So, you've undergone a root canal treatment to save a decayed tooth. The tooth has a new lease on life — and the pain is gone too. But there's a reality you need to keep in mind — your tooth could become re-infected, putting you back in the same painful circumstance.

Root canal treatments are often necessary when decay works its way deep within a tooth, into the pulp. The excruciating pain a person feels is the infection attacking the bundle of nerves within the pulp tissue. If the infection isn't addressed promptly, it will continue to work its way to the root, eventually damaging the tooth beyond repair.

During a root canal treatment, we drill into the tooth to access the pulp chamber. After clearing it completely of its infected tissue, we then fill the chamber and root canals with a special filling and then seal off the access. A short time later we'll bond a crown over the tooth to protect it and to make it more attractive.

Most of the time, this preserves the tooth for many years. Occasionally, though, re-infection can occur. There are a number of reasons why: the first infection may have been more extensive than thought; the root canal network was more complex and some tinier canals weren't able to be identified; or the protective crown may once again get tooth decay contaminating the root canal.

If infection does reoccur it doesn't mean the tooth is lost. It's possible a second root canal treatment can successfully correct any problems, especially those that may not have been detected the first time. More complex cases might also require the services of an endodontist, a specialist in root canals. They're skilled in advanced techniques and have specialized equipment to handle even the most complicated root canal networks.

In the meantime, if you notice signs of re-infection like pain or swelling around a treated tooth, contact us promptly for an appointment. You should also contact us if the tooth is injured in an accident. The sooner we can treat your tooth, the more likely the second time will be more successful.

If you would like more information on preserving a tooth through root canal treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment: How long will it Last?”

You’ve recently learned one of your teeth needs a root canal treatment. It’s absolutely necessary: for example, if you have decay present, it will continue to go deeper within the tooth and it will spread to the roots and bone and could ultimately cause you to lose your tooth. Although you’re a little nervous, we can assure you that if we’ve recommended a root canal treatment, it’s the right step to take for your dental health.

There’s nothing mysterious — or ominous — about a root canal. To help ease any fears you may have, here’s a step-by-step description of the procedure.

Step 1: Preparing your mouth and tooth. We first take care of one of the biggest misconceptions about root canals: that they’re painful. We completely numb the tooth and surrounding tissues with local anesthesia to ensure you will be comfortable during the procedure. We isolate the affected tooth with a thin sheet of rubber or vinyl called a rubber dam to create a sterile environment while we work on the tooth. We then access the inside of the tooth — the pulp and root canals — by drilling a small hole through the biting surface if it’s a back tooth or through the rear surface if it’s in the front.

Step 2: Cleaning, shaping and filling the tooth. Once we’ve gained access we’ll clear out all of the dead or dying tissue from the pulp and root canals, and then cleanse the empty chamber and canals thoroughly with antiseptic and antibacterial solutions. Once we’ve cleaned everything out, we’ll shape the walls of the tiny root canals to better accommodate a filling material called gutta-percha, which we then use to fill the canals and pulp chamber.

Step 3: Sealing the tooth from re-infection. Once we complete the filling, we’ll seal the access hole and temporarily close the tooth with another filling. Later, we’ll install a permanent crown that will give the tooth extra protection against another infection, as well as restore the tooth’s appearance.

You may experience some mild discomfort for a few days after a root canal, which is usually manageable with aspirin or ibuprofen. In a week or so, you’ll hardly notice anything — and the tooth-threatening decay and any toothache it may have caused will be a distant memory.

If you would like more information on root canal treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Step-by-Step Guide to Root Canal Treatment.”

Primary (baby) teeth might not last long, but their impact can last a lifetime. Their first set of teeth not only allows young children to eat solid foods, but also guide permanent teeth to form and erupt in the proper position.

Unfortunately, primary teeth aren't immune to tooth decay. If the decay is extensive, the tooth may not last as long as it should. Its absence will increase the chances the permanent teeth won't come in correctly, which could create a poor bite (malocclusion) that's costly to correct.

If a primary tooth is already missing, we can try to prevent a malocclusion by installing a “space appliance.” This keeps nearby teeth from drifting into the empty space intended for the permanent tooth. The best approach, though, is to try to save a primary tooth from premature loss.

We can often do this in much the same way as we would with a permanent tooth — by removing decayed material and filling the prepared space. We can also perform preventive applications like topical fluoride or sealants that strengthen or protect the tooth.

It becomes more complicated, though, if the pulp, the interior of the tooth, becomes decayed. The preferred treatment for this in a permanent adult tooth is a root canal treatment. But with a primary tooth we must also consider the permanent tooth forming below it in the jaw and its proximity to the primary tooth. We need to adapt our treatment for the least likely damage to the permanent tooth.

For example, it may be best to remove as much decayed structure as possible without entering the pulp and then apply an antibacterial agent to the area, a procedure known as an indirect pulp treatment. We might also remove only parts of the pulp, if we determine the rest of the pulp tissue appears healthy. We would then dress the wound and seal the tooth from further infection.

Whatever procedure we use will depend on the extent of decay. As we said before, our number one concern is the permanent tooth beneath the primary. By focusing on the health of both we can help make sure the permanent one comes in the right way.

If you would like more information on caring for children's primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment for Children's Teeth.”