No dental treatment is immune to the possibility of failure, and that certainly includes root canals. Even though success rates with endodontic treatment are as high as they’ve ever been, it is still important to know what some of the potential causes of failure are, what they mean, and how they can be addressed.
It is also important to break down root canal failure into two categories: failures that occur due to the nature of the procedure, and those that cause previously successful root canals to fail. Let’s examine the former group first.
Root canal treatment is a highly complex operation and requires years of education and experience to effectively deliver. There are dozens of variables that can cause root canals to fail even as the procedure is underway. Many of them are unavoidable.
Consider the following scenario: your dentist informs you that a tooth you have been experiencing pain and sensitivity with has a deep crack in it, one that may be threatening the nerve of the tooth. For that reason, he or she refers you to an endodontist for evaluation and treatment. The endodontist recommends root canal treatment, and the procedure begins. However, while accessing the pulp chamber and cleaning out the inside of the crown of the tooth, the endodontist notices that the crack in the tooth is, in fact, deeper than originally believed. So deep, in fact, that it has spread to the floor of the tooth beneath the bone or into one of the roots themselves. This situation, unfortunately, prevents successful completion of a root canal. Therefore, it may not be accurate to say that root canal failed in this case, only that there are circumstances that can derail treatment, and that some of them may be found only by initiating treatment, to begin with.
But suppose the tooth was not cracked and the endodontist completed the root canal. The only problem is, you are still experiencing pain in the days and weeks after treatment. This is often attributable to incomplete cleaning of the canals or failure to remove all of the dental pulp. This can happen for a few reasons. First, many teeth have curved roots or canals with complicated anatomy. Aside from the operator’s own knowledge and clinical expertise, there is no test to ensure that all infected pulp has been removed. Therefore, it is possible that some diseased tissue can be left behind—the very tissue that was causing pain in the first place.
There may also be “hidden” canals that are not part of normal anatomy and are missed. Still, other canals may branch off from main canals and be so tiny that they are essentially undetectable. The bottom line is that any amount of diseased tissue left behind can cause lingering pain and thus the root canal is considered to have failed.
It also bears mentioning the operator error can contribute to root canal failure. If a cleaned canal is not obturated (filled) all the way to the canal opening, there exists the potential for infection to reoccur. If canals are perforated (i.e., have a wall pierced by an instrument), the procedure cannot be completed. Again, though, these sorts of “iatrogenic” problems (those caused by the operator) are rare and reinforce the idea that a root canal specialist is probably the best doctor to see for root canal treatment in the first place. Another reason you might seek the endodontist is if you have a failed root canal treatment that has been done by another dentist in the past, and now it needs to be retreated (redone) by a specialist to improve the quality of the treatment and save the tooth.
There are other factors that can cause a root canal to fail after it has been successfully completed. Some of these may even happen years down the road. For example, if a root-canal-treated tooth develops a cavity that goes undetected or untreated, it can allow bacteria to re-enter the tooth and potentially cause infection. Similarly, a dental crown that was placed on the tooth incorrectly may allow bacterial leakage or a break in the crown may do the same. Finally, a root-canal-treated tooth may fracture in a way that makes the tooth non-restorable. Instances of decay can usually be addressed, whereas fractures—depending on the severity—can not. In those cases, extraction is the only option. This leads us to another important question.
As dental patients, most people are at one point or another faced with a financial decision regarding treatment, specifically weighing the pros and cons of the cost of treatment. Unlike in other forms of medicine, dentistry usually presents multiple options with varying price points. This gives patients an unusual amount of autonomy regarding their dental care, allowing them to play an active part in the treatment decision process. Some treatments, such as root canals, represent a relatively significant investment in the health and vitality of a tooth. Given the root canal alternatives a patient may have, it is important to determine whether or not root canal treatment price is worth it. The short answer is—yes—the price of a root canal is by far worth its value. Let’s take a look at a few reasons why.
The first thing to understand is that, without a root canal, an abscessed tooth has no other recourse but extraction. When bacteria invade a tooth, they receive nourishment from the dental pulp—the soft tissues within the tooth that contain the nerve and blood vessels. Many abscessed teeth are managed with antibiotics, but antibiotics alone cannot completely eradicate the infection. As long as the bacteria have a source of nourishment (in this case the pulp) the infection will always be present. This is why a root canal is the only option for saving an abscessed tooth. That fact alone makes root canal treatment price worth it. For further understanding, it is prudent to examine the costs—monetary and otherwise—of the alternative: losing a tooth to extraction.
