Definition

The removal of dental pulp when it has become infected or died. Dental pulp is the soft core of the tooth containing nerves, blood vessels, and connective tissue. It extends from the top of the tooth, called the crown, all the way down to the roots in branches called canals.

Tooth

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Common signs of pulp problems include:

  • Pain when biting down on a tooth
  • Unprovoked pain at a time when the tooth is not being used
  • Sensitivity to hot or cold food or beverages
  • Tooth discoloration
  • Swollen gums around the infected tooth
  • A draining boil-like structure (called a fistula) on the gum adjacent to the tooth

Parts of the Body Involved

Mouth, teeth

Reasons for Procedure

Dental pulp may become infected because of an untreated cavity , trauma to the tooth, or long-standing gum disease . When dental pulp becomes infected or dies, a painful abscess within the jawbone will occur. Removing dead or diseased dental pulp will prevent infection from spreading to other areas of the mouth and destroying bone around the tooth. If a root canal is not performed, the tooth will need to be removed.

Risk Factors for Complications During the Procedure

  • Immunosuppression
  • Bleeding disorders
  • Circulatory problems (such as diabetes), which can cause healing problems
  • Heart valve conditions, which increase the risk of endocarditis from dental procedures

What to Expect

Prior to the Procedure

Your dentist or endodontist will do a thorough dental exam and x-rays .

During Procedure

Anesthesia will be administered to the site to numb the area around the tooth.

Anesthesia

Local anesthetics, such as lidocaine

Description of the Procedure

A small hole is made through the top of the tooth that extends through the enamel and dentin and into the pulp. Steel files are inserted to extract the pulp tissues. All teeth have between one and four individual canals, and pulp will need to be extracted from all canals in the affected tooth. Once all pulp has been removed, the walls of the root canal are reshaped and enlarged, and medication is inserted to kill bacteria.

At this point, the dentist may insert a temporary filling to protect the tooth until the next appointment. Or, the procedure may be completed in its entirety within one visit, depending on the condition of the tooth.

The canal is dried, sterilized, and then filled with a rubbery material called Gutta-percha to prevent recontamination.

After Procedure

The area is permanently sealed, and a gold or porcelain crown is placed over the tooth to strengthen its structure.

How Long Will It Take?

The procedure may take 1 to 3 appointments, and each appointment may last up to 1 to 2 hours.

Will It Hurt?

Anesthesia prevents pain during the procedure. You may have some discomfort for a few days during recovery, and pain medication may be used as needed.

Possible Complications

  • Pain and swelling
  • Surgical-wound infection
  • Persistent abscess

Average Hospital Stay

This procedure is typically done at the dentist office.

Postoperative Care

  • Use warm, salt-water rinses to soothe your mouth.
  • For a few days, avoid heavy biting and chewing on the side of the mouth that has the root canal.
  • See your dentist or endodontist for a follow-up x-ray about six months after the root canal.

Outcome

In approximately 95% of cases, root canal therapy is successful, and the treated tooth should last a lifetime. However, root canal treatments may need to be retreated if:

  • Pulp was left inside a canal that was overlooked.
  • The root canal did not seal properly.

In some instances, the tooth cannot be saved with a root canal and requires extracting or pulling. These cases involve:

  • A tooth that is fractured below the gum surface, down into the roots
  • A tooth that is too badly damaged by decay and/or trauma

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the surgical area
  • The tooth feels loose after root canal therapy
  • Headache, dizziness, muscle aches, or general ill feeling