Root Canal Therapy

Inside teeth there are a collection of living blood vessels, nerves, lymph, and connective tissue known as the dental pulp. The pulp resides in a chamber near the chewing surfaces of the teeth and extends to the root end of the tooth via a root canal, eventually exiting into the jawbone. A ligament surrounds each tooth root in the jawbone that helps anchor the tooth while you chew food; many different nerves are located in this ligament.

Most of the time, the dental pulp is healthy. However, at times deep dental decay (a cavity), cracks from past dental trauma, or injury from dental work can irritate the pulp, producing inflammation inside the tooth and in the ligament around the root ends. At this stage patients usually suffer from significant pain spontaneously, when they chew on their tooth, or when they try to enjoy cold or hot food/drink. This inflammation can cause an infection around the tooth roots in the jawbone called a dental abscess. If this dental abscess matures and the infection gets worse, sometimes a cellulitis (or a facial swelling) can form. This may cause fever and rarely may cause difficulty swallowing and/or breathing.

 

 

When significant inflammation and infection of the dental pulp exists (usually with patient experiencing painful symptoms), root canal therapy is necessary. Routine treatment has a very high success rate of ~90-95%.

Unlike other areas of the body, once the dental pulp becomes injured with inflammation or infection it is not able to naturally heal itself properly. Sometimes the body may “strike a balance” between the infection inside the tooth and the outside area of bone and ligament; although the dental abscess is still present, the usual pain and symptoms may go away for a period of time. This does NOT mean that the tooth no longer needs root canal therapy. Just because the tooth doesn’t hurt does not mean that the abscess in the jawbone will go away or isn’t a problem anymore. In fact, this abscess usually gets larger and matures into a more robust infection with time, potentially decreasing the success rate of root canal therapy by up to 20%.

 

After gently numbing your tooth with special topical jelly and anesthetics, Dr. Kruszewski will isolate your tooth with a small rubber sheet (think of it as a “tooth poncho”). This ensures that there will be no contamination of the inside of the tooth from saliva (which naturally has much bacteria), and will protect you from the strong disinfectants and materials used during treatment. A small hole will be made, or access opening, on the chewing surface of the tooth. This enables Dr. Kruszewski to reach the infected pulp space of your tooth. The inside of your pulp chamber and root canal areas will be cleaned and disinfected, removing the infection with special tiny instruments and disinfectant solutions.

 

 

An xray will be taken to verify the fit of the root canal fillings in your tooth and the inside of the root canals will then be dried. Dr. Kruszewski will then seal the inside of the root with a permanent gutta percha filling, a special rubber-like material with cement. A temporary filling will then be placed in the access opening and final xray will be taken.

Once root canal treatment is complete, it is recommended you return to your general dentist within ~2 weeks. Then, your general dentist will replace Dr. Kruszewski’s temporary filling with a permanent filling of their choice, called a core buildup. A crown is usually completed after the core buildup, but your general dentist will explain what is best for your tooth.

 

After treatment, you may have some mild discomfort when you chew on your tooth for a few days to 1 week while the area is healing. Dr. Kruszewski will explain which medications are appropriate to use during healing.

Your body will begin to heal the area in the bone where the abscess was located near the root tips. This process usually takes 1-2 years to occur, and in some cases may take up to ~4 years. We will re-examine your tooth at appropriate times after treatment to ensure the bone is healing properly.