Dental Questions: Are root canals painful?

If there was a ever a classic trope of bad dental experiences, it would certainly be the root canal. From cartoons to movies to TV shows, we are taught from a young age that root canals are the most painful of all dental procedures. Fortunately, this bad press is entirely undeserved. Root canal treatment offers relief from excruciating pain and a near instant improvement of symptomatic teeth!

For starters, a "root canal" is a dental procedure where the nerve inside the tooth is removed and replaced with sealing material. It is usually performed on a tooth with an infection (where the now-dead tissue is feeding bacteria) or with an inflamed nerve. In either circumstance, removing the internal nerve pulp and cleaning the inside of the tooth relieves symptoms of extreme pain and pressure. After performing a root canal, the tooth will most likely need a crown and/or post placement to add strength back to its structure. 

A root canal procedure will not be more painful than any other dental treatment. Endodontists (root canal specialists) require that the patient is completely numb so that there are no undue delays or interruptions to the root canal process. The most common complaint after receiving this therapy is a sore jaw from staying open for the duration of the procedure. In cases of extreme infection, some teeth may be difficult or impossible to fully anesthetize. In these cases, the endodontist may elect to use antibiotics or mild sedation to maximize the numbing effect. Either way, you will be completely comfortable for the entire appointment. 

If you have dental pain and think you might need a root canal, don't panic! Tooth pain comes from a number of different causes and requires a complete dental exam to diagnose. If you would like to schedule an appointment today, please give our office a call!

What is your mouth telling you?

If you pay attention, your mouth does a great job of cluing you into its problems. From color changes to random aches and pains, the oral cavity responds very vividly to alterations in environment. With this in mind, we made a list of some of the most common complaints at dental exams and screenings nationwide. However, this article isn't a substitute for an actual diagnosis. Only a dental professional in a clinical setting can give you the full story! Read on to see how and why we respond to these common complaints:

Red/puffy/bleeding gums- This usually indicates some type of disease process occurring in the periodontal tissues. While fixing the problem involves a dental checkup and cleaning, it usually starts with better brushing and flossing techniques at home. 

Sensitive teeth near the gum line- Gingival recession (where the gums wear away from the necks of the teeth) affects about 50% of the adult population and almost 90% of those over 65. As the gums recede back, they reveal bare tooth root material, called cementum. This layer conducts cold to the nerves much quicker than enamel. We recommend switching to a sensitivity toothpaste like Sensodyne to help ease the shock with cold foods. 

Sore teeth/jaw on both sides- This is typically an indication of clenching or grinding. While we can make a custom fitted night guard to protect dental enamel, grinding itself is a psychological process that occurs subconsciously. 

Tooth sensitive to chewing after a filling- While post-filling sensitivity can indicate many problems, pain to chewing is a telltale sign of a high spot in the new material. This is easily fixed at a follow up appointment to re-contour the biting surface. 

Lingering pain to temperatures- Prolonged sensitivity to hot and cold usually means the nerve within the tooth is irritated irreversibly. That tooth will most likely need a root canal or other nerve therapy. 

Cracked lips or burning gums after switching toothpaste- Many toothpastes contain a compound called sodium lauryl sulfate (SLS). Some patient's soft tissues will become irritated, red or swollen after being exposed to this chemical. For those with more sensitive gums, we recommend seeking out a milder product like Sensodyne or Biotene paste while avoiding products with SLS.

 Food constantly stuck between two back teeth- This usually indicates that a physical space has opened between two adjacent teeth. With time, the teeth move as they adapt to changes in jaw space and biting forces. An opening between two posterior chewing teeth should be addressed to protect the gums and bones in this area. Constant food impaction will speed up the progression of periodontal disease exponentially. 

In general, it is difficult (or impossible) to properly diagnose a dental problem without an exam and appropriate x-rays. This list serves as a general idea of how a dentist may interpret your complaint into a treatment or recommendation. It does not take into account your personal dental history, medical history or any other specific information. If you would like more information on dental exams, diagnosis or emergency treatments, please give our office a call!

Endodontists we work with

At Thousand Oaks Family Dentistry, we take our patient's individual needs very seriously. With this in mind, we have cultivated a network of highly skilled dental specialists to address any and every concern. For our patient who require root canals and other endodontic services, we are proud to work with Conejo-Simi Endodontics and Southern California Endodontic Group.

