One of the most common procedures that I do in my office is fillings. Fillings are essentially a surgical treatment of an infection on a tooth where I remove the infection/cavity and I replace the lost tooth part with either a white or silver filling. Much like every other surgery, the body will need time to heal, and particularly with teeth, I am most concerned with how the nerve will heal as that is the living tissue inside teeth.. Thankfully, fillings are fairly predictable and 95% of the time everything heals well and no issues happen. However, if I do 100 fillings in a month, I will have a few patients who come back with a nerve that does not heal. For these patients where the nerve does not heal like we wanted it to do, we discuss the option of fixing the tooth with a root canal. The most important parts of considering whether or not to do a root canal are understanding the root canal therapy or RCT process, the prognosis of the tooth, and the health of the rest of the mouth.
When Do You Need Root Canal Therapy?
Root canal therapy is done when a nerve is either dead or so irritated that it is unlikely to heal normally. The treatment itself can either be done by a general dentist or a root canal specialist called an endodontist. The RCT process is done either in one or two visits. The tooth is numbed, the chamber for the nerve is surgically accessed, the nerve is removed and the area is cleaned. After the area is cleaned, either a medicine is placed in the tooth to allow it to heal or if the tooth is cleaned sufficiently, then a filler can be placed and a filling placed over the filler. After the root canal is done, if it is a back tooth, the tooth will need a crown placed on it to help protect and support it. If it is a front tooth that is done, the tooth may not require a crown, but rather it would depend on the esthetics and how much tooth structure is lost. If a crown needs to be done, it must be done sooner after the root canal is completed otherwise the tooth can fracture straight down the middle and not be fixable.
Before an RCT is started the dentist will first determine whether or not the tooth is fixable. I personally do not mind trying to do a less expensive filling on a tooth with a questionable long term prognosis but I am less likely to recommend an RCT and crown on a tooth that might not last long. The first factor that I consider is how much of the tooth is remaining. If there is less than one third of the tooth remaining or the cavity is deep below the gums and near the bone, I am less likely to recommend saving the tooth as it has already been seriously compromised. The next part is the health of the bone and gums. If the tooth has moderate to advanced gum disease, I usually do not recommend the root canal because in these cases the support for the tooth is so broken that the tooth will not be able to survive long. Finally, the esthetics of the tooth help determine whether or not a root canal is recommended. If the tooth is one of the front teeth or in the smile, generally patients want to save these teeth whereas if the tooth is a wisdom tooth, I usually recommend that these teeth come out.
The final decision for whether or not to do an RCT depends on the other teeth. If a patient presents with a new cavity at every cleaning or if I notice a lot of cavities (more than 8), I usually will recommend removing the tooth and placing an implant as implants do not get cavities. If a person comes to me with most teeth being in good shape, I am more favorable to doing an RCT and crown as this procedure will likely be a one off problem. I do not recommend implants in these cases as implants take longer to complete than fixing a tooth with a RCT and crown and are usually more expensive. Also as far as other teeth are concerned, I want to see how useful the tooth is to the person. For example, the most common root canal treated tooth in the mouth is the six year old molar because it does around ninety percent of the chewing for a person. However, if a person needs a RCT on a twelve year old molar and doesn’t have the matching tooth on the opposite jaw, I would recommend removing this tooth because the tooth will not serve any purpose. Last but not least, the most important part in the decision is what the patient wants to do. I have seen patients want to remove teeth that are important in my opinion (such as front teeth) and very fixable. The exact opposite is true where I have patients who want to save bad teeth because they do not want to have a tooth removed no matter what. Both views are legitimate to me as it is the person’s body and they are free to do what they want.
Root canal therapy or RCT is a common dental treatment and predictable as well. We dentists love saving teeth as it is kind of what we do all day. RCT’s to me are usually one off procedures for most of my patients and I’d be willing to bet that most of my patients over the age of fifty who have a full set of teeth (24 to 28) probably have one or two root canal treated teeth in their mouths. That being said, I still do my best to avoid root canals for my patients, but unfortunately, sometimes root canals happen. If you are worried about your teeth or have questions about root canals in general, please call our office at 504-392-5104 and we will help you out.