Permanent teeth are meant to last a lifetime. When one is lost, there can be far-reaching, long-lasting effects in the mouth. One example is bone resorption. The human body has highly specific signals that instruct certain cells to either create or destroy bone. These signals are initiated by the amount of pressure and force that is exerted on bone. When a tooth is no longer present, the chewing forces that once stimulated the bone around the tooth are gone. What results is a slow but deliberate resorption of bone that can have effects on the neighboring teeth, as well, causing them to become loose or more prone to infections. Missing teeth create gaps that can lead to shifting of teeth throughout the arch, as well as teeth drifting out of their socket. This happens when the missing tooth’s “antagonist,” or tooth that opposed it during chewing, gradually elevates from its socket, a process known as “supraeruption.” All of this is to say nothing of the reduced function of the teeth and greater difficulty in chewing.
There are also financial costs when it comes to losing teeth. More specifically, there are costs associated with replacing missing teeth.
One of the most advanced and popular tooth replacement options are dental implants. Implants are widely regarded as the best tooth replacement option available, but they cannot replicate your own, natural tooth. Furthermore, dental implants represent arguably the most expensive tooth replacement option. The implant itself, a post that is placed in jaw bone, can cost several thousand dollars, not including the crown that is cemented to the top of the post. At present, dental implants are not covered by any major dental insurance provider. In contrast, root canals are a fraction of the cost, are almost always covered by dental insurance, and allow for retention of your own tooth—something that is irreplaceable.
Another common tooth replacement option is a dental bridge. A bridge consists of a series of crowns fused together that span a toothless space, thereby re-creating chewing functionality. Bridges, however, come with several drawbacks. First, they require irreversible alteration of teeth adjacent to the gap, even if the teeth are perfectly healthy. Bridges are also challenging to keep clean, since they are cemented permanently in place and must be carefully flossed underneath every day. Finally, a dental bridge does not solve the issue of bone resorption, since it hovers just above the gum line and does not stimulate bone in any way. Combined with the cost of the initial extraction, many bridges will end up costing more than one root canal.
Removable dentures are another option for replacing missing teeth. A new partial denture will usually cost at least as much as a root canal, but is not nearly as functional. Dentures can be uncomfortable, difficult to eat with, and can lead to teeth shifting and ongoing bone loss. It goes without saying no denture can replace a natural tooth.
By examining the alternatives to root canals and the many different costs associated with them, it is plain to see that root canal treatment price is abundantly worth its outcome. Other treatments are more expensive, damaging to other teeth, or plainly uncomfortable and dysfunctional. The bottom line is that no prosthesis can replace the function or aesthetics of your natural tooth. Only a root canal can facilitate this.
If you are experiencing a toothache, you should visit your endodontist for a definitive diagnosis. The prognosis of root canal treated teeth is much higher when the infection is treated early. Do not rely on self-diagnosis or attempt to “wait out” the pain—abscessed teeth are a serious condition that can lead to systemic health problems when untreated. With root canal treatment, you can restore health and pain-free function to your tooth that can preserve it for decades to come.
Are Root Canal Procedures Painful?
Similar to the myth that root canals can cause systemic illness, the widely held public belief that root canals are painful is based on outdated, anecdotal information. In decades past, it was possible that root canal treatment could present the possibility of discomfort or pain. This is due to the fact that infected teeth are more difficult to anesthetize. Without complete anesthesia, root canals years ago may have been more difficult on patients than they are today,
Modern anesthetics and the array of advanced delivery methods make it easier than ever to ensure complete, profound anesthesia of abscessed teeth, meaning essentially all root canal procedures are completed with no pain.
Some people may not have difficulty as far as tooth discomfort goes, but may find that their jaw becomes sore in response to being open for an uncommon amount of time while treatment is performed. There are several devices that can be used to comfortable prop the mouth open and allow the jaw muscles to relax. There is an answer for truly every possible unpleasant aspect of root canal treatment.
Will a Root Canal Hurt Afterward?
Although root canal procedures typically come with no pain either during or after the procedure, there are some instances in which mild discomfort may be felt in the days following root canal treatment. There are several mechanisms that can cause mild, lingering discomfort after having a root canal.
