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Root Canal

Lynne Heckert, DDS, JD

What is a Root Canal?

The center of a tooth contains a chamber that contains the tooth's main nerve's as well as blood and lymph supply.  A root canal (or endodontic therapy) removes the tissue (sometimes live, sometimes dead) from the pulp and replace it with clean filling material.  Root canals allow patients to keep their own tooth and no  replacement is as good as a person's own natural tooth.

When is  Root Canal Needed?

In most cases, a root canal is needed because the pulp tissue is inflamed and dying or already dead. Once the tissue is dead, the tooth may become infected or abscessed.  This injury can be caused by decay in or near the pulp, a crack or fracture,  or a disturbance in the tooth's blood supply (usually during orthodontics).  An  inflamed tooth cannot repair itself. 

The way inflammation and death of a tooth from deep decay affects an individual patient is highly variable. Sometimes the entire progression occurs over days, sometimes over years.  Sometimes there is pain, sometimes not.  Often, a cavity that lies close to the pulp is filled and, years later,  the tooth dies.  One person can have horrible pain with an abscessed tooth; another can have an abscessed tooth for years and have no discomfort. 


There are also times when a tooth with a healthy pulp needs to have a root canal in order to allow it to support a crown or other prosthetic dental work. When a tooth is broken or substantial tooth structure is missing, your dentist may need to do an  "intentional" root canal so that a post may be placed inside the pulp area allowing a crown to be properly attached.

A root canal may also be needed when a tooth is fractured in an accident. This usually happens to front teeth.  Common causes are sports injuries (wear a mouth guard), auto accidents (wear a seat belt), falls on ice or slippery bathrooms, occasionally a bar room fight.   

Does Every Tooth that Has a Root Canal Need a Crown?

No, there are some situations where a root canal tooth does not need a crown, usually when the tooth is structurally intact and strong.   But often a  tooth that has had a root canal may already be weak due to decay and previous fillings.  Also, a tooth becomes a bit more brittle after having a root canal. Your dentist will be able to tell if the tooth needs a crown to protect it from breaking later. Some teeth should always be crowned after a root canal. These are usually multi-rooted molars that, because of their shape, may split lengthwise through the tooth.

Does Every Tooth That Needs a Crown Also Have to Have a Root Canal?

No, if a there are many situations in which a tooth needs a crown but, because the pulp is healthy, a root canal is not needed.  Sometimes a tooth that has been crowned will later die and need a root canal. This is usually because of a past filling that was deep or a crack that extended into the pulp area.  If a root canal needs to be done on a crowned tooth, there are two ways to proceed.  The dentist can tap off the crown, do the root canal and then re-cement the crown.  Alternatively, the root canal can be preformed with the crown in place,  by making an access hole in the top of the crown.


Do Root Canals Hurt?

No, root canals do not hurt because the patient is given local anesthetic. The days of root canal torture are long over. If a tooth is infected, an antibiotic may also be given. This may be amoxicillin, or in case of penicillin allergies, erythromycin. A few dental infections may need clindamycin if they are infected with a bacteria that is not susceptible to amoxicillin. If your tooth is not dead but not infected, you will not need antibiotic coverage in most cases.

What if I Do Nothing?

If you have an infection in your jaw, common sense dictates that it cannot stay there. You need to have a root canal or have the tooth extracted.  Even if it is not hurting now, it will and if the infection gets out of control you could actually die.  Nothing is not a reasonable option.
Sometimes, patients learn that taking antiobiotics they have around the house help an abscessed tooth.  Yes, this may work but the infection does not really resolve since the dead pulp tissue is still ther (I.e., it's not like a pimple).  More virulent bacteria may move in, or next time your resistance may be lower, or yo may be unable to get help when it recurs next time and does not go away. 
Sometimes a patient will come in with an abscess and have the first phase of a root canal (cleaning out the pulp chamber) but not return to have the root canal finished (filling of the chamber).  They are out of paid after the first visit to they do not retuen for completion.  This will haunt the patient also as the pulp chamber will become infected again. 

Copyright© 2005-2010 Lynne Heckert, DDS, JD  All rights reserved.  No portion of this or any DentalSmarts.com site  may be used without express written permission.   

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Please remember that information on these site is not all-inclusive and it may or may not apply to your situation and you need to call your own dentist.  A dentist needs to see the tooth, take and x-ray, etc. to diagnose and treat.   I cannot respond to email inquiries or phone calls.  Thanks for visiting!

The "pulp" is the tissue found in the hollow  canal in the center of the tooth. It is composed of nerve, blood and lymph tissue.  In a root canal, the pulp is removed and replaced with filling material.