Root Canal Treatment
Nothing is as good as your natural tooth!
Saving your natural tooth should always be your first choice when dental care is needed. Nothing, not even the most advanced bridges and implants, can truly replace your natural tooth.
- If your dentist recommends extracting your tooth, ask if it can be saved with an endodontic procedure, also known as root canal treatment. Endodontic treatment removes the injured pulp (soft inner tissue) of your tooth and fills and seals the space. Your tooth is then restored and can function just like any other tooth for the rest of your life, ensuring comfortable chewing and a natural appearance.
- Although some general dentists perform root canal procedures, many refer their patients to endodontists. Endodontists are specialists who have two to three years' additional training after dental school and limit their practices to endodontic procedures. They can often save the most severely injured teeth.
- If your tooth cannot be saved - and some cannot - you may consider replacements such as a bridge or dental implant. Your options may depend upon the condition of surrounding teeth and bone structure.
- Dental implant procedures can be complex, costly and they often require several visits and several month's healing time before the procedure can be completed.
Do everything possible to save your teeth before considering extraction. Nothing is as good as your natural tooth! And sometimes your natural tooth may need root canal (endodontic) treatment for it to remain a healthy part of your mouth.
Most patients report that having root canal (endodontic) treatment today is as unremarkable as having a cavity filled.
If you've been told you need root canal (endodontic) treatment, you can find the answers to your questions below.
ROOT CANAL TREATMENT
Who performs endodontic treatment?
All dentists, including your general dentist, receive basic training in endodontic treatment in dental school. General dentists often refer patients needing endodontic treatment to endodontists.
Who is an "endodontist"?
An endodontist is a dentist with special training in diagnosing and treating problems associated with the inside of the tooth. They do only endodontic procedures in their practices because they are specialists. To become specialists, they complete dental school and an additional two or more years of advanced training in endodontics, one of the nine specialties recognized by the American Dental Association. They perform routine as well as difficult and very complex endodontic procedures, including retreatment of previous root canals that have not healed completely, as well as endodontic surgery. Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose.
Why would I need an endodontic procedure?
Endodontic treatment is necessary when the pulp, the soft tissue inside the root canal, becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep decay, repeated dental procedures on the tooth, or a crack or chip in the tooth. In addition, an injury to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.
What are the signs of needing endodontic treatment?
Signs to look for include pain, prolonged sensitivity to heat or cold, tenderness to touch and chewing, discoloration of the tooth, and swelling, drainage and tenderness in the lymph nodes as well as nearby bone and gingival tissues. Sometimes, however, there are no symptoms.
How does endodontic treatment save the tooth?
The endodontist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the canal, a channel inside the root, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Will I feel pain during or after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anesthetics, most patients report that they are comfortable during the procedure.
For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your endodontist's instructions carefully.
Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure or pain that lasts more than a few days, call your endodontist.
How much will the procedure cost?
The cost varies depending on how complex the problem is and which tooth is affected. Molars are more difficult to treat, the fee is usually more. Most dental insurance policies provide some coverage for endodontic treatment.
Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration. With root canal treatment you save your natural teeth and money.
Will the tooth need any special care or additional treatment after endodontic treatment?
You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings.
Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment does not heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, redoing the endodontic procedure can save the tooth.
What causes an endodontically treated tooth to need additional treatment?
New trauma, deep decay, or a loose, cracked or broken filling can cause new infection in your tooth. In some cases, the endodontist may discover additional very narrow or curved canals that could not be treated during the initial procedure.
Can all teeth be treated endodontically?
Most teeth can be treated. Occasionally, a tooth can't be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn't have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. When endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
With proper care, most teeth that have had root canal (endodontic) treatment can last as long as other natural teeth. In some cases, however, a tooth that has received endodontic treatment fails to heal. Occasionally, the tooth becomes painful or diseased months or even years after successful treatment. If your tooth has not healed or has developed new problems, you have a second chance. Another procedure, endodontic retreatment, may be able to save your tooth.
Who performs endodontic retreatment?