Perhaps the most common one is inflammation of the ligaments that hold the tooth in the socket. An abscessed tooth is under tremendous assault from bacteria and inflammation. Once the pulp is removed, the source of inflammation and bacteria is gone and can no longer produce pain. However, the tiny ligaments on the outside of a tooth’s roots may remain inflamed or sore for several days or a week afterward. This often results in discomfort when chewing. This type of post-operative discomfort usually subsides on its own without the need for further treatment. Your doctor may recommend a regular does of over-the-counter medications such as ibuprofen or acetaminophen.
Another very common cause of a sore tooth following root canal procedure has to do with the material used to fill the access hole that was created. When the root canal is completed, everything is ready to go except for the fact that there is still a large hole that was used to access the pulp. Endodontists typically fill this hole with one of several temporary materials, as the final restorative option will usually be made at a later date with a general dentist. Sometimes, the filling material that is placed by the endodontist is left a little too “high.” In other words, an over-use of filling material may cause that tooth to be higher than the surrounding teeth, causing the opposing teeth to hit it too hard when biting down. This process alone is enough to cause moderate discomfort, but when added to the fact that the tooth’s ligaments may still be sore, it is easy to see how a high filling can cause definite discomfort following treatment.
Finally, although not very common, there is another occurrence that leads to post-operative pain. In a very few cases, the nerve that leads to the tooth still has painful symptoms and behaves as if it were still inflamed. Even though the infected part of the nerve has been removed, the larger trunk of the nerve that runs through the jaw may still be agitated. This “phantom pain” is perplexing both to patients and doctors alike, but luckily it is exceedingly rare.
In short, root canal treatment almost always results in immediate relief from pain, but there are select instances in which post-operative discomfort may be present. The good news is that none of them can compare to the pain that the root canal treated, and each postoperative symptom is typically fleeting and easily managed with over-the-counter medications.
Despite the tremendous advances in medical and dental care over the last century, many people still feel drawn to alternative treatments and remedies. Holistic dentistry, as it is called, refers to the philosophy of treating dental disease by taking into account factors other than the immediate symptoms. A common phrase associated with holistic dentistry is “treatment of the whole person.” Although the intentions and convictions of holistic dentistry are noble, unfortunately, holistic dentistry often involves many unproven, ineffective treatments for serious dental problems.
For instance, holistic dentists often prescribe herbal remedies that have no basis in fact or scientific evidence as it relates to treating dental disease. Some holistic dentists even go so far to eschew the use of fluoride, a substance that has been definitely proven to reduce the incidence of tooth decay when administered in safe amounts. The practice of holistic dentistry also involves the use of select materials, which are considered to be “natural” or safer to the patient, despite scientific evidence proving as much.
Not surprisingly, adherents to the philosophies of holistic dentistry generally consider root canals to be dangerous, unnatural procedures that can pose harm to patients. This belief, of course, is absurd considering that root canals not only save teeth from extraction, they eradicate harmful infections. Bacterial infections that go untreated can cause a litany of problems, and severe cases of sepsis can be fatal. Antibiotics are the only way to kill bacteria, and root canals are the only way to permanently eliminate bacterial infections of teeth.
While there is certainly a place in dentistry for many holistic concepts, such as prevention and the treatment of patients as whole person, the clinical principles of holistic dentistry are not only ineffective, they are dangerous. This is especially true for abscessed teeth. There is only one proven treatment for bacterial abscesses: root canal treatment. Do not risk losing your tooth—or worse—when it comes to choosing holistic dentistry over endodontic treatment.
Can Root Canals Cause Heart Problems?
Among the many myths that exist regarding root canal treatment, the belief that root canals can cause systemic illness is easily the most antiquated and was debunked decades ago.
To understand the origin of this myth, a brief history lesson is in order.
In the early 1900s, a concept is known as “focal infection theory” had an enormous influence on the practices of medicine and dentistry. This concept contends that many, if not all, systemic illnesses are the result of small, localized “foci” of bacterial infection. As it happens, teeth are natural harbors for bacterial infection, thus it was believed that infected teeth could cause a wide array of diseases and conditions. What’s more, the dental community at that time was of the belief that even teeth that been treated with root canals were suspect—that is, they had bacteria left behind that could continue to cause problems. Since a tooth that had been treated with root canal therapy was one that had obviously been infected at some point, many dentists extracted these teeth carte blanche, regardless of whether the tooth was causing problems or not.
Today, it is well understood that focal infection theory is incongruent with the true nature of pathology and the effects of bacterial infection.
