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How do you know when your tooth needs root canal treatment?

It will take an examination by your dentist to determine if root canal treatment is indicated for your tooth. Not only must your dentist determine if the treatment can be an appropriate solution for your situation but also that the overall condition of the tooth in question warrants the time and expense involved.

Here are some situations where root canal therapy might be the proper solution:

A tooth is currently causing you pain or else has a history of being painful.
You have noticed the presence of tenderness and/or swelling in your gums near a tooth.

There can be times when you have a tooth that is in need of having root canal treatment but you are unaware of this fact because there has been no swelling or pain associated with the tooth.

A) Problem teeth identified by x-rays.
The nerve tissue inside a tooth can degenerate and die quietly. The death of a tooth's nerve is not always a painful experience. In these instances a tooth's need for root canal treatment can remain undiscovered, even for some years. This is because the virulence of the infection inside the tooth is low and your body's defensive mechanisms, while not being able to clear up the infection totally, are able to keep it in check.

Dentists often discover teeth that need root canal treatment during routine x-ray evaluations. In the most obvious of these cases the dental x-ray will show a dark spot at the tip of the tooth's root. This dark spot indicates that there has been a reduction in the density of the bone surrounding the root's tip. This bone damage has occurred as a result of the infection that is present inside the tooth.

B) A persistent or recurring pimple on your gums.
Sometimes a tooth whose nerve has died will produce a pimple like lesion on a person's gums. The presence and/or size of these pimples (dentists call them fistulous tracts) can come and go. Because they are literally drains for pus from an infected tooth, a person might notice that they discharge a bad taste (the pus). It is possible that a dentist will discover this type of lesion while performing a routine examination, even though the patient hasn't noticed it at all.

C) Exposure of a tooth's nerve.
There can be times when your dentist will find that your needed dental work has resulted in the exposure of your tooth's nerve. The term "exposure" used here simply means that your dentist, while performing your dental work, has literally been able to visualize your tooth's nerve tissue. Sometimes a patient will feel a little prick of pain when the exposure occurs. However, many times a patient is totally unaware of the event.

An exposure can lead to the degeneration of a tooth's nerve tissue. Your dentist may determine that in your situation it is best to go ahead and perform root canal treatment on the tooth now so to avoid possible problems and complications with the tooth later (such as a painful tooth abscess).

D) Teeth which have been traumatized in an accident.
The nerve tissue in teeth which have a history of having been traumatized (such as being bumped in an accident) can deteriorate, thus leading to the need for root canal treatment.

Immediately after the traumatic event the outlook for the nerve's health can be difficult to predict. Sometimes traumatized teeth do quite well, even for many years.

It is always possible however that at some point the health of the tooth's nerve tissue will degenerate and subsequently die (often without symptoms). A tip off that the nerve tissue inside a tooth is undergoing degenerative changes is that the tooth, in comparison to its neighbors, appears darkened.


What is the purpose of root canal treatment?
You could say that the purpose of root canal treatment is to create an end result where the tissues that surround a tooth's root will maintain a healthy status despite the fact that the tooth's nerve has undergone degenerative changes. Specifically, we mean that the tissues surrounding a tooth's root are not affected by bacterial infection and/or irritating substances leaking from those inner aspects of the tooth originally occupied by the tooth's nerve tissue.

Possibly in more scientific terms, our bodies, as a defense mechanism, will initiate an "inflammation reaction" when irritants (such as those that might seep out of a problematic tooth) have injured or destroyed body tissues. So if we choose to incorporate the term "inflammation" into our description we would say, root canal treatment is the treatment of the inner aspects of a tooth (whose nerve has undergone degenerative changes) so to provide an environment where the tissues surrounding a tooth's root are free of, and will likely to continue to be free of, the presence of inflammation.

How does root canal treatment accomplish this goal?
In a nutshell, the process of root canal treatment first removes (as thoroughly as possible) bacteria, nerve tissue, the organic debris left over from the breakdown of nerve tissue, and bacterial toxins from within the inner aspects of a tooth (the area originally occupied by the tooth's nerve tissue). Each of these items can produce tissue irritants that can cause your body to activate an inflammation reaction.

Subsequently, once this space has been cleansed the second half of root canal treatment involves filling in and sealing up the interior of the tooth. This aspect of the treatment is an attempt to minimize the possibility that bacteria will be able to recolonize the inner aspects of the tooth or that tissue fluids can seep inside the tooth, become stagnant, and subsequently break down. (Either of these situations could produce a state of persistent inflammation in the tissues surrounding the tooth's root.) The seal also contains and encapsulates any debris that could not be fully removed during the cleaning aspect of the root canal treatment process so that it can't leak out and trigger an inflammation reaction.

Why go to all of this trouble?
If you get an infection, say from bacteria entering a cut in your skin, your body will transport white blood cells to and from the area (by way of your blood vessels and lymphatic system) so to combat the bacteria that have caused the infection. In most cases your body will win the battle and kill off the offending bacteria.

The problem with teeth and infections is that once a tooth's nerve tissue has started to degenerate and bacteria have taken up residence in the tooth's nerve area, there is no effective way for white blood cells to get at the bacteria to combat them. The dying nerve's blood and lymphatic vessels used to transport white blood cells will have begun to degenerate too.

The net result of all of this is that the nerve space inside a tooth can provide a nice cozy cave-like location for bacteria to persist because it's a place where your body's defense mechanisms can't get at them effectively. With this scenario, at best your body will only be able to cordon off the infection caused by the bacteria living inside your tooth. At worst, this bacterial infection will overwhelm your body's defense mechanisms and pain and swelling will ensue (an acute tooth abscess).

The idea behind having root canal treatment is that it provides the bulk of the clean up work for your body. It removes bacteria and tissue irritants that are present inside the tooth, especially those in the locations where your body would have the most trouble combating them. As an end result, once root canal treatment has been completed it provides your body with an environment where its mechanisms are able to clear away any residual bacteria and tissue irritants that may still be present, thus allowing complete healing (resolution of the inflammation) to occur.

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