If there's any one dental topic that is misunderstood, it's root canals. Maybe it's because of the name. If you think about it, almost every other dental treatment term sounds fairly harmless (filling, cap, crown, bridge, implant, etc). Heck, they even sound somewhat pleasant. But "root canal" sounds downright hideous (and painful), doesn't it?
Then there's the "legend" of the root canal. Everyone knows someone who "had a root canal, and it was horrible! In fact, it was the worst five hours of my life!!!" (Note: they must have had a really slooow dentist. Root canal therapy does not take five hours.) I guess this is where the expression "I'd rather have a root canal" to describe something really unpleasant comes from.
Ok, so let's spend this post talking about root canal therapy, and why it's nowhere near as bad as you think.
Let's start with the term itself. If you notice, I've already used the term "root canal" to describe the treatment, but, truthfully, that's not accurate. The "root canal" is the center of the tooth where the circulatory system and nerves are located. In other words, we ALL have "root canals." And when we need our root canals worked on, it's called "root canal therapy" or "root canal treatment," or the technical term, "endodontic therapy." But I'm splitting hairs here -- if you want to call the treatment a "root canal," that's fine -- everyone (even me) will know exactly what you are talking about.
Now that we have the name cleared up, let's discuss why one would need root canal therapy. The most common "obvious" cause is an infection/abscess at the bottom of the tooth. Once a tooth has gotten to a point where it's infected, root canal therapy is usually the only hope of "saving" the tooth. Untreated cavities can lead to this type of infection, as can cracking/fracturing. Many times, the reasons for infection can go unnoticed until it's too late. A dentist may also recommend a root canal if he or she feels future infection is inevitable.
In fact, I personally feel it's the infection/abscess factor that leads to most of the "root canal dread" people experience. See, an infected tooth is often very painful -- if you've had a swollen face/abscessed tooth, you know exactly what I am talking about. Bite on an infected tooth and prepare to cry out. So yes, if we're going to dive in there and fix it, it's going to be deemed unpleasant, even if the pain is actually coming from the affliction, not the treatment. Couple this "painful infection" factor with the fact that, until recently, root canal treatments usually took multiple visits, and you have the makings of a horror story worthy of telling around the campfire.
However, in my long career as an NYC Cosmetic Dentist I can tell you that in almost every case, my patient has been relieved to have had the root canal therapy, because I made the constant pain go away. And to be honest, infections are usually handled with antibiotics before we start and Novocain generally ensures a pain-free procedure. So don't be afraid if you need root canal therapy -- the good it will do will outweigh the bad by a considerable amount.
Moving along, let's talk about the treatment itself. In a nutshell, root canal therapy involves drilling into the tooth and removing the infected pulp, then drilling the nerves out of the root canals (hence the assumed name of the procedure). The dentist will also usually irrigate the area to remove anything else present, and then the root canals are filled with a latex-based material (usually gutta-percha). Admittedly, this is the quick and dirty version -- some root canal therapies can differ based on individual circumstances. Sometimes, more than one visit will still be necessary for the root canal treatment itself, depending on the level of and location of the infection, the tooth structure or a myriad of other factors.
As you can likely guess, the root canal therapy will "kill" the tooth, as almost all the nerves and blood vessels are removed. This is why, in most cases, a crown is almost always recommended after a root canal. In most cases, the tooth would not have a chance of lasting without one. Hence, root canal therapy can be expensive -- you have the cost of the procedure, and then the added expense of a crown (which I've discussed in a previous post). And yes, crowns dictate a return visit.
In the end, root canal therapy is generally very effective in saving the tooth, with Delta Dental reporting an eight-year success rate of 97 percent. I personally like them as well. However, there are plenty of naysayers, and even some who say root canal therapy can be harmful. We'll likely look at that side in a future post.
But until then, keep smiling!
Rotstein I., Salehrabi R. (December 2004), "Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study", Journal of Endodontics 12 (30): 846-50
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