All dentists receive basic training in root canal treatment in dental school. However, because endodontic retreatment can be more challenging than providing first-time treatment, many dentists refer patients needing endodontic retreatment to endodontists.
Endodontists are dentists with at least two additional years of advanced specialty education in diagnosis and root canal treatment. Because they limit their practices to endodontics, they treat these types of problems every day. Endodontists are experts in performing nonsurgical and surgical retreatment. They use their special training and experience in treating difficult cases, such as teeth with narrow or blocked canals or unusual anatomy. Endodontists may use advanced technology, such as operating microscopes, ultrasonics and digital imaging to perform these special services.
Why do I need another endodontic procedure?
As occasionally happens with any dental or medical procedure, a tooth may not heal as expected after initial treatment for a variety of reasons:
- Narrow or curved canals were not treated during the initial procedure.
- Complicated canal anatomy went undetected in the first procedure.
- The placement of the crown or other restoration was delayed following the endodontic treatment.
- The restoration did not prevent salivary contamination to the inside of the tooth.
In other cases, a new problem can jeopardize a tooth that was successfully treated. For example:
- New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth.
- A loose, cracked or broken crown or filling can expose the tooth to new infection.
- A tooth sustains a fracture.
- What will happen during retreatment?
First, the endodontist will discuss your treatment options. If you and your endodontist choose retreatment, the endodontist will reopen your tooth to gain access to the root canal filling material. In many cases, complex restorative materials-crown, post and core material-must be disassembled and removed to permit access to the root canals.
After removing the canal filling, the endodontist can clean the canals and carefully examine the inside of your tooth using magnification and illumination, searching for any additional canals or unusual anatomy that requires treatment.
After cleaning the canals, the endodontist will fill and seal the canals and place a temporary filling in the tooth. If the canals are unusually narrow or blocked, your endodontist may recommend endodontic surgery. This surgery involves making an incision to allow the other end of the root to be sealed.
After your endodontist completes retreatment, you will need to return to your dentist as soon as possible to have a new crown or other restoration placed on the tooth to protect and restore it to its full function.
Is retreatment the best choice for me?
Whenever possible, it is best to save your natural tooth. Retreated teeth can function well for years, even for a lifetime.
Advances in technology are constantly changing the way root canal treatment is performed, so your endodontist may use new techniques that were not available when you had your first procedure. Your endodontist may be able to resolve your problem with retreatment.
As with any dental or medical procedure, there are no guarantees. Your endodontist will discuss your options and the chances of success before beginning retreatment.
How much will the procedure cost?
The cost varies depending on how complicated the procedure will be. The procedure will probably be more complex than your first root canal treatment, because your restoration and filling material may need to be removed to accomplish the new procedure. In addition, your endodontist may need to spend extra time searching for unusual canal anatomy. Therefore, you can generally expect retreatment to cost more than the initial endodontic treatment.
While dental insurance may cover part or all of the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check with your employer or insurance company prior to retreatment to be sure of your coverage.
What are the alternatives to retreatment?
If nonsurgical retreatment is not an option, then endodontic surgery should be considered. This surgery involves making an incision to allow access to the tip of the root. Endodontic surgery may also be recommended in conjunction with retreatment or as an alternative. Your endodontist will discuss your options and recommend appropriate treatment.
What are the alternatives to endodontic retreatment and/or endodontic surgery?
The only other alternative is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these options require extensive surgery or dental procedures on adjacent healthy teeth, they can be far more costly and time consuming than retreatment and restoration of the natural tooth.
No matter how effective tooth replacements are-nothing is as good as your own natural tooth. You've already made an investment in saving your tooth. The payoff for choosing retreatment could be a healthy, functioning natural tooth for many years to come.
Why do I need endodontic surgery?
To understand endodontic surgery, it helps first to know something about the nonsurgical endodontic procedure, or "root canal." Root canal treatment is necessary when the soft inner tissue, or "pulp," of the tooth becomes inflamed or infected. This may happen as a result of deep decay, repeated dental procedures on the tooth, or an injury to the tooth. Root canal (endodontic) treatment removes the damaged pulp. Then the tooth's canals are cleaned and filled to help preserve the tooth.
