Root canal is still one of the most feared dental procedures. There are also those who have a negative view of root canal due to a bad experience, result or the cost of the procedure. Once the pulp of a tooth becomes infected, a root canal is the only way to save the tooth. In most cases, a root canal is the best option, but there are many factors that go into that decision. Although an experienced dentist can usually perform a root canal with minimal discomfort and with a high degree of success, problems can and do occur. In some cases, new technology used by some general dentists and endodontists (root canal specialists) called cone-beam computed tomography (CBCT) could help diagnosis root canal problems.
The root canal procedure involves the dentist making a small hole in the tooth and then removing the tiny infected nerves and blood vessels within the tooth’ s root(s). The roots are then shaped, disinfected, and filled with an inert material. The procedure is usually successful about ninety percent of the time when properly performed. When a tooth with root canal is successful, a person will have no pain or other signs or symptoms of infection. Of course, this also means that about ten percent of the time, a root canal will become re-infected or”fail”, and continue to cause problems for the person.
A root canal that is failing will usually continue to cause pain or discomfort, especially when biting down. In some cases, a failing root canal will cause swelling, also known as an abscess. There are several reasons why a tooth that has root canal can fail. A root canal can fail if some of the infected nerves and blood vessels are left inside the roots, the inert filling does not completely seal off the roots from bacteria, the tooth is damaged during the procedure (perforation), or the tooth fractures between or within the roots. A root canal is more likely to fail if a permanent filling or crown (cap) is not placed to protect the tooth. A root canal can fail within days, weeks, months or even many years after the procedure has been completed.
In some cases, it is difficult to diagnose the reason a root canal fails. It your dentist cannot discover the reason the root canal has failed with conventional x-rays and clinical tests, referral to a root canal specialist with CBCT technology should be considered. CBCT can give a three dimensional view of the tooth that will be better able to show missed roots or nerves, fractures inside the tooth, and difficult anatomy within the tooth. In most cases, a failing root canal can be retreated, or a procedure called an apicoectomy (removal of the root tip) can be performed to save the tooth. If these measures are unsuccessful or deemed unlikely to succeed, the tooth will usually need to be extracted.
Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: https://dentalcomfortzone.com/staging.