Root Canal in Vancouver, WA

Hello and welcome! My name is Dr. Roman from Pacific Park Family Dental, and today we are discussing root canals.

Dr. Roman, what is a root canal?

Okay, so roughly put, a root canal is when we go inside the tooth and clean out the area that has been infested with bacteria.

Why does that happen?

So sometimes the decay gets inside into the root. If there's a tooth here, the bacteria starts to chip away from the side and then eventually makes it down to the core. At the core of the tooth, there are nerves and blood vessels, and bacteria starts to populate that. To them, this is a feast. When that happens, they start to eat all of that tissue, your tissue dies off, and this is why you have pain. When the tissue is inflamed and dying, you will be suffering, and you will be seeking your dentist at that point. What's happening is the bacteria is starting to actually disintegrate this nerve tissue, and they're doing a lot of damage as well as waste production. This waste is toxic to the body, and of course, your tooth is kind of hollow at the bottom. This is the entrance to all of those roots and nerves that we talked about before, and the toxic material that bacteria is going to produce is going to start to leak out of that bottom and infect your bone. This is what we call an abscess. So here are the steps to an inflamed nerve and an abscess: the bacteria chips away the tooth—that's step one. Step two, bacteria starts to populate that center of the tooth, dissolving the nerve and eating away the blood vessels. Then, step three, it's going to produce so much toxins that they're going to leak out of your tooth and create an abscess, and this is why you swell at the end. So when you see a patient come into a dental clinic with a face this big, you know exactly what's happening. I know exactly what's happening, but there's good news—I know how to take care of it.

What are possible signs and symptoms I may need a root canal?

Okay, so as mentioned before, the signs and symptoms are as follows: as bacteria drill into your tooth, you might not feel anything, but as soon as they get into that nerve, it gets inflamed. Once that inflammation is happening, you know about it. How do you know about it? You will feel intense pain, spontaneous pain, sensitivity to hot, sensitivity to cold, and sometimes you'll just have a diffused sensitivity or pain that shoots up into your temple or to your ear. Those are the classic symptoms of an inflamed nerve. When a patient tells me these things, my mind goes exactly there. This must be a root canal scenario.

Should I see a dentist or an endodontist for a root canal?

Okay, so the difference between dentists and endodontists is that endodontists are dentists who love to do root canals. Yes, they have some extra training. Not everybody's anatomy is similar; some teeth have very tricky anatomies when the endodontist needs to take a look at this. But 98% of root canals done nationwide are done by general dentists.

Is it okay to delay a root canal treatment?

You may not want to do this. Okay, so there are two typical outcomes for root canals: one is chronic, and another one is acute. In chronic situations, you have had an infection, and it's kind of brewing there. Sometimes it happens for years, and that may be okay and tolerable. You might not even know about it, but when your dentist tells you about it, you should probably do something about it. The second one is the acute one, and this is the trouble one. This is when people can die if they delay treatment. So what we want to do is monitor symptoms. They are as follows: you can have immense swelling, sensitivity to pressure, sensitivity to biting, and when the swelling reaches the point where you are having trouble swallowing, that is an emergency, and we would advise you to go to an emergency room right away. But before it gets to that point, of course, please visit your dentist so we can do something about it.

How painful is a root canal?

Oh, the root canal is probably one of the most painful situations you can find yourself in. I have ladies who have given birth to tell 10 children, and they tell me, "You know, I'd rather be pregnant one more time and give another birth than have to deal with this." It is immensely painful, so please don't find yourself in that situation.

What types of anesthesia is available during a root canal?

Okay, there's a couple of different ways we can numb a tooth. There are what we call hot teeth. So let's say you come in with a great deal of pain; it's been happening for the last two days, you haven't slept a wink. If you find yourself in that situation, yes, we can try and numb the area just locally. Sometimes that works; sometimes we have to do what's called a nerve block. We have to numb a little bit further up the stream on the nerve so the whole branch of the nerve that innervates this tooth goes numb. That doesn't always work when the tooth is that hot. When it hurts so bad, even the slightest pressure can send you through the roof. At that point, we may need to kind of numb the area directly, which involves opening up the tooth and numbing the tooth nerve right inside the root.

What is the process for a root canal?

Okay, so the process is pretty straightforward. We are opening up the tooth, cleaning out the inside, washing it until it's immaculately clean with no bacteria and no debris left, and then we put an obturator inside. This material is what keeps the inside of the root clean forever.

How many dental visits does it take to complete the root canal?

