Endodontic FAQ

What is endodontics?

Endodontics is a branch of dentistry recognized by the American Dental Association involving treatment of the pulp (root canal) and surrounding tissues of the tooth. When you look at your tooth in the mirror, what you see is the crown. The rest of the tooth, the portion hidden beneath the gum line, is called the root. Though the outer portion of the root is a hard tissue called dentin, the inside channel or “root canal” contains a pulp of soft tissue, blood vessels and nerves. Bacteria that are introduced into the pulp as a result of tooth decay, periodontal disease, tooth fracture or other problems, can severely damage the pulp. When that happens, an endodontic specialist, such as Dr. Puckett, removes the diseased pulp to save the tooth and prevent further infection and inflammation. After successful endodontic treatment, the tooth continues to perform normally.

I’m worried about x-rays. Should I be?

No. While x-rays will be necessary during your endodontic treatment, we use an advanced non-film computerized system, called digital radiography, that produces radiation levels up to 90 percent lower than those of already low dose conventional dental x-ray machinery. These digital images can be optimized, archived, printed and sent to cotherapists via e-mail or CD-ROM. For more information contact Sirona Dental Systems, Inc.

What about infection?

Again, there’s no need for concern. We adhere to the most rigorous standards of infection control advocated by OSHA, the Centers for Disease Control and the American Dental Association. We utilize autoclave sterilization and barrier techniques to eliminate any risk of infection.

What happens after root canal treatment?

When your root canal therapy has been completed, a record of your treatment will be sent to your restorative dentist. You should contact his office for a follow-up restoration within a few weeks of completion at our office. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth. It is rare for endodontic patients to experience complications after routine endodontic treatment or microsurgery. If a problem does occur, however, we are available at all times to respond.

What new technologies are being used?

Operating Microscopes:

In addition to digital radiography, we utilize special operating microscopes. Magnification and fiber optic illumination are helpful in aiding the doctor to see tiny details inside your tooth. Also, a tiny video camera on the operating microscope can record images of your tooth to further document the doctor’s findings.

Do you remove the roots?

No. We only remove the inside of the roots leaving the rest to support the tooth.

What is a root canal?

To fully appreciate the root canal procedure it helps to be familiar with the basic anatomy of the tooth. A tooth is composed of a number of different types of tissues. Perhaps the most familiar of these parts of a tooth is enamel. Enamel is the hard mineralized material that covers the outside of a tooth. Beneath this enamel layer lies the dentin. Like enamel, dentin is also mineralized however it is somewhat softer than the enamel layer on the exterior. Inside the dentin we find the dental pulp (commonly referred to as “nerve”). The dental pulp, in contrast to the other parts of a tooth, is a soft tissue. This soft tissue is composed of nerves, blood vessels, & other types of tissues. The dental pulp plays an important role in the formation of teeth early in life however when teeth are fully formed its purpose is greatly diminished.

Endodontics (Endo=inside dontic=teeth), is the dental specialty that involves the study and treatment of the tissue inside of a tooth, the dental pulp. Endodontic treatment is often required when the pulp becomes either infected or irreversibly inflamed. This infection or inflammation of the dental pulp can occur in a number of ways: decay, dental procedures, trauma, diet, etc. . The pulp is different from most other tissues in the body; it is encased within a confined space and lacks a large blood supply that is found throughout the body. These characteristics contribute to the body’s inability to respond to the inflammation or infection present within the pulp. Therefore, whenever the pulp becomes inflamed or infected it must be removed. If left untreated, this can lead to pain or an abscess. The pulp can be removed in one of two ways – either removal of the entire tooth (tooth extraction) or removal of the pulp only (root canal therapy).

The root canal procedure involves a number of steps. Local anesthetics are used to anesthetize the tooth. Next, a rubber sheet is used to isolate the tooth, this helps to keep the tooth clean and dry throughout the procedure. The pulp is then located by making an access cavity through the tooth. Once the pulp has been located the nerve tissue within the root(s) is removed using small metal instruments (files) and irrigating solutions. When the canal(s) have been properly cleaned and disinfected they are filled with gutta-percha, a rubber filling material. Finally, the access cavity is filled with either a temporary or permanent filling.

