Root Canal - Long Island City, NY 11101.
What are Root Canals?
When we talk about a tooth needing a root canal, we mean that the nerve needs to be taken out of the tooth. Afterwards the root canal gets a filling material placed within it to prevent any future dental infection. That's the basic overview but we need to review the full anatomy of a tooth to better understand root canals.
Anatomy of a tooth
The tooth is composed of four different types of tissues:
Enamel. The most highly mineralized part of the tooth and also the hardest substance in the body with a mohs hardness scale of 5. The primary mineral is hydroxyapatite.
Dentin. This is the mineralized connective tissue of the tooth. It has a large matrix of collagenous proteins. It is not as hard as enamel and is the layer separating the enamel from the pulp or the nerve of the tooth.
Cementum. This is a specialized bone like layer that covers the root of the tooth. This
Dental pulp. This layer is where the nerve of the tooth and also its blood supply is. Basically what keeps the tooth alive and supplies it with nutrients.
When we talk about doing a root canal treatment, it means that we are actually cleaning out the entire root canal which houses the dental pulp. The entire pulp gets removed, so the tooth nerve and also the blood supply will be permanently gone.
We often refer to the procedure as a root canal but some teeth may have multiple root canals within a single tooth.
The front teeth typically only have 1 root canal
The premolars typically have 1-2 but sometimes more.
The back tooth or the molar has at least 3 root canals. There have been instances of it having much more than that such as five or even eight canals.
The number of canals will also determine the cost of a root canal.
Some examples of root canals
This is what they look like on x rays. Notice that after root canal procedure is completed, there are white lines going through the entire root of the tooth. That is the filling material in the canal. Now let's take a look at what it looks like inside the mouth.
This is the same exact tooth but viewed from inside of the mouth. Do you see those 3 pink dots? Those are the root canal filling material. Yes, this tooth had three canals!
Also do you notice that vertical crack going across the tooth? This tooth is fractured because the patient did not return soon enough after the root canal to get her porcelain crown. A lot of times, people get the treatment done and never return for the tooth cap, thinking that the entire process is completed... Please do not delay getting the crown after a root canal.
Once the tooth cracks like that, it can no longer be saved. Unfortunately this person will lose their molar tooth. So at most only wait 1-2 weeks after your root canal before coming back for a permanent restoration.
While we're still on the topic. This is what the root canal filling material looks like. It is called gutta percha and the filling process is called obturation.
What is gutta percha?
Gutta percha actually comes from a plant called Palaquium gutta.
It is a latex elastomer
It is biologically inert and very biocompatiable.
Contains barium sulfate to increase radiopacity on x rays
Contains Zinc oxide to reduce brittleness and improve plasticity
How do you use it?
After you finish cleaning out the root canal, you stick this all the way down into the canal and make sure it fits.
Apply some gutta percha cement to it and reinsert.
Then you sear it off with a heated dental instrument.
How do you remove the nerve?
We talked about what it looks like and how you fill the canal but we never spoke about how to clean out the canal.
How do you take the nerve out of the tooth?
To remove the nerve, we use small nickel titanium files.
We start with the smallest file first and progress it gradually.
We try to use it to open up the canal by making it bigger with each pass.
Then we move on to progressively larger files until the whole tooth is clean.
From the start to finish, the size of the canal will have expanded, this is to ensure that we got all of the infected nerve tissue.
In between each file we do use a lubricant to help it get down the canal.
We also flush out all of the debris with sodium hypochlorite.
Sodium hypochlorite is the irrigant we use to sterilize the canal and also to flush out all of the debris. Doesn't it sound familiar? Where have you heard it before?
We would love to tell you otherwise but it is actually just the same ingredient as in Chlorox Bleach. Bleach literally kills everything, including COVID-19 and your infected nerve tissue is no exception.
When this liquid comes into contact with all of the nerve tissue, it just disintegrates everything! Wait are you wondering if it is safe to use inside your mouth? What if you swallowed bleach? Worry not... because we have THIS.
