What is root canal treatment (endodontic therapy)?

What does root canal therapy do?

You may find yourself in the situation where you’ve been told that your tooth needs root canal treatment. And you understand that it offers a way of saving your tooth.

But what you don’t get is how it accomplishes this. You don’t understand the underlying purpose of having endodontic therapy, and what it changes about your tooth.

These issues are the subject of this page. Below we outline the goals and objectives of this procedure, and explain what’s different about your tooth afterward that makes it so it can be retained.

Our website also explains …

After you’ve read this page, scroll back to the list below. It contains links to our other pages that provide additional information about having root canal.

• What you can expect during your procedure The steps. What they’re like., as well as afterward. The post-op experience.
• Ways teeth are rebuilt What decides? following their treatment including: Crowns Post & cores
• Treatment costs. Endodontic fees.
• Why a tooth’s therapy might fail. Reasons.
• Treatment alternatives Options (such as implants vs. root canal Which is better?).

1) What is root canal treatment?

Root canal (endodontic) therapy refers to the process where a dentist treats that space inside a tooth originally occupied by its “nerve.”

Definitions.

The formal terminology for a tooth’s “nerve” is “pulp tissue.” On our pages we use all of these terms interchangeably: nerve = nerve tissue = pulp tissue.

Root canal therapy is used to treat conditions involving a tooth’s nerve space.

During treatment, the space is cleansed and sealed off.

2) What does root canal treatment accomplish? / What’s its purpose?

• A dentist both resolves the tooth’s internal (nerve space) problems (by way of removing dead or dying pulp tissue, clearing up infection, sanitizing the tooth’s root canal system, etc…) …
• … and also sets the stage so the person’s body’s healing process can successfully return those tissues that surround the tooth’s root that have been affected by its internal condition, back to a normal healthy state.

The procedure itself is a two-stage process.

Stage 1: Cleansing the tooth’s interior.

Nerve tissue that’s been removed from a tooth.

Microorganisms (bacteria, fungi) that have invaded this space are removed too, along with the associated debris and contaminants they have formed.

Stage 2: Sealing off the treated area.

The procedure is then completed by sealing off (filling in) the tooth’s cleansed internal space (usually with an inert rubbery material), so contaminants and microorganisms can’t leak back into or out of it.

Details –

Stage 1: Cleaning the tooth. – What does this step accomplish?

Background.

Dentists use the same root canal process to resolve a wide range of nerve-related problems. For example, this fix is the solution when a tooth’s pulp tissue is: 1) Irreversibly inflamed, 2) In the process of dying, or 3) Completely necrotic (dead). It’s also the solution for when the tooth’s interior harbors infection (either chronic or acute).

And although each of these conditions represents a different status, what they all have in common is that they each involve, or ultimately will at some point, a situation where the tooth’s nerve space harbors contaminants that will leak out of the tooth’s root tip and persistently irritate (inflame) the tissues that surround it.

The goal.

Therefore, as the underlying purpose of the cleaning portion of the root canal procedure The steps., the dentist’s goal is to sanitize the interior of the tooth as effectively as possible. So irritants won’t exist inside it to ultimately leak out and persistently irritate the tissues that surround its root.

In their attempt to accomplish this goal, they’ll remove the remaining remnants of the tooth’s pulp tissue (live or dead), the organic debris left over from the breakdown of this tissue, microorganisms (bacteria, fungi) and the toxins and other byproducts they have created.

Stage 2: Sealing off the tooth’s interior. – Why is this important?

Sealing the root canal space (filling it in) prevents contaminants from entering or exiting it.

• One of them is for the filling material to create a seal that prevents contaminants from seeping back into the tooth and recontaminating/reinfecting its interior space. (If this occurs, the tooth would again be a persistent leaking source of irritants to the surrounding tissues.)
• The other goal is just the opposite. The seal prevents any irritants still trapped within the tooth’s root canal system from seeping out (we explain in greater detail below). (If this is not prevented, once again, the tooth would be a persistent source of irritants to the tissues that surround its root.)

▲ Section references – Torabinejad

How is it that contaminants can seep out of a treated tooth? Hasn’t its interior been cleansed?

Root canals don’t really have a precise shape like we show in most of our illustrations.

