The term “root canal” is unfortunately often used as slang for an obnoxious experience as in “about as much fun as a root canal” or “it was worse than a root canal”. Patients will often wince or refuse treatment as soon as they hear the term “root canal”  It is better to first describe the clinical status of the tooth- “Mrs Jones, when we see this shadow around the tip of your tooth, it usually means there is infection inside the root. We will need to clean out and disinfect the root and then seal it up so the bone holding the root can remain healthy. This is typically known as a ‘root canal’ “. (Note that the alarming term is used only after the explanation of the procedure).

More often than not, the tooth requiring endodontic treatment will be picked up first on the radiograph in a non-pain situation. Mrs. Smith, we noticed on your x-rays that there is a shadow (“lesion” is an alarming word to many) at the end of the root on that front tooth with the large filling. This usually means that it is a dead tooth (non-vital).

“But Doctor, I can still feel that tooth!”

Yes, you are feeling the live bone and gum around it and the healthy ligaments that hold the tooth in the jaw but the tooth root itself is no longer alive. It is hollow now where the nerve and blood supply used to be and it has some infection inside the root that is starting to spread to your jaw and that is why we can see it in this x-ray. This infection needs to be cleaned out and the root sterilized and sealed up. Then the bone can heal around this root and you can keep the tooth!

“Isn’t that really painful?”

No, and especially not on a tooth that is already dead with no nerve inside it. All we need to do is make a small opening in the back (or top) of this dead tooth (note the repetition that there is no longer a live nerve inside the tooth) and clean out the infection with very precise instruments that we measure with an x-ray and then carefully shape and clean the inside of the tooth before we seal it up.

“What will you do then?”

Because non-living teeth like this tend to be more brittle than a healthy live tooth, we will put a strengthening post in the tooth and bind it all together with a natural looking tooth colored crown.

Endo Pain Situation

“Doctor, this tooth is really killing me now, it hurts all the time, and especially when I drink something hot!”

There are very specific clinical criteria for making the determination between reversible and irreversible pulpitis that we all learn. Clinical experience will greatly improve this important diagnosis and patients will understand the basics a bit better if put this way:

Mrs. Jones, often when a tooth hurts for just a bit, when you eat sweets or drink something cold or just had a new filling, we know the nerve is irritated and a little inflamed. This is usually a condition that will calm down after a period of time. However, when a tooth begins to increasingly hurt for no reason or for long periods of time or when hot instead of cold bothers more, that often means the tooth’s nerve is probably becoming infected and pressure or swelling may be building up inside the tooth. We can still save the tooth but this infection needs to be cleaned out and the pressure relieved. Then the hollow root sterilized and sealed. We will make sure the tooth is very numb and then make a small opening in the top and clean this infection out. You should feel a lot better very soon.

[Note the use of the word “inflamed” for reversible situations and “infected” for irreversible ones. Patients will generally wait the required healing time due to reversible “inflammation” and often readily proceed to treatment to remove “infection.”]

Note also the avoidance of the delightful endodontic terms “drill, file, reamer, spreader”, etc.

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