Endodontics 101

Endodontic (root canal) treatment is based on a very simple concept: the dental pulp in a mature tooth can be removed when it becomes inflamed or infected and the tooth remains healthy without it. The pulp itself consists of very small blood vessels and nerve tissue located in the center of each tooth in the root canal. The primary function of the pulp is to lay down hard tooth structure (dentin) during the developmental stage of each tooth. It has a limited blood supply, however, and is highly susceptible to inflammation and infection. Dr. Richard Bush, Dr. Wesley Reed, Dr. Steven Forgione, Dr. Timothy Gresla, and Dr. Ali Salepour are endodontists in Winchester, MA and Burlington, MA just north of Boston. They specialize in endodontic treatment,  apicoectomy and the treatment of teeth injuries, utilizing the latest in dental technology.

What would cause the pulp to become inflamed or infected?

Decay, trauma, or extensive restoration of a decayed or cracked tooth may result in pulpal inflammation or infection. Pulpal inflammation is a common occurrence following a deep restoration (filling) or preparation for a full crown. Unfortunately, fillings do not last forever. Over time they can break down and begin to leak which can promote decay or small cracks in the underlying tooth structure. For this reason, fillings eventually need to be replaced or, in some cases, filled teeth may require the support of a full crown restoration. The very act of replacing a restoration or preparing a tooth for a crown may result in inflammation and a damaged pulp. Evidence of this inflammation may be extreme sensitivity to cold, heat, or pressure from biting. Endodontic treatment eliminates this sensitivity and allows the tooth to be healthy and functional.

How is endodontic treatment performed?

Although the rationale for endodontic treatment is uncomplicated, the treatment itself can, at times, be tedious. As we age, the canals in our teeth tend to narrow or “calcify.” This can make the process of locating and cleaning them somewhat time-consuming. With the use of our operating microscopes, treatments can often be completed in a single long appointment. It should be stressed that, although the treatment may require a long appointment, it should in no way be painful. To begin, a local anesthetic is administered and, once the area is completely numb, treatment is initiated. An opening is made in the biting surface on a back tooth or the tongue side of a front tooth. Through this access-opening, small instruments (files) are inserted to remove the pulp tissue and widen the root canals. This accomplishes two things: first, it eliminates the pulp, which is the source of inflammation or infection and second, it creates a shape inside the tooth that will accept a root canal filling. The filling material is called gutta-percha, which is a rubber-like material that is biocompatible and has been used successfully for this purpose for many years.

How should a tooth feel after endodontic treatment?

It is a very common misunderstanding that a tooth is “dead” or without any sensation following endodontic treatment. The pulp that is removed from within the tooth is, however, is responsible for only part of the feeling of the tooth. Around its outside surface in the root area is the source of nutrition that keeps the tooth alive, the periodontal ligament. The nerves in this area transmit pressure sensitivity. The periodontal ligament is not only alive but also somewhat temporarily inflamed from an endodontic procedure. For this reason, it is normal for a tooth to be pressure sensitive following endodontic treatment. The severity and duration of this pressure sensitivity depends on the prior condition of the tooth as well as the amount of manipulation required during treatment. Sensitivity to a degree that requires analgesics usually diminishes in about 48 hours.

What is the success rate for endodontic treatment?

Success rates are in the 95% range. Factors that limit the success are the presence of lateral canals or irregularities in the root canal system that are difficult to thoroughly clean, or cracks in the tooth that permit contamination from the outside of the tooth. These limiting factors are infrequent and the majority of endodontically treated teeth remain comfortable and functional for a long time. For a more detailed description of endodontic treatment as well as pre-treatment and post-treatment recommendations, please visit our procedures link.