The tooth in the animation shown below is slightly more realistic. It illustrates that the canal inside a tooth’s root can be like a river, in the sense that it has a main channel that may give birth to small divisions that wander away and then return. Or else branch off and follow a different route entirely.

Complex root canal systems can be impossible to completely disinfect.

This poses a significant challenge for the dentist.

• They’ll use root canal files to scrape and clean Process explained. the walls of those aspects of the canal system they can fit into. (This will be the main/larger canals of the system.)
• They’ll also rinse out the tooth’s interior Process explained. with a disinfecting solution, in hopes that it will seep into the smaller branches of the canal and cleanse them.

But despite their best efforts, it’s always possible that some amount of debris will still remain. And in fact, the reality of the matter is that studies have shown that the root canal system of a tooth really can’t be completely cleaned and disinfected. (Hargreaves)

▲ Section references – Hargreaves

3) Why are contaminants harbored within a tooth such a big issue?

Your body’s ability to handle infections inside teeth is different than with other parts of your body. That’s because teeth are hard, cavernous objects.

A) Soft-tissue infections.

B) Infections inside teeth.

Now, consider the scenario with teeth. Once a tooth’s nerve tissue has started to degenerate (die-off), and bacteria have taken up residence inside the tooth’s empty nerve space, it’s difficult for white blood cells to effectively get at the microorganisms to combat them.

The empty, hollow space inside a necrotic tooth is a difficult location for your body’s immune system to fight infection.

There’s limited transportation available.

The consequences.

With this scenario, at best your body will only be able to cordon off the infection stemming from inside your tooth, via setting up a perimeter of defensive tissues and cells around the tooth’s root.

As a worst case, the infection will massively overwhelm your body’s wall of defenses, resulting in pain and swelling (an acute tooth abscess).

▲ Section references – Ingle

So, here’s what root canal treatment accomplishes.

Endodontic therapy provides for a third outcome, one where an infection associated with a tooth is not just cordoned off but instead can actually be cleared up by your body’s defense mechanisms.

• The root canal treatment assists your body’s infection-fighting process by removing (disinfecting) and sealing off (entombing) bacteria and contaminants inside your tooth that it would otherwise have difficulty dispensing with.

• Following the completion of your tooth’s treatment, no further leakage of irritants from its root should occur.
• Any microorganisms and contaminants that have already exited, and as a result have inflamed the tissues that surround your tooth’s root, can be dealt with in normal fashion by your body’s immune system.
• The expectation is that this cleanup and healing process will be successful. The result will be an inert tooth root (one that doesn’t leak irritants) surrounded by normal healthy tissues.

▲ Section references – Hargreaves

Other things you need to know to understand root canal treatment.

Where precisely in a tooth is its nerve?

Total tooth nerve space = Canal(s) + Pulp chamber

a) The pulp chamber.

b) Root canals.

Root canals are tiny tunnels that run the length of a tooth’s root. (From its pulp chamber down to the root’s apex (tip).)

(FYI: Measuring the length of these canals How it’s done. is a very important part of the root canal process.)

As a rule, every tooth root (note: some teeth have more than one root) will contain at least one canal. But a root having more than just one canal is possible, and commonplace with some specific kinds of teeth.

(For more in-depth information, visit our page: How many roots and root canals do teeth have? What’s normal? | Variations.)

Isn’t it important for a tooth to have a nerve?

No, not really. A tooth’s pulp tissue plays a role in its formation and development. But once that’s been completed, it’s not so vitally important. So, having it removed during root canal treatment isn’t that big of a deal.

You don’t really get much “feeling” input from a tooth’s nerve.

Under normal circumstances, the nerve tissue inside our teeth provides us with comparatively little information.

Yes, when subjected to pressure or temperature extremes, or exposed to severe insult (like advancing tooth decay or the formation of a crack), teeth do respond with a painful sensation. But other than that, the nerves inside our teeth remain relatively unresponsive.

Proprioception.

You might think that when you push on your teeth, or else close them together, the pressure sensation that you feel (proprioception) is a signal from within your tooth.

▲ Section references – Eliyas

You’ll never miss your tooth’s nerve.

Due to the above, from a standpoint of normal function, the presence of live nerve tissue within a tooth is pretty much optional. If it’s present and healthy, then wonderful. But if it’s been removed as a part of root canal treatment, then that’s fine too. You’ll never miss it.