Do I need a root canal?

Inside every tooth is a soft core called the pulp. It holds the nerve and blood supply that kept the tooth alive while it was growing. When bacteria reach the pulp, or the tooth is badly injured, the pulp can become inflamed or infected. It cannot heal on its own once that happens.

A root canal removes the damaged pulp, cleans and disinfects the space inside the tooth, and seals it. The tooth stays in place, keeps working like a natural tooth, and no longer has a source of infection inside it.

Most root canals trace back to one of a few causes:

• Deep decay. A cavity that is left alone can work its way through the tooth until it reaches the pulp.
• A crack or chip. Even a small crack can give bacteria a path inside.
• Repeated dental work. A tooth that has had several large fillings or procedures can become irritated over time.
• An injury. A blow to the mouth can damage the pulp even when the tooth looks fine from the outside.

Only an exam and imaging can confirm it, but these signs are worth a call:

• Tooth pain that lingers. A deep ache or throbbing that keeps coming back, or wakes you up at night.
• Pain when you bite or chew. Pressure on the tooth makes it hurt.
• Sensitivity that stays. Hot or cold causes pain that lasts well after the food or drink is gone.
• Swollen or tender gums. The gum near one tooth looks puffy or feels sore.
• A bump on the gum. A small, pimple-like spot near the tooth, sometimes with a bad taste.
• A darkening tooth. The tooth turns gray or darker than the teeth around it.

Some infected teeth cause no symptoms at all and are found during a routine exam. That is one reason regular checkups and imaging matter.

An infected pulp does not get better on its own. The infection can spread to the bone around the root and form an abscess, which can lead to more pain, swelling, and in some cases the loss of the tooth.

Sometimes the pain stops on its own. That can feel like good news, but it often means the nerve inside the tooth has died while the infection is still there. A tooth that suddenly stops hurting after days of pain should still be checked.

A root canal is done with the tooth fully numb, and many patients say it feels much like getting a filling. Treatment usually follows these steps:

• Numbing. The area is numbed so you are comfortable throughout.
• Cleaning. A small opening is made in the tooth, and the damaged pulp is removed.
• Disinfecting. The canals inside the root are cleaned and shaped.
• Sealing. The space is filled and sealed to keep bacteria out.
• Protecting. Many teeth, especially back teeth, need a crown afterward to protect them from breaking.

At our office, Dr. Balani talks with you about pain management before treatment and sets a plan around your comfort level. Sedation is available if you feel anxious, and imaging is done right here in the office.

It is normal for the tooth to feel tender for a few days. Over-the-counter pain relief, taken as the label directs, usually helps. Avoid chewing hard foods on that side until any final crown is in place.

If a tooth cannot be saved, removing it may be the better choice. A missing tooth can then be replaced with an implant, a bridge, or a denture. Dr. Balani will walk you through which option makes sense for you.