Root Canals that go bad Tuesday, May 31 2011 

Often, I have patients that are reluctant to have a root canal. Either they have had a bad experience or later lost a tooth that had a root canal, or a friend or family member has. With a 90% success rate, this does not happen often, but it can. The reasons are not numerous and the most common one can be controlled.

Most teeth that have had a root canal and fail have extensive decay into the root surface. This has happened because the patient failed to have a filling, or crown placed on the tooth. They left the office and felt better, and never returned to complete the treatment. The access hole in the tooth, which is drilled to allow entrance into the nerve chamber, has to be sealed with some sort of permanent filling. When the root canal is completed, a temporary filling is placed which after a few weeks crumbles and allows food and bacteria into the tooth. Decay starts, which naturally does not hurt since the tooth had a root canal. But,  in a short time there are problems.

The most common problem is that the tooth breaks since it has been weakened by the root canal and the decay. This could have been prevented with a filling or crown. The other reasons for failure are more nefarious.

The root of the tooth can be fractured. This can happen before the root canal or after the treatment has been completed. A fractured root is difficult to diagnosis since the fracture is microscopic. It is only discovered after the fact when the patient is still having problems with the tooth despite having a root canal. In most cases, the only option is to remove the tooth. Root fractures are not very common, and are a small percentage of the reasons for failure.

The next reason is a recurring infection. This can be caused by the dentist not completely cleaning out the root and some tissue is left in the tooth which creates an infection and pain. The other part of this recurring infection situation can be a nerve that was not treated when the root canal was finished. The nerves can be very small, and some times difficult to locate. The good news is that in most cases the tooth can be retreated with a new root canal.

The other procedure for re treatment of  the root canal is apical surgery. This means that the root of the tooth is exposed surgically and a small portion is removed. The area is cleaned out and a small filling placed in the tip of the root. The area is then sutured closed. In most cases this would not be the first choice for treatment of the problem with a failed root canal since it is drastic. However, it is effective and can solve the situation.

This is just a short over view of the root canal and what can be done to save a tooth which has died or had some trauma which has caused the nerve to die. If you need a root canal it is important to follow through on the treatment. Don’t stop after the root canal! Have the core and crown completed in order to ensure that the tooth does not break or begin to decay again.

After the Root Canal Wednesday, May 25 2011 

So, you survived the root canal. It was not that bad and you almost fell asleep twice during the procedure. The rubber dam was a bit inconvenient, but it did keep the chemicals out of your mouth, and they do taste bad. The tooth feels great and you can even chew on it.  What next?

If the tooth had a large filling, or a great deal of decay, it will need a crown and possibly a buildup or post and core. What are those things? The buildup and post and core add strength to the tooth and help support the crown. One of the big problems after a root canal is the tooth breaks or fractures. This happens a great number of times. You feel good, the tooth is happy and you do not want another visit to the dentist. But that is exactly what you do need. Without support and internal strengthening, the tooth is going to break or fracture. It is very sad to see someone who has spent a lot of money on saving their tooth, only to have it break and have to be told that it cannot be saved. It could break in  a month or a year or two later, but at some point, there will be problems. Get it fixed, or at the very least have the buildup completed before something happens that will cause you even greater problems.

A tooth that already had a crown can be treated differently. If there was not a tremendous amount of  decay, or the crown was recently placed, a filling or post and core can be put in the tooth and this will solve the problem. If the crown was old and there was a huge amount decay, it might need a new crown in addition to the buildup. A tooth that is part of a bridge can be saved in this manner also, However, if the decay is severe or the tooth does not look good, a new bridge might be in order.

Get the tooth fixed properly and you will not regret spending the money for the root canal and other work. The tooth will hold up and give you years of service. Brush and floss and treat it like your other teeth with TLC and you will be very happy and so will the tooth.

First post Tuesday, May 24 2011 

Since this is my first post on this blog, I decided to use that as the title. Maybe not very inventive, but accurate. The name of the blog reflects the fact that I am a dentist and also a private pilot. I have been a dentist far longer than I have a been a pilot –over 30 years, verses 18 years. So the topics will be more dental with flying stories added for some variation.

I do a lot of root canals in my practice. According to some information that the dental supply company I deal with generated, about two to almost three times as many as most general dentist. The new tools for doing root canals sure have helped–electric handpieces that reverse when a file begins to bind in a canal, apex locator, and all of the rotary files that can be used as well as the ultra sonic tips that can placed in the various machines to assist with difficult situations. Much better than when I started dentistry.

Most patients are afraid of root canals which is understandable. They have a bad reputation and can be difficult. But most are uneventful and even boring.  Who wants to hear about the easy root canal, when you can listen stories about the pain , suffering and problems that  your friend experienced at the dentist office.

What I have found over the years, is that most people do very well with the root canal if they follow directions for post operative care, and the tooth has not been “sick” for some time. By “sick” I mean infected, swollen, and been a problem for months. These are the teeth that will give the patient and dentist problems. Some time spent explaining  the procedure and what to expect certainly helps a great deal also.

The single biggest factor in doing the root canal is what the dentist call “profound anesthesia”. This means the patient is really, really numb. Some times getting to that point can be challenging, but methods exist to achieve that goal, and it is a very important part of the procedure. For someone is who very fearful, or possibly had an unpleasant experience, I suggest sedation. In my office we use  pills which produce excellent results and are very safe. With sedation, the patient has no memory of the procedure or even being at the dental office.

Another factor in the successful outcome of the root canal is not chewing on the treated tooth for several days. The root canal creates bruising  of the periodontal ligaments which hold the tooth in the bone. These need some time to recover, and if left alone, will heal in a short time and the patient can then chew on the tooth. Of course some pain medications whether prescription or over the counter can be used to help the situation along.

Keep in mind that over fourteen million root canals are performed every year and have over a ninety percent success rate according to the American Association of Endodontist. That is a lot of teeth that are being treated and saved instead of tossed in the waste basket.

Next time, what to do after the root canal to make the tooth last will be discussed.

Hello world! Monday, May 23 2011 

Welcome to After you read this, you should delete and write your own post, with a new title above. Or hit Add New on the left (of the admin dashboard) to start a fresh post.

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