In fact, root canal treatment cures and prevents the very problem that adherents of focal infection theory were so concerned about. It is true that infections in the body can migrate and cause significant issues elsewhere. For example, an abscessed tooth that is left untreated can lead to a condition called “cellulitis,” in which the bacteria escapes from the confines of the tooth and jaw and affects interstitial spaces and under the skin. Due to the swelling that is often present, cellulitis is often times a medical emergency.
Further, if bacteria enter the bloodstream and travels to the heart, they can colonize certain cardiovascular structures and create life-threatening problems, such as endocarditis. Because an abscess is a source of bacteria that could do exactly that, it’s plain to see that root canals not only do not cause heart problems, they actually help prevent them!
Bacterial infections, regardless of where they are in the body or how small they are, have the potential to grow and affect many parts of the body. Root canal treatment is performed exclusively to eradicate bacterial infection, thus preventing that very occurrence. Do not believe the myth that root canals can cause heart issues or other illnesses. On the contrary: they may be the very thing that saves you from such problems.
Why So Many People are Afraid of Root Canals (and Why They Shouldn’t Be)
Within the American lexicon, the phrase “root canal” is instantly understood by everyone to mean a horrible experience. How many times have you heard, “I’d rather have a root canal”? This anecdotal designation of root canals as one of life’s most unpleasant experiences is well-ingrained, but extremely unfair. In the world of modern dentistry, one could argue that having a root canal is one of the easiest dental procedures to undergo. Nevertheless, fear and widespread misinformation continue to haunt root canals and give them an undeserved bad rap. Here are a few reasons why people fear root canals, and the reasons why they shouldn’t.
1) Root canals hurt!
Obviously, the expectation of pain is the number one reason root canals are considered to be so torturous. The truth is that root canals should not cause any pain; certainly no more than any other dental procedure. The incorrect belief that root canals are painful arguably stems from two facts.
First is the fact that the problem that necessitates a root canal is in fact very painful. An abscessed tooth is one of the painful things a person can experience. Perhaps people assume that since the toothache is so awful, the procedure for fixing it must be equally as bad? Luckily, that is not the case.
Second, from a purely clinical standpoint, teeth that are infected by bacteria are often times more difficult to get numb. In the “olden days,” it may have been more likely for a patient to experience brief episodes of sensitivity or pain while having a root canal, simply because the tooth was not fully anesthetized. But again, in modern dentistry, this is rarely an issue. Many people actually fall asleep during their procedure. How bad could it be?
The truth is that root canals do not hurt, and there is no reason why one cannot be completed without discomfort of any kind.
2)Fear of the unknown
Root canals are one of the least understood procedures in dentistry. Many people assume it to be so awful because of the true nature of what a root canal is escaped most people. And, unfortunately, explaining a root canal procedure does not make it sound very pleasant. For example, saying “a root canal procedure consists of drilling a hole in your tooth and using special instruments to remove the nerve and blood vessels from the interior of the tooth” does not exactly instill feelings of calmness or acceptance. As bad as it may sound, actually having a root canal is pretty boring—and pain-free
3)Fear of the cost
Root canals are a complicated, specialized procedure, and thus are among the more expensive dental treatments. However, nearly all dental insurance plans cover at least some cost of a root canal (and the subsequent crown). More importantly, the value of a root canal is far greater than its price, especially when you consider the only other option is to extract the tooth—at which point you’ll have to pay even more to replace it with something like a dental implant.
The bottom line is that root canals have an awful reputation that is completely undeserved. Almost all root canals are completed painlessly and relatively quickly. Rest assured that if you need to have a root canal, there is nothing to fear
Among the public, there is some confusion as to why the specialty of endodontics exists. Endodontists are dentists who have received additional training that makes them experts and extremely proficient at performing root canal treatment. These doctors limit their practice solely to root canal and other, lesser-known endodontic procedures.
All general dentists are trained on how to perform root canals. But root canals are highly complex treatments that require specialized instruments and a wealth of experience to master. Because endodontists receive three additional years of training in the practice of performing root canals, they have a decided advantage in terms of expertise and experience over general dentists. Furthermore, by limiting their practice to only performing root canals, endodontists build on their expertise every day, becoming more proficient as time goes on.
Most endodontists also utilize highly advanced tools, such as high-powered microscopes, that make root canal treatment much more efficient and predictable. General dentists rarely use the types of tools and equipment that endodontists invest in, meaning general dentists are at a disadvantage when it comes to successfully performing root canal treatment.