You may be referred to an endodontis' office to diagnose and treat certain types of tooth pain or resolve an infection. Specialists like Conejo-Simi Endo and So-Cal Endo have technology like microscopes and cone-beam CT scanners that can better visualize cracks, abscesses and root fractures on teeth. If the tooth in question is savable, an endodontist can then perform a root canal to remove infection or stop tooth pain. Their technical expertise shines in treating posterior teeth, where root anatomy can become complicated and difficult to visualize. Nevertheless, our specialists have years of experience and will always strive for the best treatments possible!

We typically refer to out to endodontists following an exam and X-rays. However, certain types of pain will clue us in to your need for a specialist even before looking in the mouth. Our office is positive that you will have a great experience at Conejo-Simi Endodontics or Southern California Endodontic Group. If you would like to know more about the specialists we refer to or why we use them, please give us a call!

Dental Questions: What is a root canal?

Before and after X-rays of a completed root canal (rightmost tooth). Notice how the roots have whiter centers once the procedure was finished. 

In today's article, we are going to shed some light on a common (and commonly misunderstood) dental procedure: the root canal. Many patients fear and dread these treatments when in actuality they are painless and routine. We hope you find this information helpful!

Root canals fall under the dental field of endodontics. These procedures may be carried out by a general dentist or at a specialist's office. Then end goal of any root canal treatment is to remove the nerve tissue from the inner tooth, desensitize it and eliminate any bacteria or infection. This process allows us to save and treat many teeth that would otherwise need to be extracted. 

The first step in root canal treatment is to get the tooth in question completely numb. These procedures can be time consuming, so complete anesthesia is absolutely crucial. Contrary to popular belief, modern root canal therapy is virtually painless, with the many patient leaving the office with much less pain than they were in before!

Once the patient is numb and comfortable, a small opening is made in the top of the tooth to access the innermost layer called the pulp chamber. Here, the nerve endings that cause symptoms such as pain and cold sensitivity are cleaned out from the tooth.  This step is continued down the roots of the teeth, where a series of small files are used to clean and shape the root system. Once the pulp chamber and roots are completely cleaned, the tooth is filled with a thick, rubbery material called gutta percha. This step is crucial as it creates a plug against bacteria and recurrent infection.

After the treatment is complete, the top of the tooth is filled and restored, typically with a tooth-colored material. In many instances, teeth that receive root canals will need crowns for optimal strength. This is something the treating dentist will discuss with you and plan ahead of time. 

As with many dental treatments, this article is a general guideline and doesn't cover all aspects of endodontic therapy. If you have been told you need a root canal or want to know more about this type of procedure, please give our office a call. We will be more than happy to ease your mind and point you in the right direction!

Dental Questions: What can I do to make a toothache feel better?

Generally, toothaches are caused by inflammation of the nerve inside the tooth. The best way to temporarily relieve the pain is by taking a nonsteroidal anti-inflammatory over-the-counter medication such as naproxen sodium (Aleve) or ibuprofen (Motrin).  If the tooth is sensitive to temperature and biting pressure, then it likely needs a root canal to completely resolve the pain.  If there is swelling around the tooth or in the face, then the nerve inflammation has progressed to an infection and antibiotics and a root canal are required to fix the situation. 

You may be tempted to use over-the-counter toothache remedies such as topical anesthetic (Orajel). However, these medications are best used to treat sore gum tissue caused by ulcers or canker sores and will do little to remedy actual tooth pain. Remember, a toothache is caused by an inflammatory process that is occurring within the tooth (and not in the surrounding gums). Additionally, do not try crushing aspirin or other medications and placing them against the tooth area. These medications are only meant to be taken orally, and can cause serious chemical burns on the gum tissue and mucosa. 

Dental Questions: What Does It Mean If My Face Is Swollen?

Dental abscesses start small but can have very serious effects.

A swollen face in relation to tooth discomfort means that the tooth has an abscess that has not found a way to drain on it’s own.  An abscess forms when the body has detected a bacterial infection and “walled off” the affected area, but cannot naturally eliminate it. The associated swelling signifies a serious infection that has caused inflammation of the facial tissues. This is a health emergency and requires antibiotics and drainage of the abscess. 

