The visible, exterior layer of a tooth is called the enamel. Beneath the enamel is another hard layer, called the dentin. The dentin surrounds a small chamber at the center of the tooth that contains the pulp. Tooth pulp is a soft tissue made up of nerves, arteries, and veins. The pulp extends from the pulp chamber down through narrow channels, called the root canals, to the tips of the roots.
The two most common causes of infection in the pulp are deep cavities and fractures or broken teeth. Both expose the pulp to bacteria that live in saliva. These bacteria, which are always present in your mouth, can cause an infection that can kill the pulp. Without treatment, the pus from the infection can eventually gather down at the root tip and pass into the jaw bone, causing an abscess (a pus pocket). The abscess can then damage the bone that surrounds the tooth. The resulting pressure inside the bone and ligaments surrounding the tooth can cause excruciating pain, and left untreated, can even be life threatening.
You may have realized that you had an infected tooth because it was sensitive to hot and cold, was swollen and painful, or had given you a bad taste in your mouth. On the other hand, you may have been completely unaware that you had an infection because you experienced no symptoms at all.
An infected tooth will never heal on its own, and as it gets worse, it will continue to be a source of infection that depletes your immune system, which can affect your entire body. Years ago, your only option would be for us to extract the tooth. But today, we can remove the infection with root canal therapy, and save your tooth.
Root canal therapy often takes two or more appointments to complete. A temporary filling or crown is placed to protect the tooth between appointments, but you should take the following precautions to protect your tooth and ease any discomfort.
Usually, the last step after root canal treatment is the placement of a crown on the tooth. A crown covers the tooth and protects it from breaking in the future. Please call our office if your bite feels uneven, if you have persistent swelling or pain, or if you have any other questions or concerns.
To further reduce pain and swelling, rinse three times a day with warm salt water (a teaspoon of salt in a cup of warm water). To protect the tooth and help keep your temporary filling or crown in place, avoid eating sticky or hard foods (especially gum), and if possible, chew only on the opposite side of your mouth. It's important to continue to brush normally, but floss very carefully. To prevent removal of the crown, remove the floss by pulling it through the teeth, not down or up from between the space between teeth.
Your lips, teeth, and tongue may be numb for several hours after appointments in which we've used an anesthetic. Avoid chewing anything until the numbness has completely worn off.
It's common, and not a problem, for a small portion of your temporary filling to wear away or break off between appointments. If the entire filling falls out, or if a temporary crown comes off, call us so that we can replace it.
It's normal to experience some discomfort for several days after a root canal appointment, especially when chewing. To control discomfort, take pain medication as recommended. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.
Crown Needs Root Canal
A crown restores a tooth that has been seriously damaged. While the crown protects the outside of a tooth, it can't protect the soft inner layer called the pulp, which contains the tooth's nerves, veins and arteries.
In some cases, the initial damage repaired by the crown may have spread from the hard exterior of the tooth to the soft inner pulp chamber. In other cases, a crowned tooth can sustain damage that affects the pulp. And occasionally, the pulp of a crowned tooth becomes damaged or infected for reasons we cannot pinpoint. In any case, when the tooth pulp becomes damaged, it becomes vulnerable to infection from bacteria that are normally present in your mouth. If a crown covers a tooth that has an infected pulp chamber, we must remove the infection by performing root canal treatment on the crowned tooth.
Layers of a tooth A file removes infection We understand that some patients have anxiety about root canal treatment, but we want to assure you that it will be comfortable for you. Treatment is, in fact, the most comfortable option, because a tooth with an infection in the pulp chamber will never heal on its own. The unpleasant consequences of infection will worsen and become more painful with time, and may even spread throughout your body.
Because your comfort is important to us, we'll make sure your mouth is thoroughly numb before we begin. Next, we'll place a rubber dam around the infected tooth to isolate it from the rest of your mouth. The rubber dam keeps the tooth dry and accessible for us and prevents anything from falling to the back of your throat.
To get to the infected tooth pulp, we'll make an opening through the top of the crown down into the pulp chamber. In some cases, we may have to remove the entire crown in order to access the pulp chamber. We'll then use a tiny tool called a dental file to carefully remove the infected tissue and shape the root canals to receive a filling material.
At this point, we may take X-rays to be sure that all of the infected pulp is removed. We then fill the root canals with a restorative material. Then we’ll fill the hole in your crown with a restorative material or, if we’ve removed the crown, we’ll take steps to create a new crown.
Post & Core
Sometimes, when a tooth has broken off due to fracture or decay, there's simply not enough of your natural tooth remaining to place a crown. Fortunately, we can replace the missing portion and save your tooth by placing a post inside your tooth, which will then anchor a filling material, called a core.
The first step in placing a post is performing root canal therapy on the tooth to remove the infection and shape the root canal to receive the post. We'll use a small instrument called a dental file to shape the top of the root canal, select a post, and then cement or bond it in place. Depending on the situation, we may use posts made of metal, fiber-reinforced plastic, or carbon fiber.
After the post is in place, we fill the tooth with the new core material. Once it has hardened, the core material is shaped and prepared to receive a crown. We then take an impression of your teeth so that a dental laboratory can custom-craft a crown that will precisely fit your tooth.
We'll place a temporary crown to cover and protect the prepared tooth while your custom crown is being created. To ensure the proper fit of your final crown, it's important that your temporary crown stay in place, but on rare occasions, it may become loose or fall out. If this happens, keep it and call us and so we can re-cement it. You'll also need to be careful when you floss, removing the floss from the side of your tooth rather than the top so you don't pull off the temporary. Avoid eating hard or sticky foods (especially gum), and if possible, chew only on the opposite side of your mouth.
At your next appointment, we’ll remove the temporary crown and replace it with your new custom crown.