This is what we call a rubber dam. It basically isolates the tooth and protects it from all outside environmental factors. This means that even if liquids spill out, it will land on the dam and not down your throat. We can easily suction up whatever comes out.
Another really important point is that the rubber dam keeps the tool clean and sterile. The mouth naturally has a lot of bacteria and especially in your saliva. Your saliva is NOT clean. This prevents any of that from touching the tooth. You needed a root canal in the first place because bacteria got inside of the nerve so you don't want to repeat the same mistake.
This method ensures your safety and also the cleanliness of the canal! Unfortunately you can't really talk with the rubber dam on but we assure you it will be well worth it.
How would I know that I need a root canal?
The most obvious reason for needing a root canal is when you are experiencing extreme dental pain. The toothache may be so bad that it can keep you up at night. The tooth nerve pain will literally interrupt your daily life with a throbbing tooth pain that comes and goes. The cause of this is usually due to a tooth cavity or tooth decay that has traveled all the way to the nerve.
Once this happens it is officially a tooth infection and needs to be addressed before you develop a dental abscess. It is very important to seek out a dentist immediately because when left alone, the abscess may lead to facial swelling and that could be life threatening.
Here is a list of reasons for needing a root canal:
Tooth decay has reached the nerve.
The tooth filling was so deep that it sits right on top of the nerve
Trauma from falling, hitting your teeth like in hockey!
Tooth could just sporadically die for unknown reasons.
You chipped your tooth really badly
Word of Caution:
You may not always be experiencing tooth pain even if the tooth decay has reached the nerve. You may feel completely fine but if the cavity has already reached the nerve then it still needs a root canal. This is similar to how high blood pressure and high cholesterol do not cause any pain until the last second right before a heart attack. That is why they are called the silent killers. Root canals may behave in a similar way sometimes.
Other times the tooth may already have an infection at the tip of the root. It typically shows up as a dark circle around the tip of the root. So don't be surprised if you feel completely fine but some how have a tooth infection.
What are the consequences if I don't do the treatment?
Oddly enough, many people may be walking around with a tooth infection and never know it because they may stay asymptomatic for a long period of time. Nonetheless, you can count on the body to eventually let you know about it when it decides to act up. Often it does so at the most inopportune times such as while you are on vacation or during a holiday weekend. When it does hit you, it hits you hard with an excruciating toothache. The tooth pain will be something that you've never experienced before! Hopefully we can get you numb on the appointment, in fact you may be wishing that you get some prolonged numbness with the novocaine even after the procedure!
Aside from that, we believe that it is prudent for everyone to be PROACTIVE rather than REACTIVE especially when it comes to their health. The whole point is to address problems before they arise so that you don't have to experience any dental pain. Besides that, why would you leave a festering dental abscess in your mouth? Your tooth is connected to the rest of your body via the blood stream and it is neighbors with your brain.
So are you proactive or reactive?
What do 1311 Jackson Ave Dental dentists offer?
Yes! Our dentists in island city does offer root canal treatments. We will remove the nerve from the tooth and disinfect the entire root canal. All of this is done under a rubber dam.
Afterwards we will place a dental crown over it once the treatment is completed. A crown or tooth cap is needed because the blood supply also gets removed along with the nerve. When there is no more blood and nutrients going to the tooth, it starts to get very brittle and may break if you bite into something hard. A second reason is that once the nerve is taken out, the tooth is now dead and it will start to discolor over time so the tooth cap is also for cosmetic reasons as well. You may notice the tooth start turning a very dark grey color over time. Hopefully that answers your question about if you need a crown after a root canal.
It is especially important to get a crown if it involves your front tooth due to the noticeable cosmetic result. It is not very aesthetic to be walking around with a front tooth a completely different color from the rest
If you were to get a front tooth cap, we would recommend an all porcelain crown so that you don't see the metal show through. There are different types of porcelain but we recommend to get the empress max or emax crowns because they can be bonded on your teeth. The metal crowns don't get bonded in and are held in by surface friction.
Your front tooth cap can fall off so it would be prudent to give it extra retention capabilities. Imagine your front tooth cap falling off during a social event like a public dinner. That is one serious dental emergency and very embarassing!