What is endodontics?
Endodontics is a specialty branch of dentistry, recognized by the American Dental Association, which is focused on treating disease of the dental pulp. Endodontic treatment or root canal therapy is one of the most common dental procedures. Approximately 20 million are performed annually in the United States alone. The procedure involves removal of unhealthy tissue from the space within the tooth. During this process the tooth is disinfected and inflamed or infected tissue is removed to create an environment for healing. After the canal space is cleaned, shaped, and dried, it is sealed with materials to minimize the re-entry of bacteria. Root canal treatment, if indicated, allows you to preserve your natural tooth in a healthy state.

What is an endodontist?
An Endodontist is a dental specialist who has completed additional two years of postgraduate training after dental school in order to develop the advanced skills for diagnosing and treating complicated endodontic cases. This includes challenging diagnostic cases, complicated non-surgical root canal therapy, and microsurgery. Dr. Hanlon is a specialist who has limited his practice to endodontics and he treats complex types of problems every day. He uses his special training and experience in diagnosing pain and treating difficult cases, such as teeth with narrow or blocked canals, unusually complex internal anatomy, retreating previously failing endodontic cases, patients with complex medical issues, and extremely anxious or fearful patients.

Will the procedure be painful?
No, we will take every measure to ensure that your procedure is comfortable. If treatment is needed, the tooth will be numbed with a local anesthetic. Dr. Hanlon is an expert and has years of experience in achieving profound anesthesia, even in the most difficult of circumstances.  For most patients, the feeling of numbness usually subsides after 2-3 hours.

How long will it take?
The length of time is dictated by the complexity of the case. Many endodontic procedures done in our office are completed in a single visit. Some may require two or more visits due to pain control issues, swelling, persistent drainage, or complex anatomy. 

Will it be uncomfortable afterwards?
Most patients do very well following endodontic treatment. They experience pain relief and feel minimal discomfort the next day. A non-steroidal anti-inflammatory drug will be dispensed to you in the office following treatment. We recommend taking it before the anesthesia wears off to prevent pain recurrence. Depending on an individual’s pain tolerance, a minority of patients may experience moderate to severe pain following treatment. The number one predictor of post-operative pain is the level of pre-operative pain.   The second most common reason for moderate post-operative pain occurs in patients that clench or grind their teeth. The jaw muscles can put great pressure on the tooth and surrounding tissue which then results in moderate, persistent pain. 

The tooth is uncomfortable a week or more later. Is that normal?
A root canal treated tooth will not have any hot or cold sensitivity once the pulp tissue has been removed. It could remain tender to touching or biting for a few days, weeks, or longer. After the root canal, your body begins the healing process and your tooth will become more comfortable over time.

Will I need to come back?
Once the endodontic treatment is completed, we may want to see you back in our office for a follow-up exam appointment and possible radiograph to ensure that things are healing normally.

How soon will I need to follow-up with my general dentist?
When your endodontic therapy is completed, Dr. Hanlon will explain if your tooth will need additional treatment at your general dentist’s office. Doctor Hanlon will explain the type of restoration that was placed and what, if any, additional treatment your tooth will require. We will work closely with your general dentist to provide the best outcome for you. A treatment report will be sent to your dentist. When your root canal therapy has been completed, you may have a temporary filling in the treatment access preparation in the tooth. You should contact your general dentist for a follow-up restoration to be done within a few weeks of your visit with us. Your restorative dentist will decide on what type of restoration is necessary to protect your tooth.
It is very important you have the tooth properly restored afterwards, since failing to do so in a timely manner may result in bacterial contamination or damage due to cracks. Cracks can jeopardize endodontic treatment. An extensive crack can result in tooth loss. If a definitive crown is planned, cautious chewing should be exercised until the protective “temporary” crown is in place.

Is my tooth dead after root canal treatment?
Retaining an endodontically treated tooth in your mouth is a healthy alternative to tooth extraction. The tooth structure that remains in your mouth after treatment is not dead tissue. The principle tooth structure, known as dentin is an end product of cells known as odontoblasts and dentin is actually not a living tissue, even prior to root canal treatment. Other examples of tissues that are by-products of live cellular function that are supported in the body are fingernails and hair. Cutting those tissues produces neither bleeding or pain. The only part of a tooth that is vital, as defined by having blood circulation, is the pulp tissue. The tooth will function normally without the pulp tissue. It will, however, be insensitive to stimulation by hot and cold, for example. Once pulp tissue is removed from the tooth, the dentin can be cut without sensation.

Can’t I just take an antibiotic?
Although antibiotics are sometimes indicated to relieve a patient’s symptoms of pain and swelling, they do not get into the root canal space and affect the source of the problem. Antibiotics are dependent on intact blood circulation. If the antibiotic cannot get to the source of the problem there will be no resolution.  In most cases, what is needed is removal of the tissue, since that is the source of the problem. Once the source of inflammation is removed, your immune system is very capable of healing the tissues around the roots.  Antibiotics therapy is rarely necessary.

What if I decide not to have a root canal?
The only alternative to root canal treatment is extraction or removal of the tooth. Once the pulp is affected beyond its ability to heal, it will lead to either an inflammatory response or over time an infection. Neither is healthy, and both require some form of treatment. While some patients may prefer extraction because it is less expensive, in the long-term, it can be more costly. After an extraction, replacing the tooth with a bridge, implant, or removable partial denture is generally more expensive than root canal treatment and a crown. Our goal is for you to save your natural tooth for as long as possible.

I have heard of implants. Are they better than root canals?
Nothing is better than your natural tooth. Maintaining your natural teeth is one of our main priorities, but if we feel that root canal treatment is not predictable, then a dental implant may be indicated. Implants appropriate for replacing missing teeth and we will recommend one if we believe that it is a better long-term investment in your health.

What is the success rate of endodontic therapy?
Endodontic therapy has a very high success rate. Approximately 95% of endodontically treated teeth can be retained after careful-complete therapy. Of course, each patient and tooth is unique and some teeth are not amendable to endodontic treatment. Careful diagnosis and case selection will lead to the best prognosis. Many failing root canals can be retreated either surgically or non-surgically. Common causes for tooth loose include:
• Unusually heavy tooth function as with clenching,  grinding, and bruxing
• root fractures from excessive forces
• Compromised structural integrity of tooth due to caries or previous dental treatment 
• Advancing periodontal disease that affects the bone supporting the tooth
• Leaky crowns that allow for bacterial invasion and ultimately re-contaminate the previous root canal treatment.
These causes have little to do with the endodontic therapy itself, which is why careful diagnosis and treatment planning is paramount.