Types of tooth problems root canal treatment can fix. -

A listing of dental conditions that can be remedied by performing endodontic therapy.  /  Details and selected videos that cover this topic.

Conditions and situations where root canal therapy is indicated.

This page lists the types of dental problems that a dentist will typically resolved by performing root canal treatment on the offending tooth.

Note: As you read through this information keep in mind that what most people call a tooth's "nerve" should really be referred to as its "pulp" or "pulp tissue."

Also, even though listed individually on this page, these problems and conditions are typically interrelated, in the sense that one will often cause or progress into another.


A) Teeth that have a necrotic pulp.

The term "necrotic" refers to the situation where the pulp tissue inside a tooth has died.

Once this has occurred:

  • The nerve space inside the tooth simply exists as a hollow chamber.
  • It becomes a harbor for debris (pulp tissue breakdown byproducts) and is vulnerable to colonization by bacteria.
  • For that reason, necrotic teeth require root canal treatment.

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 tooth problems mentioned on this page), the final result, ultimately, will be pulp tissue necrosis.

Signs & Symptoms :

Discomfort -

Teeth with necrotic pulps may be tender to pressure (like when chewing, or tapping on them) or even outright painful but this doesn't have to be the case.

It's possible for a "dead" tooth to exist in this state, even for some years, without causing the person any noticeable discomfort at all.

Tooth darkening -

Dark byproducts formed during the degeneration of a tooth's pulp may leach into its hard tissues and as a result cause it to darken, sometimes quite noticeably. (This effect is easiest to observe with front teeth like incisors and canines.)

For this reason, any individually darkened tooth, especially one that has a history of receiving trauma, should always be investigated by a dentist.

Gum boils -

Necrotic teeth frequently have an associated "gum boil" nearby. Dentists refer to these as "fistulous tracts."

These pimple-like lesions are literally drains for pus. They typically grow and shrink in size (over days, weeks, or months) as the infection harbored within the tooth waxes and wanes.

Acute tooth flare-ups -

In those instances where the bacteria living inside a necrotic tooth become active, they can form an acute tooth abscess. This may involve pain, throbbing and swelling, each of which can be quite severe. In some cases, the tooth itself may seem "elevated" (slightly taller than its neighboring teeth).

Videos about necrotic teeth and root canal therapy:

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 Watch Video What's the purpose of root canal treatment? (necrotic tooth)

Run time: 2 minutes 15 seconds.   /   Type: Animation

Details about this video.

This video explains why necrotic teeth require endodontic therapy.

Note: Root canal treatment is frequently performed before a tooth has reached a fully necrotic state (typically because the patient has experienced discomfort).

But any tooth that has a severely compromised "nerve" (such as those situations discussed below) will ultimately end up this way. How long this might take however (weeks, months, years) can vary widely.

More about this video ...

This video explains that necrotic teeth require root canal treatment because the debris and bacteria they harbor leaks out of the tooth's root and as a result inflames the surrounding tissues (this is an unhealthy state).

  • A chronic status may exist for much of the time (low-grade, persistent inflammation localized around the tooth's root).
  • But, unpredictably, the tooth is always at risk for an acute flare up (abscessed tooth formation).

As it happens, necrotic teeth (which are hard hollow objects that contain tissue irritants and bacteria) are a special case and one the human body is incapable of handling.

As a solution, root canal treatment assists the body in accomplishing what it would otherwise not be able to do on it's own.

 Watch Video Opening the pulp chamber (necrotic tooth).

Run time of segment selected: 1 minutes 16 seconds.   /   Type: Clinical video

Details about this video.

This video shows what a dentist sees as they "open" a necrotic tooth in preparation for performing its root canal treatment.

More about this video ...

As previously mentioned, once a tooth's "nerve" has died the space it occupied simply exists as a pulp hollow chamber and root canals, filled with assorted debris and bacteria.

