Root Canal (22)
The procedure of a root canal is the process of removing inflamed or necrotic (dead) tissue from the space within the tooth. During this process it is disinfected to reduce the number of bacteria as much as possible. After the canal space is cleaned and dried, it is filled with a root canal filling material to minimize the re-entry of bacteria.
The roots of your tooth are not removed. The inside of the roots are cleaned and the rest of the root is left to support the tooth.
We will take every measure to ensure that your procedure is not uncomfortable or painful. If treatment is needed, we will inject a small amount of anesthesia to gently numb a concentrated area of your mouth. For most patients, the feeling of numbness usually subsides after 2-3 hours.
What constitutes life is a great question for a philosophy class, and if you argue that the tooth was never alive, then it is possible that it could never die. Your tooth will no longer be sensitive to hot or cold, but it will still have feeling due to the bone and ligament that hold your tooth in the jaw.
Teeth are often uncomfortable after a root canal, and discomfort usually peaks about two days after treatment. It is common for the tooth to still be a little uncomfortable for a week or so. It is important that the tooth is getting better over time.
Your jaw may be sore and your lip may be numb, but you should be in good shape to continue your regular schedule. I don’t recommend leaving your appointment and going straight to an important lunch meeting (unless you wear a bib 🙂 In terms of your schedule, it should be no different than getting a filling or a crown.
Unless there are contraindications (ask your physician) I usually recommend 600-800 mg of ibuprofen (Advil, Motrin, or generic) about every 6 hours. If you are still uncomfortable despite the ibuprofen, then take about 1000mg of Tylenol (acetaminophen) along with the ibuprofen. If you have been given a prescription for either Vicodin or Percocet, then you may take that with the ibuprofen instead of the Tylenol.
More than half of the root canals done in this office are done in one visit. Many are done in two visits due to severe pain, swelling, persistent drainage or complex anatomy. A second or third visit does not mean you will need to pay more. It just means that we want to give you the best quality root canal regardless of the number of visits it will require.
In most cases, you will be referred back to your general dentist who will assure the tooth has an adequate permanent restoration. Most back teeth will require a crown if there is not already one in place. In this office, a permanent filling is often placed (instead of a temporary) to assure the tooth is adequately sealed. We will assure that you are informed of the next step in your dental treatment.
If you have received a temporary in our office, and your root canal is completed, I recommend getting the permanent filling within three weeks.
Yes, for most root canal treatments, we recommend that patients return to the office 1 year after the procedure was finished. Our office will send a reminder notice to you when you are due for a recall appointment. There is no charge for this visit.
I do not recommend chewing on the tooth until it has received a permanent restoration. The risk of tooth fracture is very high in root canal treated teeth that have not been permanently restored.
If you already have a crown, most of the time the root canal will be done through a small opening in the top. Your dentist will need to repair the opening after your root canal is completed. A new crown may be indicated if there are imperfections that do not lead to predictable dental health.
Crowns with porcelain (tooth colored crowns) are susceptible to fracture of the porcelain (happens less than 5% of the time). If the porcelain fractures in a way that the crown is no longer functional or esthetic, then replacing the crown may be necessary.
Nitrous oxide sedation is not offered in this office. If you feel that you need something to calm your anxiety, then an oral medication is often prescribed – usually Halcion (triazolam). If you take this medication, then you will need someone to drive you to and from your appointment. Anxious patients who take this medication predictably have a pleasant experience at the dentist.
If you feel that this may be necessary for you, please request a consultation appointment prior to treatment so that all areas of your care can be evaluated.
Many patients ask if they can come to me for all of their dental work. The answer is that I specialize in root canal therapy and limit my practice to that area of dentistry. Out of respect for your dentist, who has referred you to us, we will return you to their care. If you do not have a dentist, then we can help you find an appropriate match.
The fees in our office are on par with those throughout the Denver area. The cost of treatment is due to the high cost of dental supplies, the cost of running a small business (including taxes!), and the years of training it took to gain a mastery of the procedure.
If the cumulative cost of your dental treatment is not financially feasible, consult with our financial manager who will familiarize you with some programs to help finance the cost of your dental care.
We will help you by submitting claims to your insurance company. We do not participate in most capitation plans, but you will find that your out of pocket expense for an out-of-network provider may be close to that of an in-network provider. Call us so that we can help you determine the cost of your care.
One reason for not participating in many insurance plans is that they simply will not reimburse at an acceptable rate. Some companies reimburse specialists and generalists the same amount. This is unacceptable when you consider that the complexity (and therefore the time required) of cases treated by a specialist is much greater than those treated by general practitioners. Some reimburse at rates close to what I experienced in dental school!
Though the care you receive in our office is not affected by the type of insurance you have (or don’t have), we have had to limit ourselves to those companies that recognize and reimburse for the quality care we render.
Maintaining your natural teeth is one of our priorities, but if we feel that root canal treatment is not predictable then a dental implant may be indicated. Implants are great for replacing missing teeth, and will be recommended if it is believed that they will be a better long-term investment in your health. The use of the dental operating microscope helps in predicting the outcome of treatment.
Only when it must be done immediately and you can not be seen by your dentist or an oral surgeon. Since an implant may be placed in the site where the tooth is being removed, I often recommend that the person placing the implant should be the one removing the tooth. This way the site will be prepared in a way that is familiar to the person placing the implant.
Use of a microscope adds superior lighting and magnification while treating your tooth. From the time I started my endodontic training, I have considered the microscope a necessary adjunct in providing top-quality care. Take away my scope and I quit! 🙂
I acknowledge that you want to spend as little time in the dental chair as possible. The idea in dentistry that faster is better is false (in most cases). You would never tell your cardiologist to do your bypass as fast as possible. Rather, you would say “Please do your best.” If your root canal is taking longer than expected, it is because we care about the quality of care you are receiving, and we are trying to treat the entire anatomy present in your tooth. I re-treat many root canals that were done by a fast-paced practitioner oblivious to the nuances that make root canal therapy successful.
If you have not had your tooth permanently restored in a timely manner, the canal system may have become re-infected with bacteria. In this case a re-treatment may restore your tooth to health. In most cases you will need to pay for the cost of re-treatment, so getting the tooth restored early is a wise use of resources.
The rate of fracture for an unrestored root canal treated tooth is very high. If the tooth has cracked then it may not be restorable, and you will lose what you have invested.
If you are unable to afford the restorative phase of treatment at this time, please discuss this with your dentist. At a minimum, the tooth should get a permanent filling and receive a temporary crown or be removed from occlusion (shaved down so you can’t bite down on it).