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Root Canal Treatment Rochester, Fairport and Canandaigua NY

A root canal is one of the most common dental procedures performed, well over 24 million procedures every year. This simple treatment can save your natural teeth and prevent the need of dental implants or bridges. Remember, nothing is better than keeping your natural tooth!

When you look at your tooth in the mirror, what you see is the crown, which is made of enamel and dentin. The rest of the tooth is hidden beneath the gum line, which is called the root. Inside the root(s) are small, thin passageways containing pulp tissue that branch off from the top chamber through the root tip.

Sometimes the pulp inside the tooth becomes infected by disease or bacteria, or damaged by a traumatic injury. Fractures of the tooth, periodontal disease and even repeated dental procedures may contribute to pulpal degeneration. Endodontic treatment is necessary when the pulp becomes inflamed or infected. If pulpal inflammation or infection is left untreated, it can cause pain or lead to an abscess. An infected and untreated root canal can allow bacteria in the mouth to enter the bloodstream where it will then lead to erosion of the bone beneath the tooth and cause infections to travel along facial spaces and spread further.

Signs/Symptoms you may need a Root Canal

• Moderate to severe lingering toothache pain when drinking hot or cold liquids or foods.
• Moderate to severe pain when biting on a tooth
• Sensitivity to tapping or pressure on the tooth
• Toothache that wakes you up in the middle of the night
• A pimple on your gum that may release pus or blood
• Radiating pain from one area of the mouth to another

If you are experiencing one or more of these symptoms, chances are you have an infected tooth that is in need of a root canal.  The root canal treatment, while common, can be difficult to complete successfully.

The Root Canal Process, John Lepore DDS, Advanced Endodontic Solutions, Fairport, Rochester and Canandaigua, NY

The goal of endodontic therapy (or root canal therapy) is to eliminate the diseased pulp that is threatening your tooth. This is accomplished through a set of procedures that clean, shape, and decontaminate the hollows (canals) of your tooth’s interior. The root canal process can be broken down as follows:

Rubber Dam

Before treatment begins, a small piece of soft rubber is placed over your tooth. This serves to keep the working area clean, dry, and isolated from the rest of the mouth to help prevent contamination.

Root Canal Access

After the rubber dam is placed in the mouth, Dr. Lepore will prepare a small opening through the surface of your infected tooth in order to access the pulp chamber.

Canal Cleaning and Shaping

Once an access opening has been created, Dr. Lepore, aided by the use of an endodontic microscope, will use a series of tiny tooth files to clean out the inflamed pulp from your tooth’s root canal chamber. These files are also used to re-shape the inside of your tooth, clearing the way for the filling material that will be inserted at the end of the procedure. The use of an endodontic microscope allows Dr. Lepore to identify every canal in your tooth interior and ensure that nothing is left contaminated.

Filling the Root Canal

The final step for Dr. Lepore is to fill the newly-cleaned root canal with a material called gutta-percha. This material protects the pulp chamber and produces a tight seal that blocks any further infection from reaching the tooth’s roots.

Root Canal Post-Op Care

After the Root Canal procedure seals the roots of the tooth, Dr. Lepore will cover the top of the tooth with a temporary filling. Within two weeks of completing root canal therapy, you should schedule an appointment with your general dentist to obtain a permanent restoration (a dental crown). Postponing this final step could lead to your tooth becoming fractured or damaged, so be sure to get your final restoration as soon as possible.

Meanwhile, as you wait to see your general dentist, there are several steps you can take to ensure your rescued tooth heals well.

Caring for Treated Teeth

Refrain from chewing or eating using the side of your mouth that was treated. Until a dental crown is in place, your tooth remains weakened and could fracture if too much pressure is applied. Eat a soft diet for at least two days, avoiding the healing tooth.

Upon arriving home, you may want to take recommended medication for pain relief so you are prepared once the local anesthesia wears off. An over-the-counter medication like Advil, Motrin or Tylenol can be taken for the first 3-4 days after treatment (ask your doctor for correct medication). Additionally, applying an ice pack to the side of your face for about ten minutes every twenty minutes will help minimize swelling. If you have been prescribed antibiotics, be sure to complete the full course as directed

Smoking, alcohol, and strenuous exercise should also be avoided, as they can delay the healing process.

When Teeth Have Trouble Healing

Endodontic therapy has a 95% or greater success rate. With proper care, teeth that have undergone a root canal procedure can last just as long as your other natural teeth. However, there are some cases where even a well-cared for tooth may not heal properly after treatment.

Improper healing is usually signaled by prolonged pain, with or without swelling. Sometimes non-healing may only be discerned through an x-ray where changes such as bone reduction around the tooth’s roots can be seen.