Points to watch for in this video -
  • This video begins at a point where the dentist's drill has already begun to penetrate through the tooth's deteriorated filling and decay.
  • Even at this point you can already see hints of the tooth's pulp chamber. And as the dentist drills further and further, more of the tooth's internal anatomy becomes visible, including the openings of its root canals.
  • Once full access has been made to the pulp chamber, it's obvious in this video that this tooth is necrotic (meaning it's "nerve" has died).

    Signs: 1) No pulp tissue is visible. 2) There is no bleeding from the tooth... 3) If you were present in the room, you would likely smell a foul odor coming from this tooth.

    All that this empty chamber contains is assorted debris resulting from the breakdown of the tooth's pulp tissue. And while not visible, bacteria are no doubt present too.

  • Necrotic teeth require root canal treatment because the debris and bacteria they harbor leak out of the tooth's root, leaving them at some level of persistent inflammation.


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.)

How things usually work -

In most cases, once the situation that triggered the event has passed or been resolved, the inflammation response (the pulpitis) will subside and the tooth will revert back to a normal healthy state.

Irreversible pulpitis -

In severe cases, the tooth's inflammation may reach a point where it becomes "irreversible." This simply means that the tooth's pulp tissue has been damaged beyond a point where repair is possible.

Even if the condition that has caused the irritation 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 at the other extreme take years. It may be painful, or just as likely, take place without any apparent symptoms.

Causes :

Types of tooth insult that can lead to irreversible pulpitis, and therefore the need for root canal treatment, include:

  • Forceful traumatic events

    Examples: Accidents or blows to the mouth.

  • Chronic tooth clenching and grinding.

    This habit can expose teeth to extreme forces.

  • Advanced tooth decay.

    The process of removing the decay, or the presence of the decay itself, can be causes of pulpal inflammation.

  • Trauma created by dental work.

    Examples: Instances where tooth trimming involved areas near its pulp. Situations where the process of trimming the tooth was allowed to overheat it.

  • Irritation caused by dental restorations.

    Examples: Cases where fillings that are too "high" or especially sensitive to cold stimuli are not remedied in time.

Signs & Symptoms :

The classic sign of irreversible pulpitis is one where an irritating stimulus (like hot or cold) triggers tooth pain that lingers. (As opposed to discomfort that starts to fade promptly as soon as the stimulus has been removed.)

In other situations, the person's discomfort may occur spontaneously, meaning without the provocation of a stimulus.

In some cases, a postural change (like bending over or lying down) can act as the trigger that leads to pain.

Types of pain -

The type of discomfort that a person experiences with irreversible pulpitis, and the process of pulp tissue degeneration that follows, 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 in a fashion where regions near its pulp tissue are involved, it may require root canal treatment.

Causes :

Just 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 or blow), eating hard foods (hard candies, crunching ice), unexpected items in foods (bones, pits), tooth clenching and grinding, and inappropriate oral activities (like biting off bottle caps).

A tooth can also be vulnerable to breakage if it's had a dental restoration placed that's unable to withstand the pressures under which it must serve, like the case where a dental filling has been placed instead of a dental crown (link opens to Animated-Teeth.com).

Signs & Symptoms :

  • Cracked teeth are often painful, although possibly only when chewing or biting pressure is applied (or released).
  • They can be sensitive to hot or cold, or sweet or acidic foods.
  • Sometimes a person's symptoms are vague and hard to attribute to an individual tooth.

D) Teeth whose pulp is sacrificed as a planned event.

Due to a patient's existing oral conditions (like when crowning severely misaligned teeth) or the nature of the dental procedure being performed (such as creating overdenture abutments, dental post insertion, or root amputation), a dentist may know in advance that the pulp of an otherwise healthy tooth will be compromised when the patient's treatment is performed.

If so, the dentist will need to perform root canal therapy before completing the patient's other dental procedures.


E) Teeth that are extremely sensitive to temperature changes.

When alternative treatment approaches have not been able to provide a suitable remedy (such as the application of fluoride or other compounds, dental restoration replacement), root canal treatment may be the only way a dentist can remedy extreme tooth sensitivity caused by thermal insult (hot or cold foods and drinks).

 
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