Don't Wince—Root Canals Help Save Your Teeth

Mention the words “root canal” to most people and watch the response. They cringe. Some of us would do almost anything to avoid a root canal.

It’s unclear exactly how root canal came to be so dreaded, but the procedure saves about 18 million teeth a year. Without root canals, people would lose the affected teeth, leaving them to choose between an empty space in the mouth, a bridge, or an implant.

Despite what you may have heard, a root canal should be no more dramatic than a routine filling.

And it can usually be done in one office visit that lasts about an hour.

Details of the procedure

What is a root canal? It’s a procedure in which your dentist or an endodontist (a dentist who specializes in root canals) removes the source of tooth pain—the inflamed pulp tissue inside canals deep in the tooth. The pulp contains the nerve to the tooth as well as the often-throbbing blood vessels. The pulp’s removal leaves an empty space that is cleaned, filled with a rubbery compound and sealed.

These are the most common reasons for needing root canal treatment:

  • Infection or painful inflammation from decay that is approaching or has entered the pulp inside the tooth

  • Tooth damage caused by trauma from an accident, fall, or sports injury

  • A tooth that has broken down after a lot of restorative work

In some cases, chronic grinding of teeth can break down the tooth structure and lead to a root canal.

About 95 percent of abscessed or infected teeth undergoing root canal are saved, according to the American Association of Endodontists. Many of these teeth go on to last a lifetime.

Dentists or endodontists who suspect a problem will perform several tests. They will press on the tooth and then tap on and around it to see if it is sensitive to direct pressure. They’ll test for sensitivity to heat, to cold, and to electrical stimulation, using a special wand that emits electrical pulses.

Although the inflamed pulp may be bacteria-laden, antibiotics are usually not necessary. The cleaning and reshaping of the canal does the job.

In recent years, advances have made root canal diagnosis and treatment more efficient. Local anesthetics have been improved, while nickel-titanium rotary instruments have replaced stainless steel files used to ream, or clean, the inside of the tooth.

New surgical microscopes that attach to the wall or ceiling and swing on a mechanical arm provide a much better view of the tiny areas that need attention. Prevention, of course, is your best bet. Take care of your teeth—brush and floss daily, see your dentist as recommended for checkups and cleanings, and do your best to avoid trauma to your mouth—and there’s a good chance you will never need a root canal treatment.

Root canal or dental implant?

When there’s something seriously wrong with one of your teeth, your dentist often chooses one of two treatments: a root canal or a dental implant. A recent review found those treatments achieved virtually equal success when it comes to the survival of the treated tooth or implant.

The review, published in a 2007 supplement to the International Journal of Oral and Maxillofacial Implants, looked at 68 related studies and found no significant differences in the survival of compromised teeth that had either been restored with root canal therapy followed by a crown or replaced by a single tooth implant.

That means the decision to treat a tooth with a root canal or replace it with an implant should be based on such factors as the complexity of your case, your individual health, or your preferences.

The AAE has looked at various risk factors to help dentists make treatment choices. Risk factors can include smoking, bone quality, and estrogen level. For example, the AAE says, women with lower estrogen levels may encounter more treatment failures with implants.