, though,  have advanced dramatically in terms of technique and technology from 20 or even 10 years ago. In many cases, a root canal now relieves dental pain, instead of intensifying it.

Your endodontist is trained in pain management for root canals and other procedures that involve the roots and nerve pulp of your teeth. The amount of discomfort you experience during and after a root canal will vary with your individual circumstances, but here are some of the most common factors that can impact your pain level.

What Factors Influence Root Canal Pain?

1. The amount of infection in or damage to the tooth prior to the procedure. Root canals are performed on teeth with infected, inflamed, or damaged tooth pulp. One common symptom of tooth pulp damage is persistent tooth pain. If your tooth is badly infected before your root canal, it can also be more sensitive afterward.
2. How you use pain relievers after your root canal. Some tenderness and sensitivity is expected after the procedure. Your endodontist can provide guidance on when to take over-the-counter pain relievers and what kind of dosing schedule to maintain until the pain is no longer a distraction.
3. How closely you listen to and follow post-procedure instructions from your endodontist. After your root canal, you will want to avoid chewing with the affected tooth until it has received a permanent dental restoration (typically a crown). You will also want to choose soft, cool foods like applesauce or yogurt to eat for the first few days. Hard, hot, or crunchy foods increase the likelihood you will feel sensitivity or pain when you eat.
4. How quickly you report any severe post-procedure pain. It’s imperative you call your endodontist right away if you experience sharp or severe pain after your root canal; this can indicate that infection has returned. You will need to be seen to assess the situation, and your endodontist can plan additional pain and infection management steps.

“Today’s root canals rarely involve severe pain,” says Dr. Susan L. Wood, who practices at the Phoenix Endodontic Group. “Your endodontist is your partner in managing discomfort after a root canal and is the first person you should call if that pain becomes severe.”

While more and more Americans are becoming aware of the benefits of preserving natural teeth, you may still find yourself with a number of questions and no little anxiety when a root canal is the suggested option for saving a diseased or damaged tooth. Root canals can be an intricate procedure, depending on the extent of the damage to the tooth. Occasionally, sedation is called for. However, most of the time, patients are awake during the procedure and fully aware of each step the endodontist is taking. Each case is different, though, so let’s look at the issue a little more broadly.

How Endodontists Manage Pain And Patient Awareness During Root Canals

• For most root canals, local anesthesia is used to numb the area around the affected tooth. This is a necessary step because your endodontist will be removing pulp and nerve fibers from your tooth. You will likely be fully awake during the entire procedure. Your mouth, including your lips, may feel numb for several hours after the procedure, so it is important to be careful if you eat or drink before full feeling returns to the numbed area. Be sure to follow your endodontist’s guidelines for eating and drinking, though.
• For patients with dental anxiety or dental phobia, some level of sedation may be necessary for the root canal to be a success. Sedation can range from minimal (just to take the edge off your jitters) to deep (where you may be barely conscious, but able to be awakened). It can be delivered by inhalation, orally, or intravenously. General anesthesia – during which you are completely unconscious – is rarely used for root canals and requires special training to safely administer.

Dr. Susan L. Wood, of the Phoenix Endodontic Group, encourages patients to discuss questions related to wakefulness and anxiety with their endodontist during the planning stages of their root canal. “In our practice, we make sure all our patients are fully informed and arrive ready for their root canal,” she says. “We can discuss your individual needs prior to beginning the procedure and offer solutions that will help you feel comfortable, safe, and pain-free.”