In a few cases, however, root canal (nonsurgical endodontic) treatment alone cannot save the tooth. In such a case, your dentist or endodontist may recommend surgery.
Who performs endodontic surgery?
All dentists received training in endodontic treatment in dental school. However, because endodontic surgery can be more challenging than providing nonsurgical treatment, many dentists refer patients needing surgery to endodontists.
Endodontists are dentists with at least two additional years of advanced education and training in root canal techniques and procedures. In addition to treating routine cases, they are experts in performing complicated procedures including surgery. They often treat difficult cases-such as teeth with unusual or complex root structure or small, narrow canals. This special training and experience can be very valuable when endodontic surgery is necessary.
Why would I need endodontic surgery?
Surgery can help save your tooth in a variety of situations.
- Surgery may be used in diagnosis. If you have persistent symptoms but no problems appear on your x-ray, your tooth may have a tiny fracture or canal that could not be detected during nonsurgical treatment. In such a case, surgery allows your endodontist to examine the entire root of your tooth, find the problem, and provide treatment.
- Sometimes calcium deposits make a canal too narrow for the instruments used in nonsurgical root canal treatment to reach the end of the root. If your tooth has this "calcification," your endodontist may perform endodontic surgery to clean and seal the remainder of the canal.
- Usually, a tooth that has undergone a root canal can last the rest of your life and never need further endodontic treatment. However, in a few cases, a tooth may not heal or become infected. A tooth may become painful or diseased months or even years after successful treatment. If this is true for you, surgery may help save your tooth.
- Surgery may also be performed to treat damaged root surfaces or surrounding bone.
Although there are many surgical procedures that can be performed to save a tooth, the most common is called apicoectomy or root-end resection. When inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure, your endodontist may have to perform an apicoectomy.
What is an apicoectomy?
Removal of the very end of the root is called apicoectomy. In this procedure, the endodontist opens the gingival tissue near the tooth to examine the underlying bone and to remove any inflamed or infected tissue.
A small filling may be placed in the root to seal the end of the root canal, and a few stitches or sutures are placed in the gingiva to help the tissue heal properly.
Over a period of months, the bone heals around the end of the root.
Are there other types of endodontic surgery?
Other surgeries endodontists might perform include dividing a tooth in half, repairing an injured root, or even removing one or more roots. Your endodontist will be happy to discuss the specific type of surgery your tooth requires.
In certain cases, a procedure called intentional replantation may be performed. In this procedure, a tooth is extracted, treated with an endodontic procedure while it is out of the mouth, and then replaced in its socket.
These procedures are designed to help you save your tooth.
Will the procedure hurt?
Local anesthetics make the procedure comfortable. Of course, you may feel some discomfort or experience slight swelling while the incision heals. This is normal for any surgical procedure. Your endodontist will recommend appropriate pain medication to alleviate your discomfort.
Your endodontist will give you specific postoperative instructions to follow. If you have questions after your procedure, or if you have pain that does not respond to medication, call your endodontist.
Can I drive myself home?
Often you can, but you should ask your endodontist before your appointment so that you can make transportation arrangements if necessary.
When can I return to my normal activities?
Most patients return to work or other routine activities the next day. Your endodontist will be happy to discuss your expected recovery time with you.
How do I know the surgery will be successful?
Your dentist or endodontist is suggesting endodontic surgery because he or she believes it is the best option for saving your own natural tooth. Of course, there are no guarantees with any surgical procedure. Your endodontist will discuss your chances for success so that you can make an informed decision.
What are the alternatives to endodontic surgery?
Often, the only alternative to surgery is extraction of the tooth. The extracted tooth must then be replaced with an implant, bridge, or removable partial denture to restore chewing function and to prevent adjacent teeth from shifting. Because these alternatives require surgery or dental procedures on adjacent healthy teeth, endodontic surgery is usually the most biologic and cost-effective option for maintaining your oral health.
No matter how effective modern artificial tooth replacements are-and they can be very effective-nothing is as good as a natural tooth. You've already made an investment in saving your tooth. The pay-off for choosing endodontic surgery could be a healthy, functioning natural tooth for the rest of your life.