If your tooth is at risk, why not get the best and most reliable treatment? Put simply, by choosing an endodontist for your root canal treatment, you are choosing the highest quality treatment possible.
Over the course of the last two decades, dental implants have emerged as the leading tooth replacement option in almost every case. Implants boast many attributes that make them stellar dental prostheses and are truly unmatched by any other type of tooth replacement treatment. Coincident with the rising popularity of dental implants is the idea that having a diseased tooth extracted and replaced with an implant might be a better option than treating the diseased tooth and restoring it to functionality. But while dental implants are at the forefront of modern dental technology, always remember that they, along with dentures and bridges, are not designed to replace teeth. They are designed to replace missing teeth. Sometimes broken or diseased teeth cannot be saved. In those instances, extraction and implant placement is an excellent course of action. But any time a tooth can be saved, it should be. Because not even dental implants can replace real teeth.
The most common scenario in which patients finds themselves debating saving a natural tooth or extracting it is when a tooth has become abscessed and requires root canal treatment. The mere phrase “root canal” has become synonymous with a situation to be avoided at all possible costs. This is due to widespread misconception about what a root canal actually is, what it feels like, and what it means for the tooth going forward.
A root canal procedure, in a nutshell, removes the nerves and blood vessels from the interior of the tooth. This is done when bacteria infect these tissues, a condition is known as an abscess. An abscessed tooth cannot be cured in any other way. With the tissues removed from the tooth, the hollowed-out parts of the tooth are filled with sterile, inert materials and, in almost every case, a crown is then placed on the tooth.
Root canals have significant advantages over dental implants, not the least of which is the cost. Merely placing an implant, not including a crown, will cost several thousand dollars. Often times, a root canal and crown are less expensive, not to mention commonly covered by insurance. Furthermore, dental implants are a time-consuming treatment; several months must pass before a crown can be placed on an implant and thereby making it functional. In contrast, a root canal and crown can be done in a matter of days—or even in one day.
Most importantly, though, as good as a dental implant is, it still isn’t your tooth. Nothing can replace a natural part of the body. Natural teeth feel and function differently than prostheses, and they exist harmoniously with the rest of the oral environment. If you are currently faced with the prospect of having a root canal done, rest assured that making the choice to save your natural tooth is always the best choice.
As with any pathology associated with a tooth, extraction is a fail-proof way to address the issue at hand. Obviously, though, this option comes at a steep price: loss of tooth. Losing a tooth may seem like an innocuous occurrence, but it can have long-lasting permanent side effects. When permanent teeth are extracted, the bone around them tends to slowly resorb over a period of time. The driving force behind this phenomenon is the same as that that causes atrophy of unused muscles. When a tooth is not present, the bone does not experience the compressive forces that occur when chewing occurs on the tooth. The body’s cellular processes interpret this to mean that the bone is no longer needed, and it is slowly destroyed.
The loss of bone can affect neighboring teeth, as well, causing them to loosen and drift out of their normal position. Furthermore, loss of bone in the maxilla (upper jaw) can present complications associated with the maxillary sinus, which is in close proximity to the roots of the maxillary teeth.
This is to say nothing, of course, of the reduced ability to chew and eat with maximum efficiency.
Obviously, even if extraction is chosen instead of root canal treatment, there are numerous options for replacing a missing tooth. Single teeth can be replaced with dental implants and dental bridges, for example. Dental implants, while a superb treatment option, are very expensive and time-consuming: one implant can cost upwards of several thousand dollars and may take 4-6 months before treatment is fully complete. Dental bridges can be done more quickly, but they require the irreversible alteration of otherwise healthy teeth and are somewhat challenging to keep clean.
Partial dentures are suitable when several teeth are missing, but these represent arguably the least desirable tooth replacement option. Dentures of all types can be unstable, uncomfortable, and come nowhere near the functionality of real teeth.
The bottom line is that there is no tooth replacement that can fully replicate the feel, appearance, and functionality of a natural tooth, not to mention the overwhelming physiological benefits of retaining natural teeth. That being said, root canal treatment is a far better option for an abscessed tooth than extraction.
There are instances in which the “restorability” of the tooth is questionable. What this means is that the tooth is so badly damaged that it is not certain whether the tooth can be restored to full functionality even after root canal treatment. In these cases, it is prudent to consider extraction as perhaps a more sensible treatment option. But assuming that the tooth is restorable and there are no other unfavorable circumstances, root canal treatment is by far better than a tooth extract.