What type of tooth problems does root canal treatment fix?
Endodontic therapy is used as a solution for the following conditions and situations.
(As you read through these descriptions keep in mind that what most people consider a tooth's 'nerve' should really be referred to as its 'pulp' or 'pulp tissue.' Also, while listed separately on this page, these situations and conditions are typically inter-related, in the sense that one will cause, or progress into, another.)
A) Teeth that have a necrotic pulp.
The term "necrotic pulp" refers to a situation where the pulp tissue inside a tooth has died. (This is the condition we describe in our video series "What is the purpose of root canal treatment?".)
In this state, the nerve space inside the tooth simply exists as a hollow chamber. It becomes a harbor for debris and is vulnerable to colonization by bacteria.
Causes :
Necrotic pulps aren't so much caused as they are the endpoint of the process of pulp tissue degeneration. Once a tooth's pulp has sustained an insult from which it cannot recover (which includes all of the different types of events mentioned on this page), the final result, ultimately, will be pulp tissue necrosis.
Symptoms :
Teeth with necrotic pulps may be tender to pressure (percussion, chewing), or even outright painful when provoked, but this doesn't have to be the case. It is possible for a tooth to exist in this state, even for some years, without causing the person any noticeable discomfort.
Acute tooth infections -
In those instances where the bacteria living inside a necrotic tooth become active, they can form an acute abscess. This can involve significant pain, throbbing and/or swelling. Additionally, the tooth may seem "elevated" (taller than its neighboring teeth).
Tooth darkening -
In some cases, the breakdown products formed during the pulp tissue's degeneration may cause the tooth to darken, possibly noticeably. This effect is most apparent with front teeth (incisors and canines).
Gum boils -
Necrotic teeth sometimes have an associated "gum boil" nearby. (Dentists call these lesions "fistulous tracts.") These pimple-like lesions (that are literally drains for pus) may grow and shrink in size (over days, weeks, or months), as the infection harbored within the tooth periodically waxes and wanes.
B) Teeth that have irreversible pulpitis.
Pulpitis refers to a state where the pulp tissue inside a tooth has become inflamed. (Inflammation is the body's response to tissue irritation or injury.) In most cases, once the offending situation has passed or been removed, the inflammation response (pulpitis) will subside and the tooth will revert back to a normal healthy state.
Irreversible pulpitis -
In severe cases, the inflammation state may become irreversible. This simply means that the tooth's pulp tissue has been damaged beyond repair. Even if the irritating event is removed, the pulp will not be able to recover and, as a result, will ultimately become necrotic (as described above). This process may occur quickly, or may take years. It may be a painful, or just as likely, without any apparent symptoms.
Causes :
Types of tooth insult that can lead to irreversible pulpitis and the need for root canal treatment include traumatic events (accidents, blows), chronic tooth clenching and grinding, advanced tooth decay, the trauma associated with having a dental procedure performed, or irritation caused by a dental restoration that's been placed.
Symptoms :
The classic sign of irreversible pulpitis is one where an irritating stimulus (like hot or cold) causes tooth pain that lingers (as opposed to a sensation that diminishes as soon as the stimulus is removed). In other situations, the person's discomfort may occur spontaneously, without the provocation of a stimulus. In some cases, a postural change, such as bending over or lying down, may act as a trigger for the pain.
Types of pain -
The type of discomfort that a person will experience with irreversible pulpitis, and the ensuing pulp tissue degeneration, can vary widely. The pain may involve an aching, pulsing, throbbing, radiating, stabbing or even jolting sensation.
C) Severely cracked or fractured teeth.
If a tooth has cracked or broken to the degree that regions near the tooth's pulp tissue are involved, the tooth may require root canal treatment.
Causes :
As one might expect, a tooth may crack or break because it has been subjected to excessive forces. This could include a traumatic injury (an accident, a blow), eating hard foods (hard candies, frozen food items), unexpected items in foods (bones, pits), tooth clenching, and inappropriate oral activities (removing bottle caps).
A tooth can also be vulnerable to breakage if it's had a dental restoration placed that is unable withstand the pressures under which it must serve (like the case where a dental filling has been placed instead of a dental crown - [Animated-Teeth.com]).
Symptoms :
Cracked teeth are often painful, although possibly only when chewing or biting pressure is applied (or released). Sometimes a person's symptoms are vague and hard to attribute to an individual tooth. Cracked teeth can also be sensitivity to hot or cold, or sweet or acid foods.
D) Teeth whose pulp will be compromised during a planned dental procedure.
Due to existing oral conditions (such as tooth misalignment) or the nature of a dental procedure (overdenture abutments, dental post insertion, and root resection), a dentist may know that the pulp of an otherwise healthy tooth will be compromised when the patient's dental treatment is performed. In these cases, the dentist will perform the needed root canal therapy before initiating the patient's other dental work.
E) Teeth that are extremely sensitive to temperature changes.
When alternative treatments have not been able to provide a remedy (such as application of fluoride or other compounds, dental restoration placement), root canal treatment may be the only way a dentist can remedy tooth sensitivity caused by thermal insult (hot or cold extremes).