Root Canals

Root Canal- Likely the most feared of all procedures. The name alone brings up visions of pain, discomfort and dental woes. But what is a root canal? Why would you need one? What does it do? In this article, we will shed some light on the world of endodontics, dental subspecialty that encompasses root canals. Contrary to popular belief, you will find that this procedure is both comfortable and provides near instant pain relief!

A Diagram of the different parts of the tooth. 

Before explaining how a root canal works, it is important to understand the different parts of the tooth and what they do. There are three basic layers to all teeth- the enamel, the dentin and the nerve/pulp. The enamel is mostly inorganic (nonliving) material and gives the tooth its strength and rigidity (it’s the hardest material in the human body!). Dentin provides support to the enamel and contains a mix of living and nonliving materials. The innermost layer is the pulp chamber and nerve canal. This space contains innervation that provides information on biting pressure, temperature and pain to the central nervous system. It is mostly organic material and has has it’s own blood supply.

Different teeth will have different numbers of canals. The number varies between tooth types, arch location and even person to person. In general, teeth typically have between one and four canals, with posterior teeth having more than anteriors. On top of this, a tooth can have any number of accessory canals.These can range in size from easily visible to microscopic.

With this information in mind, let’s discuss root canals. In the most basic terms, a root canal is performed by removing the root/nerve from the tooth, cleaning out the now-empty space and filling it with a stable material. Why would we remove the nerve from a tooth? This is typically done because:

A) Long term decay, stress or fracture has aggravated the nerve and it is causing constant pain. This is what happening when patients come in with a “hot tooth.”

B) The aggravated nerve has now “died,” leaving a perfect alcove of organic material for bacteria to feed on. Here, patients might have very little feeling in the tooth and may notice a change in color to a grayish hue.

C) Bacteria have found the dead tissue and there is an active infection. The bacterial abscess can be seen on an X-Ray and the patient will feel soreness, swelling or even draining from the gum tissue.

Condition A will eventually progress to condition B and usually to condition C. Since active infections are both difficult to treat and potentially life threatening, we will usually treat dying nerves early-on and aggressively. Waiting can often lead to more pain and higher long term costs to our patients.

The actual root canal procedure is based on a simple ideology: If you remove the dying/dead nerve, you remove the source of pain and bacterial “food.” We start by getting you numb using standard dental anesthesia.  You should not be able to feel any part of this procedure, from start to finish. The tooth is then isolated using a dental dam to keep your saliva and the inner tooth completely separated. We access the tooth canal and begin clean out the canal. We use a system of specialized files to shape and clean the canal, along with a number of sterilizing irrigants to eliminate any bacteria. Once the canal is the right size and shape (confirmed via X-Ray), we fill it with a material called gutta percha. Modern gutta percha is engineered in a lab, and is extremely resistant to deterioration, infection or absorption.

Tooth Second from left- Before and after root canal. The gutta percha shows up bright white in the X-Ray, highlighting the shape of the canal.

Once the canal is filled, it is topped of with a filling to give the tooth structure. This final step may be done the same day as the canal filling or may be delayed to allow the tooth time to adjust to the procedure. Most of the time, the tooth will require a crown to give it long term structural stability and strength. Removing the nerve from teeth can make them more brittle, and the capping effect of a crown can help counteract this.

After the nerve is removed from the tooth, it physically cannot feel any more pain. The surrounding tissues can still feel tender, but the specific tooth will no longer have a way to relate sensory information to the brain. This is what makes root canals great at ending tooth pain permanently and instantly.

Overall, root canals are about 80% successful long term. They are an excellent way of buying time with a tooth that would otherwise need to be extracted and replaced with an implant or dentures. At our office, we evaluate root canals on a patient-to-patient basis. If we feel your specific case could benefit from the perspective of a specialist, we will refer you to an endodontist. These tooth canal experts bring a number of technologies to handle complex or difficult cases, including microscopes, CT Scanners and cutting edge materials.

If you have further questions on root canals or why we place them, please contact our office. We understand that this procedure seems intimidating, and will try our best to make it more manageable. As with any procedure provided at our office, we want you to be happy, pain-free, and satisfied with the end result!