Pain sends many patients to the dentist. This is certainly the case when it comes to patients who need root canals. However, not feeling pain does not mean you don’t need a root canal.

Root canals are an endodontic technique to preserve natural teeth that have irreversible pulpitis, an infection of the nerve pulp of a tooth not able to be treated successfully. This condition can result from severe decay or an injury to the tooth. Often there is pain, but not always.

Here are a few important reasons to look beyond pain to discover whether your tooth needs a root canal treatment.

Looking Beyond Pain – Root Canal Treatment

1. Your endodontist is looking for infection as the cause of your troubles, not pain. Inflammation in the tooth’s nerve pulp is the cause the endodontist is looking for. Pain can accompany inflammation, but it is not a reliable guide to diagnosis.

2. Pain is only one symptom of needing a root canal. Other symptoms include teeth that are sensitive to heat or cold, swelling of the face or gums, or teeth that become gray or discolored.

3. Your infection may be draining, perhaps temporarily reducing pain, but also pouring foul toxins into your mouth. A pimple on the gum, called a fistula, or other types of pus drainage from the tooth are also symptoms of pulpitis. These conditions may temporarily reduce your pain, but the tooth will still need treatment: a root canal.

4. Pain associated with inflamed nerve pulp can be inconsistent. If your dentist puts you on an antibiotic to deal with an infected tooth, your pain may be relieved. Your pain may go away on its own, but this might be because the nerves in your tooth have died – not because the tooth is healthy again. Some patients who require root canals report “positional pain,” pain that emerges only when they sit up, lay down, or run in place.

“Determining whether a patient needs a root canal can be complex, and pain is only one factor considered in an evaluation,” says Dr. Jacqueline S. Allen, who practices with the Phoenix Endodontic Group. “Regular checkups with your general dentist and referrals to endodontic specialists as needed are the most reliable way to know if your natural teeth need a root canal to save them.” 

It can be a shock to learn you require root canal therapy to address an injured or infected tooth. If you’ve never been to an endodontist, or don’t have any friends or family who’ve had a root canal, you may naturally have a lot of questions about what to expect.

Understanding the details of root canal therapy can help you come to your first appointment better prepared. Here is a brief overview of the main stages of a root canal.

The Key Stages Of Root Canal Therapy

1. Confirmation of diagnosis. Your endodontist will confirm your diagnosis when you arrive for your first root canal therapy appointment by reviewing  your X-rays and performing  a visual inspection of your tooth.

2. Local anesthesia and dental dam placement. The endodontist will numb the area around your tooth with a local anesthetic. They will also place a rubber sheet known as a dental dam around the tooth to keep it clean and dry while they work.

3. Creating an access hole. After the tooth has been prepared and your gums numbed, an access hole will be drilled in the crown of the tooth to allow the dental pulp to be removed.

4. Pulp removal, filing, and cleaning. Once the access hole is created, the endodontist removes the infected tooth pulp, using special instruments to reshape the tooth’s canals and ensure all infected material is gone. Then the inner tooth is treated with antimicrobial washes to remove debris and aid healing.

5. Filling the root canals. This is the step that gives root canal therapy its name. A biocompatible material, usually gutta-percha, is used to fill the canals and prevent future infections.

6. Placement of temporary filling. The first part of the root canal procedure concludes with a temporary filling on your tooth to ensure the tooth heals and bacteria is not re-introduced while your permanent restoration is being fabricated.

7. Placement of permanent filling and crown. Your root canal therapy is not considered complete until a permanent filling is placed on your tooth, AND the tooth is capped with a crown. A crown provides extra protection against infection and shores up the structural integrity of your natural tooth.

“Patients are surprised sometimes to find out that root canal therapy follows a simple, straightforward process,” says Dr. Jacqueline S. Allen, who practices at Phoenix Endodontic Group. “But our profession’s approach to this procedure has been developed and refined for more than 150 years. We’re happy to explain each step in detail, and to address any concerns or questions you may have, every step of the way. We want each of our patients to be comfortable and confident.”