Two things are at the source of most improper healing:

•Inflammation – Either from before or after treatment.

•Infection – If the original infection persists, if there is a crack in the tooth, or if there is leakage from the filling.

Time and the appropriate medication, such as NSAIDS (pain relief medication) or antibiotics, can usually resolve both inflammation and infection. However, if these symptoms persist, endodontic retreatment may be necessary.

Dr. Lepore will schedule a follow-up appointment approximately six months following treatment to ensure that both your tooth and the surrounding tissues are healing normally.

Endodontic Retreatment

With the appropriate care, your teeth that have had root canal therapy will last as long as other natural teeth. Yet, a tooth that has received treatment may fail to heal. Sometimes pain may continue to exist, and may occur months or years after treatment. If so, Endodontic Retreatment may be needed.

Improper healing may be caused by:

• Bacteria and diseased pulp tissue that could not be removed during the first treatment.

• Complicated canals went undetected, or curved and narrow canals were not treated during the initial treatment.

• The restoration or crown was not placed within the appropriate amount of time following the root canal procedure. Because of this, bacteria in saliva contaminated the root canal system.

• An injury to the tooth.

In some cases, new problems can influence a tooth that was successfully treated:

• New decay can expose the root canal filling material, causing infection.

• A cracked or loose filling or crown can cause leakage into the tooth creating a new infection.

During retreatment, a rubber sheet is placed over your tooth. Dr. Lepore will then reopen your tooth and remove the restorative material to gain access to the root canal filling material. The inside of the canals will be cleaned and inspected. Once cleaned, he will fill and seal the canals and place a temporary filling in the tooth. You will then return to your dentist within a few weeks in order to have a new final restoration or crown placed to resume the tooth's normal functions.

Apicoectomy

There are many surgical procedures that can be performed to save a tooth. The most common is called an apicoectomy, or root-end resection, which is occasionally needed when inflammation or infection persists in the bony area around the end of your tooth after a root canal procedure. In this microsurgical procedure, Dr. Lepore opens the gum tissue near the tooth to see the underlying bone and to remove any inflamed or infected tissue. The very end tip of the root is also removed. A small filling may be placed to seal the end of the root canal and a few stitches or sutures are placed to help the tissue heal. Over a period of months, the bone heals around the end of the root. Most patients return to their normal activities the next day. Postsurgical discomfort is generally mild.

Why would I need endodontic surgery?

In the majority of cases a root canal or retreatment is all that is needed to save your tooth from extraction. Occasionally, these non-surgical procedures may not be sufficient to heal your tooth and Dr. Lepore may recommend surgery. Endodontic surgery can be used to locate fractures or accessory canals that don't appear on the x-ray but still manifest pain and infection. Often the end of the root has embedded bacteria in the root structure or branching of the canal(s) where it was untreatable. Damaged root surfaces or persistent infection in the bone area after a root canal treatment may also be treated with this procedure

Tooth Injuries from Traumatic Injuries

Dislodged teeth

Injuries to the mouth can cause teeth to be forcefully moved in various directions. It can be pushed back in the socket or forced partially out of the socket in any direction. Do not delay in seeking treatment. Your general dentist may need to reposition and stabilize your tooth. Depending on the severity of the pulp damage from tooth movement or symptoms, root canal treatment may be necessary.

Cracked Teeth

Cracked teeth are becoming more common than ever before. People are living longer, and dentists are helping keep teeth live longer as well. That means teeth are being exposed to more years of chewing hard things, clenching and grinding. Fractures/cracks typically do not show on x-rays, making it more difficult to locate. Depending on the severity of the crack, symptoms may include a momentary sharp pain to chewing, temperature sensitivity, or even the release of biting pressure.

Why does a cracked tooth hurt?

Not all cracked teeth hurt. When it does, chewing can cause movement of the cracked pieces of our tooth, which irritates the pulp within the tooth. Pain upon release of biting pressure can occur because the crack closes quickly, resulting in a transient sharp pain. Repeated chewing irritates the pulp. Also, the depth of the crack can cause irritation and possibly degeneration to the pulp tissue. Eventually when the pulp becomes damaged the tooth may consistently hurt. The pain may include hot or cold sensitivity as well.

Can a cracked tooth be saved?

It depends on the location and depth of the crack, as well as your symptoms. Sometimes only a restoration or crown is needed. At times root canal therapy followed by crown placement is needed to remove the damaged pulp to restore the tooth to normal function. We are specially trained to treat cracked teeth, and utilize the endodontic microscope to assist in visualization.