Congratulations! By saving your tooth with root canal treatment, you have made a significant step towards better oral health. This guide is intended to answer questions you may have about the post-operative period and to give you information on how to preserve the health of your tooth following root canal treatment.
What should I expect following endodontic treatment?
The root canal system inside your tooth has been thoroughly cleaned, and the irritated tissue and bacteria that have caused you to need root canal treatment are gone.
It is normal to feel some tenderness in the area over the next few days as your body undergoes the natural healing process. You may also feel some tenderness in your jaw from keeping it open for an extended period of time. These symptoms are temporary and usually respond very well to over-the-counter pain medications. It is important for you to follow the instructions on how to take these medications. Remember that narcotic medications, if prescribed, may make you drowsy, and caution should be exercised in operating dangerous machinery or driving a car after taking them.
Your tooth may continue to feel slightly different from your other teeth for some time after your root canal treatment has been completed. However, if you have severe pain or pressure that lasts more than a few days, contact your endodontist.
Guidelines for Post-Treatment Care
- Do not eat anything until the numbness in your mouth wears off. This will prevent you from biting your cheek or tongue.
- Do not chew or bite on the treated tooth until you have had it restored by your dentist.
- Be sure to brush and floss your teeth as you normally would.
- If the opening in your tooth was restored with a temporary filling material, it is not unusual for a thin layer to wear off in-between appointments. However, if you think the entire filling has come out, contact your endodontist.
- Contact your endodontist right away if you develop any of the following: a visible swelling inside or outside of your mouth; an allergic reaction to medication, including rash, hives or itching (nausea is not an allergic reaction); a return of original symptoms; or your bite feels uneven.
Taking Care of Your Tooth
Root canal treatment is only one step in returning your tooth to full function. A proper final restoration of the tooth is extremely important in ensuring long-term success.
Contact your dentist within two weeks to arrange your next appointment. If your tooth is being treated in more than one visit by an endodontist, do not return to your dentist for the final restoration until the root canal treatment is completed.
What the Future Holds
The tooth that has had appropriate endodontic treatment followed by a proper restoration can last as long as your other natural teeth. After the tooth has been restored, you need only practice good oral hygiene, including brushing, flossing, regular checkups and cleanings.
Your dentist or endodontist may periodically x-ray the tooth to ensure that healing has occurred. Occasionally, a tooth that has undergone endodontic treatment does not heal or pain continues. At times, the tooth may become painful or diseased months or even years after successful treatment. Often when this occurs, repeating the endodontic procedure can save the tooth.
MYTHS ABOUT ROOT CANAL TREATMENT
There are many misconceptions surrounding root canal (endodontic) treatment. The American Association of Endodontists wants you to have accurate information. As always, when considering any medical procedure, you should get as much information as you can about all of your options. Your dentist or endodontist can answer many of your questions, and if you still have concerns, it is often wise to seek a second opinion.
Myth #1: Root canal treatment is painful.
Truth - Root canal treatment doesn't cause pain, it relieves it.
Most patients see their dentist or endodontist when they have a severe toothache. The toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel.
The perception of root canals being painful began decades ago when root canal treatment was painful. But with the latest technologies and anesthetics, root canal treatment today is no more uncomfortable than having a filling placed. In fact, a recent survey showed that patients who have experienced root canal treatment are six times more likely to describe it as "painless" than patients who have not had root canal treatment.
Myth #2: Root canal treatment causes illness.
Truth - Root canal treatment is a safe and effective procedure.
Research studies performed in the 1930s and 1940s and those conducted in later years showed no relationship between the presence of endodontically treated teeth and the presence of illness. Instead, researchers found that people with root canal fillings were no more likely to be ill than people without them.
Over the past several years, however, a very small number of dentists and physicians have been claiming that teeth that have received root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This claim is based on the outdated research performed by Dr. Weston Price from 1910-1930. His research stated that bacteria trapped in the teeth during root canal treatment can cause almost any type of disease, including arthritis, heart disease, kidney disease, and others.
