When a tooth is overly traumatized as the result of decay, excessive grinding, blunt trauma, fracture, etc. then the living part of the tooth, called pulp, will become damaged and inflamed and actually die. This is called “irreversible pulpitis”. The pulpal inflammation often causes pain that can sometimes be excruciating. The only treatment for a tooth with irreversible pulpitis is tooth extraction or a root canal.
A root canal is when we remove the dying pulp from the tooth and replace it with a rubber-like material called gutta percha. This is all done under local anesthesia so the experience is pain free. Patients often associate root canals with pain. This is an unfair association since little to no discomfort is experienced during a root canal procedure. I believe the reason pain is associated with root canal treatment is because patients are remembering the sleepless nights with the toothache that proceeded the root canal.
After completion of the root canal the tooth is essentially non-vital and normally requires a crown to complete the tooth’s restoration. The purpose of the crown is to prevent the now non-vital tooth from fracturing. The non-vital tooth is much like a dead tree in a forest, if you push on the tree hard enough it will fall over. The same thing happens with a non-vital tooth, if you bite something hard it can fracture and become unrestorable. I have seen literally hundreds of teeth over the years with root canals that never had crowns placed on them that end up fractured and have to be extracted; so the root canal was done in vain.
In cases with severe pain and inflammation we will often prescribe antibiotics and pain medication in order to control the infection before attempting to perform root canal therapy. Determining the need for a root canal can be tricky as often the symptoms are rather nebulous in the beginning and quite often pain that seems to indicate the need for a root canal is actually caused by something completely unrelated to the painful tooth.
Sometimes a tooth with irreversible pulpitis never does cause pain. When this happens the only way to diagnose the need for a root canal is with an x-ray. When would we take an x-ray of a tooth that is not causing pain? We would do this typically on a routine dental exam which is another reason why regular visits to the dentist with regular x-rays is so critical. The next logical question might be, “If it doesn’t hurt, why do I need to have a root canal?” The reason is that the dying pulp causes a dental infection that can be dangerous to the overall health of the body. Dental infections have been directly linked to heart disease, diabetes and strokes and are being investigated for possible links to several other diseases including Alzheimer’s. Bottom line is that no dental infection should be treated lightly, including pulpitis.
If you suspect you might need a root canal, please call for a free consultation (714-838-0760).