Uh, that really depends on the situation. In my practice, if somebody has an acute situation, I try to spread out the treatment into two visits. Why? Well, because you're coming into my practice, and you want a break. You want to go to sleep; you want to be out of pain, and I understand that. I don't want to keep you in the practice longer than necessary. So what I do is I get you comfortable, get you numb, get you out of pain, put some medication in there, and send you on your way home because I know that you need a break from this difficult situation. However, if it's a chronic situation that we're taking care of, I just do it in one visit.

What happens if you leave a root canal without a crown?

Okay, so this is a tricky one. I see a lot of dentistry from overseas that get done where they do a root canal, but they don't crown the tooth. This generally can work for a year or two, sometimes five, but those teeth, they start to break down. The difficult thing is when a big filling exists on a tooth after the root canal—the material gets tired, it gets fatigued, and because you're chewing on that tooth quite a bit, the filling eventually will give out and the tooth will crack. To prevent that, what we do is put a tooth helmet on, and that is literally a covering on top of the tooth that binds the whole thing together like a barrel hoop so the tooth doesn't fall apart over the years.

What are the alternative options to a root canal?

If you are not in favor of doing a root canal, then the alternative option, of course, is to remove the tooth. If we don't remove the tooth, it acts as an infected splinter, and let's face it, it's in your head, it's in your mouth, you probably don't want to have that infection festering there for a long time.

What is better, a root canal or an implant?

That one I typically judge on a case-by-case basis: implant versus the root canal. If the root canal is kind of degraded and the tooth is broken and I can't promise my patients that this treatment will last for 30 years, then I don't waste my breath and money on that. My patients come to me for teeth and long-lasting results, and I wouldn't compromise that. So if I can't promise my patient that this is going to be a good repair for the next 25-30 years, I won't do it. I'll just remove the tooth and recommend an implant.

What causes a gum boil after a root canal? How do you treat it?

Uh, that's a perfect question. So a gum boil is something that is related to either chronic or acute infection. Once you have an infected root, the bacteria will produce toxins that go straight into your bone, and your body is trying to expel that. One of the ways to expel that is to create a pimple on the gum, and the pus that the bacteria and the immune system creates in that battle gets extruded out of the site, and what you see is a gum boil.

What are the reasons for root canal infection?

Oh, we have to define that question. I mean, we could skip it if you'd like. That's the question, root canal infection? Yeah, reinfection of the root canal? It just says root canal infection. I think we covered that one in the first question. Yeah, I think let's just keep on. Yeah, yeah, that's a confusing one. Okay, fine, let's go to the next one then.

How common is tooth fracture after a root canal?

Okay, tooth fractures. So they're unpredictable. If I can say that they are common, they are common enough for us to consider crowning. I have had patients that come to me with a root canal done, and I tell them, "Okay, you need to get this crowned," and they don't get it crowned. A year later, we have a broken tooth. Sometimes I'm able to salvage it. The tricky part is that I don't have a crystal ball to say that this tooth will break in such a way that I can repair it, or it will break in such a way that it renders it hopeless. Typically, patients already put in $1,500 to $2,000 worth of work into that tooth, and if that tooth breaks, it's an implant. That's a lot more money. It's so much cheaper just to get a crown.

Are root canals safe?

Yeah, root canals are extremely safe. We have been doing them for over a hundred years at this point, and when properly done and correctly executed, they last for a long time and have no symptoms.

Does bone grow back after a root canal?

Yes, so remember, as we talked about the infection in the bone, what happens within the bone when it's infected is the immune system starts to dissolve that bone underneath the tooth. When you have lost that bone, it is possible to grow it back. But first, you need to take care of the underlying issue, which is the infected root canal. Once you have done that, the bone will automatically start to kind of eat away at that infectious material and slowly regenerate. It'll take about 6 months for the bone to come back, but it will eventually come back.

Are root canals covered by dental insurance?

That is an interesting question. So insurances are tricky in this scenario because it depends on what kind of insurance you have. A lot of times, even on cheaper insurances, they want to save money on you, so they will recommend you remove a tooth rather than do a root canal. More high-quality insurances, they can cover that procedure, but at the end of the day, insurances are just businesses, and your health is a priority in this clinic.

Before you go, can we do the call to action? Like, I hope we've been able to answer some of your questions, but if you have any additional questions, got it out, give your phone number. Well, there you have it. We've answered all the questions, and hopefully, you found this helpful. If you have any more questions for me, please reach out at (360) 803-3546.