The presence of bacteria in teeth and mouth has been an accepted fact for many years. But presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma.
More recent attempts to copy the research of Dr. Price (and to check its accuracy) have been unsuccessful. Researchers now believe that the earlier findings may have been caused by poor sanitation and imprecise research techniques that were common in the early 1900s. These more recent studies support the truth we report today - that teeth that receive proper endodontic treatment do not cause illness.
Myth #3: A good alternative to root canal treatment is extraction (pulling the tooth).
Truth - Saving your natural teeth, if possible, is the very best option.
Nothing can completely replace your natural tooth. An artificial tooth can sometimes cause you to avoid certain foods. Keeping your own teeth is important so that you can continue to enjoy the wide variety of foods necessary to maintain the proper nutrient balance in your diet.
Endodontic treatment, along with appropriate restoration, is a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and placement of a bridge or an implant.
Endodontic treatment also has a very high success rate. Many root canal treated teeth last a lifetime.
Placement of a bridge or an implant will require significanly more time in treatment and may result in further procedures to adjacent teeth and supporting tissues.
Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment. Those healthy teeth are helping patients chew efficiently, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists and dentists worldwide enable patients to keep their natural teeth for a lifetime.
SAVING A KNOCKED - OUT TOOTH
Emergency Steps for Saving a Knocked-Out Tooth
More than 5 million teeth are knocked out every year. Both adults and children are at risk. With proper emergency action, a tooth that has been entirely knocked out of its socket often can be successfully replanted and last for years. Because of this, it is important to be prepared and know what to do if this happens to you or someone with you. The key is to act quickly, yet calmly, and follow these simple steps.
1. Pick up tooth by the crown (the chewing surface) not the root.
Locate the tooth immediately; do not leave it at the site of the accident. The tooth should be handled carefully -- touch only the crown -- to minimize injury to the root.
2. If dirty, gently rinse tooth with water.
If dirty, gently rinse the tooth with water, remembering not to handle the root surface.
- Do not use soap or chemicals.
- Do not scrub the tooth.
- Do not dry the tooth.
- Do not wrap it in a tissue or cloth.
3. Reposition tooth in socket immediately, if possible.
The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.
4. Keep tooth moist at all times.
The tooth must not be left outside the mouth to dry. If it cannot be replaced in the socket, put it in one of the following:
- Emergency tooth preservation kit
- Mouth (next to cheek)
If none of these is practical, use water (with a pinch of salt, if possible).
5. See an endodontist or the nearest available dentist within 30 minutes.
Bring the tooth to a dentist or endodontist as soon as possible -- ideally, within 30 minutes. However, it is possible to save the tooth even if it has been outside the mouth for an hour or more.
Reposition tooth in socket immediately, if possible.
The sooner the tooth is replaced, the greater the likelihood it will survive. To reinsert, carefully push the tooth into the socket with fingers, or position above the socket and close mouth slowly. Hold the tooth in place with fingers or by gently biting down on it.
With their more sophisticated procedures, dentists are helping people keep their teeth longer. Because people are living longer and more stressful lives, they are exposing their teeth to many more years of crack-inducing habits, such as clenching, grinding, and chewing on hard objects. These habits make our teeth more susceptible to cracks.
How do I know if my tooth is cracked?
Cracked teeth show a variety of symptoms, including erratic pain when chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes. In many cases, the pain may come and go, and your dentist may have difficulty locating which tooth is causing the discomfort.
Why does a cracked tooth hurt?
To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The loose pulp is a connective tissue that contains cells, blood vessels and nerves.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.
Why have I been referred to an endodontist?
All dentists receive basic training in the diagnosis and treatment of cracked teeth in dental school. However, some cracked teeth can be especially difficult to diagnose, and treatment may involve root canal treatment. That's why you have been referred to an endodontist.
Endodontists are dentists with at least two additional years of education that include the diagnosis and treatment of unusual dental pain. Cracked tooth pain often comes from damage to the inner soft tissue of the tooth, the pulp. Endodontic treatment, also known as root canal treatment, can relieve that pain.