What should I expect once the tooth wakes up?

It is normal to experience some soreness for 3-7 days following root canal therapy, with several reporting only minimal to no discomfort. While we would like for each patient to have only minimal post-operative discomfort, each situation and healing process can vary. The best predictor for what to expect post-operatively is the severity of pain pre-operatively, with the more severe presentations experiencing more discomfort following the procedure. The discomfort usually peaks around two days after treatment and generally subsides within a week. Occasionally the discomfort may persist for more than a week. In this situation it is important that the tooth is getting better over time. If the situation seems to be worsening please contact us to schedule a follow-up evaluation.

Can I go back to work after my root canal?

Typically, yes you should be able to return to work following your root canal treatment. You might want to schedule around a lunch meeting or a speaking engagement because your jaw may be sore and you should have some residual numbness for a few hours following the procedure.

What is the best thing to take for pain?

Unless there are other contraindications (consult your physician) I usually recommend 600 mg of Ibuprofen (Advil, Motrin) about every 6 hours. If Ibuprofen alone is not sufficient to manage any discomfort you may take Tylenol (Acetaminophen) along with the Ibuprofen. If you were given a prescription for a pain medication (Lortab, Tylenol III) you may want to take that along with the Ibuprofen in place of Tylenol. Most prescription pain medications contain a combination of Tylenol (Acetaminophen) in addition to the pain medicine. Combining a prescription pain medication with the use of Tylenol (Acetaminophen) is not recommended.

How many visits will it take to complete my root canal?

Many root canals done in our office are completed in one visit. Several others are often completed in two visits due to severe pain, swelling, persistent drainage, or complex anatomy. Needing additional visits does not mean that you will pay more; it means that we want to give you the best quality root canal regardless of the number of visits it will require. We understand the investment you have made into saving your tooth and our goal is to provide you with the highest quality treatment possible.

What happens after the root canal? Will I need more dental work?

In most cases, you will be referred back to your general dentist who will assure the tooth has an adequate permanent restoration. Most back teeth will require a crown if there is not one already present on the tooth. Failure to properly restore the tooth is the most common cause of endodontic treatment failures. I recommend getting the permanent restoration within a month following completion of the root canal. We will be sure to inform you of your next step.

Can I chew on my tooth after a root canal?

I do not recommend chewing on the tooth until it has received a permanent restoration/crown. The risk of tooth fracture is very high in root canal treated teeth that have not been permanently restored.

Why do root canals cost so much?

The fees in our office are on par with those throughout middle Tennessee. The cost of treatment is due to a number of factors. The cost of dental supplies, dental equipment, and the cost associated with running a small business all contribute to the fees associated with endodontic therapy. In addition to these main factors, other considerations e.g. high education costs and the years spent in training to gain a mastery of the procedure, also impact fees. If you have financial concerns please consult our office manager who can familiarize you with options to help finance the cost of your dental care.

Why do you use a microscope?

Use of the microscope adds superior lighting and magnification while treating your tooth. From the time I started my endodontic training, I have considered the microscope a necessary adjunct in providing top-quality care. Take away my scope and I quit! 🙂

The root canal in your office seemed to take longer than the last root canal I had. Why?

Having been a dental patient and having experienced two root canals myself, I understand that you want to spend as little time in the dental chair as necessary. The idea in dentistry that faster is better is false (in many cases). You would never tell your surgeon to get it done as fast as you can. Rather, you would say “Please do your best.” If your root canal is taking longer than expected, it is because we care about the quality of care you are receiving, and we are trying to treat the entire anatomy present in your tooth.

Will the treatment be painful?

We take every measure to ensure that the procedure is not painful or uncomfortable. Each patient is always instructed to alert us if any discomfort is experienced and this is addressed prior to proceeding with the procedure.