Patients often ask our staff at Phoenix Endodontic Group questions about their root canals looking to better understand what they will experience. Many people are concerned about the severity of the procedure or how much recovery time to plan for.

The good news is that many root canals have a quick recovery time – often just a week of special post-operative care. Many factors can impact your individual outcome, though, so it is important to understand the circumstances that brought you to the endodontist in the first place. Here’s a short list of some situations that can make the root canal procedure itself or your post-op period require extra care to ensure the root canal is successful.

What Makes A Root Canal A Serious Procedure?

1. When there is pre-existing infection or tooth damage. A crack or chip can let infection deep into a tooth’s pulp. Extensive tooth decay can also reach the pulp. If the infection causes an abscess, antibiotics may be needed first to eliminate the bacteria so the root canal can safely seal the roots so infection does not happen again.

2. When the tooth involved has multiple roots. The level of complexity involved with cleaning and sealing canals during a root canal increases with the number of canals in the tooth receiving treatment. Molars have up to four canals; premolars have one or two; canines and incisors have just a single canal.

3. When you don’t contact your endodontist if you have aftercare problems. An ordinary root canal can escalate quickly to challenging if you do not promptly call your endodontist when you experience pain that is severe or rapidly increasing; if the temporary filling placed in the tooth comes out; or if you can see swelling inside or outside of your mouth.

4. When you don’t return for your permanent crown as scheduled. The tooth being treated with a root canal should receive a permanent crown about two weeks after the procedure. Crowns provide structural support, protect the tooth from infection, and reduce nerve sensitivity to hot or cold foods and beverages. Not getting a permanent crown leaves your tooth vulnerable to further damage or infection and possible the failure of the root canal.

“The seriousness of each root canal is impacted by a patient’s individual oral health,” says Dr. Allen, of the Phoenix Endodontic Group. “We are happy to explain our assessment of your situation and provide tips for making your root canal successful and stress-free, so it can help you hold on to your natural tooth for the rest of your life.”

Popular culture often associates lasers with science-fiction weapons or real-life space exploration, but the technology can also be used inside the human body. At the Phoenix Endodontic Group, our endodontists frequently use laser-based tools to assist in root canal treatments.

The practice uses laser technology manufactured by Fontana (SSP and SWEEPS®) and Biolase (Waterlase) at its Phoenix office location. Both brands of tools provide extra assistance in the critical phases of cleaning and disinfecting tooth roots during a root canal treatment.

Lasers Bring Benefits During A Root Canal Treatment

1. The laser can provide initial cleaning in the coronal (crown) area of the tooth. An endodontist will begin a root canal by creating an opening in the crown. The laser can be used in this area of the tooth to remove calcifications and biological debris.

2. The laser can assist cleaning of the root canals. After a canal has been prepared using files or other tools, the endodontist may flood the canal with water and activate the laser while withdrawing the water from the space. The laser creates vapor bubbles, which collapse to form microbubbles and a pressure wave; these phenomena are what clean biofilm from the canals.

3. Laser treatment can also help disinfect the canals as they are being irrigated. Once the endodontist shapes the canals with their files, they will irrigate them with disinfecting liquids. Lasers can be used at this point to augment the disinfection process, with the pressure wave created by the vapor bubbles pushing the disinfectant deep into the canal recesses and generally making the process more effective than the traditional disinfecting step by itself.

4. Finally, lasers can be used to remove the chemical disinfectants prior to filling the canals. After the canals have been cleansed, shaped and disinfected, the laser tool can be used to remove the disinfecting liquid in the canals by activating it for about 30 seconds to vaporize any remaining liquid.

According to Dr. Jacqueline S. Allen, who practices at the Phoenix Endodontic Group, “One significant advantage to using lasers during root canals is that they can provide a more thorough removal of bacteria, debris and other materials without the risk of apical (tooth root area) extrusion.” She continues, “We are happy to explain to patients how we use Fontana and Biolase laser technology to enhance the safety and effectiveness of their root canal treatments.” 

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. Allen, 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.”