Early diagnosis is extremely important. Like cracks in a windshield, cracks in teeth often start small and progress slowly. The sooner a crack is detected and treated, the better the chance of saving your tooth. The endodontist's special training and experience can be valuable when a cracked tooth is suspected.
How will my cracked tooth be treated?
There are many different types of cracked teeth. The treatment and outcome for your tooth depends on the type, location, and extent of the crack.
Craze lines are tiny cracks that affect only the outer enamel. These cracks are extremely common in adult teeth. Craze lines are very shallow, cause no pain, and are of no concern beyond appearances.
When a cusp (the pointed part of the chewing surface) becomes weakened, a fracture sometimes results. The weakened cusp may break off by itself or may have to be removed by the dentist. When this happens, the pain will usually be relieved. A fractured cusp rarely damages the pulp, so root canal treatment is seldom needed. Your tooth will usually be restored with a full crown by your dentist.
This crack extends from the chewing surface of the tooth vertically towards the root. A cracked tooth is not completely separated into two distinct segments. Because of the position of the crack, damage to the pulp is common. Root canal treatment is frequently needed to treat the injured pulp. Your dentist will then restore your tooth with a crown to hold the pieces together and protect the cracked tooth. At times, the crack may extend below the gingival tissue line, requiring extraction. A nontreatable tooth is shown in the graphic above.
Early diagnosis is important. Even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth. Early diagnosis and treatment are essential in saving these teeth.
A split tooth is often the result of the long term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In rare instances, endodontic treatment and a crown or other restoration by your dentist may be used to save a portion of the tooth.
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may therefore go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a portion of the tooth can be saved by removal of the fractured root.
After treatment for a cracked tooth, will my tooth completely heal?
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases.
The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your endodontist about your particular diagnosis and treatment recommendations. S/he will advise you on how to keep your natural teeth and achieve optimum dental health.
What can I do to prevent my teeth from cracking?
While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.
- Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.
- Don't clench or grind your teeth.
- If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.
- Wear a mouthguard or protective mask when playing contact sports.
... just to remind you of basic tooth structures ...
WHAT IS INSIDE A TOOTH?
From the outside, a tooth looks like a hard, solid substance. But this cut-away illustration reveals that a tooth is really a complex system of specialized tissues.
Enamel - the shiny, hard, white tissue covering the tooth is the strongest tissue in your body. It has to be! Your jaws place as much as 128 pounds of pressure on your teeth when you chew, bite, clench, or grind.
Dentin - this tissue makes up most of the body of the tooth. Even though dentin is hard and feels solid to the touch, it's actually microscopically porous and needs a covering of enamel or an artificial crown to protect it from decay-causing bacteria in your saliva.
Gum - dentists call this the "gingiva." It covers the bone surrounding your teeth. When you brush your teeth after meals and floss daily, you keep this tissue healthy. That's important, because gum disease can cause bone loss. Gum disease can also expose the tooth roots to decay. If root decay affects the pulp, you may need root canal treatment.
Pulp - this soft tissue contains blood vessels, nerves, and connective tissue. The pulp provides nourishment for the tooth during growth and development. Once the tooth is mature, the pulp's only function is sensory. A fully developed tooth can survive without the pulp. If this tissue is damaged, your dentist or endodontist can remove it and save your tooth with endodontic (root canal) treatment.
Root canal containing pulp tissue - this is the passage or channel in the root of the tooth extending from the pulp chamber to the apical foramen (the main openi
ng of the root canal).
Periodontal ligament - like the springs that hold a trampoline to its frame, this tissue supports the tooth and holds it in place in the bony socket surrounding the tooth. This tissue cushions both the tooth and the surrounding bone against the shock of chewing and biting.
Accessory canal - any branch of the main pulp canal or chamber that communicates with the external surface of the root.
Bone - the roots of your teeth are anchored by bone. Healthy teeth stimulate and keep bone tissue healthy and vice versa.
Root - this part of the tooth sits in the bone below the gum. Believe it or not, the root of your tooth is usually twice as long as the crown, the part you see above the gumline.
Crown - this is the part of the tooth you can see above the gumline.