Are Tooth Infections Really Such A Big Deal?

These infections are a big deal if you care about toothaches and bone health. Once an infection reaches the nerve deep inside tooth’s pulp chamber, it’s only a matter of time until the infection causes a blazing toothache and pushes its way down the roots and into the surrounding bone. These are the infections that swell the face and keep you up at night with throbbing pain.

If you ignore the infection until it progresses into the bone, it can spread bacteria throughout the body and endanger your heart and brain. What starts as a tiny tooth infection can become life-threatening, if not treated. It may sound crazy, but abscessed teeth were once a leading cause of death. And they still cause brain infections, sepsis and even death when not treated promptly. Endodontic infections are definitely serious business, and root canal treatment is the primary way I remove infections from tooth canals.

Root Canal Treatments: Relieving Toothaches One Root at a Time!

A root canal treatment stops a toothache by removing dead, dying and decayed tissue from the tooth’s center and roots and then cleaning out any infected and inflamed pulp material. No more infection, no more nerve, no more pain. Then the dentist fills the roots’ canals with a rubber-like material (called gutta-percha), which then restores the tooth appropriately.

But Don’t Root Canal Treatments Compromise Teeth?

Great question. Can we answer with a question? Compromised compared to what?

Without the root canal, the tooth will erode; it’s a gonner. So, are you comparing the strength of the root canal tooth to that same tooth if left alone with its infection? Or, are you comparing it to a healthy tooth that never had an infection?

When compared to a healthy natural tooth, yes, root canal teeth fracture more easily. However, when a tooth is badly infected, keeping it requires a root canal treatment. Compared to an infected tooth, or no tooth at all, a root canal tooth is strong and functional and can stay healthy for years.

Just like other natural teeth, root canal treated teeth need regular attention and maintenance. In other words, they need to be clean. And the filling or crown that seals the root canal also needs carefully maintenance in order to prevent future infections. Remember, the tooth can still decay and get re-infected. The fact that it received treatment once doesn’t mean that it cannot get infected again if bacteria gain access again.

Benefits of Root Canal Treatments:

• Allows you to keep your natural tooth
• Preserves your gum tissue and bone around your tooth
• Generally less expensive than a new implant tooth

Are There Any Alternatives to Root Canal Treatment? Yes.

We can offer some alternatives to a root canal:

1. Extractions: The least expensive way to fix an infected tooth is to extract it. Once we remove the infected tooth, the body will clear up any remaining infection with the help of antibiotics. However, missing teeth create cosmetic and functional problems of their own.
2. Extraction and Bridge: Treating an infected tooth with an extraction and fabricating a bridge does eliminate the infection. It also solves any cosmetic issues and stops teeth from shifting. But a bridge cannot stop bone loss at the spot of the missing tooth. Bridges also cost more than a root canal and require drilling down the neighboring teeth. Whether or not a bridge is the best solution for you depends on your exact situation. Learn more about bridges here.
3. Dental Implants: Like a bridge, we place an implant in the mouth after we pull the infected tooth. Implants typically cost more than a root canal treatment and crown. However, an implant can work better than a root canal because it is stronger and potentially much longer lasting. A dental implant treats the infection, solves cosmetic issues, stops shifting AND stops bone loss. Implants also have the advantage of never being able to get a cavity or decay. Learn more about dental implants here.

It’s Just an Infection, So Why Don’t Antibiotics Work?

Toothaches act like the Terminator—”They’ll be BACK!” An antibiotic alone can make a toothache stop hurting, but it will not cure a toothache permanently. Why? A toothache infection has two parts: the infection inside the tooth and the infection in the surrounding bone and tissue.

The antibiotic works on the infection living in the bloodstream. This means that the antibiotic can reach the bone and tissue around the tooth, but it can’t really get inside the dead nerve. So, the pain will stop, but the infection, along with the pain will return.

Once a tooth gets infected inside itself, you need a dentist to clean out the infection. The only options remaining are root canal treatment or extraction.

When No More Pain is a Bad Sign: 4 Stages of Infection

Most people assume that no more pain is ALWAYS a good thing; they assume that no more pain means that the infection is gone. Right? No! Sometimes the sudden disappearance of pain signifies danger. When a terrible toothache magically ‘goes away on its own’ without treatment, the pain has stopped because the nerve has died. Even though the pain lessened or vanished, the infection may continue to grow, spreading damage to surrounding tissues. You can’t feel it anymore because the nerve, the body’s emergency warning system, is dead. To understand how this happens, you need to know about the four basic stages of tooth infection.

Stage 1 (No Pain Cavity): Bacteria take up residence on a tooth and produce acid that starts the decay process in the tooth’s enamel. The outside of the tooth is infected with dental caries, or cavities. Treatment: tooth filling.

Stage 2 (Sensitive Tooth with Cavity): Left untreated, the cavity decays through the tooth enamel and dentin to reach the nerve in the central pulp chamber. The tooth now has a large cavity and is sensitive, but it’s not a full-on toothache. Treatment: tooth filling or crown, depending on the size of the cavity, along with tooth nerve insulation or liner.

Stage 3 (Tooth Ache): The infection is in full swing creating puss under intense pressure inside the tooth and on the nerve. The infection begins to seep out of the ends of the tooth roots creating an abscess and swelling in the jaw bone. Stage 3 infections hurt intensely with throbbing, untouchable pain. These are the toothaches that people dread. Treatment: root canal treatment.

Stage 4 (No Pain Dead Nerve Tooth): The nerve dies from the pressure and infection and the bacteria and inflammation spread to the surrounding tissues. The pain stops because the infection has destroyed the mechanism responsible for transmitting pain. Without a live nerve in the area, the body only stops feeling pain until the infection spreads to another nerve and the toothache comes back with a vengeance. Treatment: still root canal treatment.

4 Key Factors for Successful Root Canals:

Talk about technique sensitive! In a root canal treatment, the operating dentist works inside tooth roots that are just fractions of a millimeter wide at the tip. In order to be successful, the dentist must completely clean out all the infected and dead tissue.

Four tips to help choose a dentist when you need root canal treatment:

1. Choose a dentist with a microscope: All endodontic specialists have microscopes that they can use to magnify the inside of the tooth and get a detailed view of all the nooks and crannies.
2. Choose a dentist with root canal experience or who has a mentor: The only way a dentist can build experience is by working on patients. While I was gaining root canal experience after dental school, I partnered with a more senior dentist who would coach me through root canals, helping prevent me from mistakes to successfully navigate the challenging parts of the procedure.
3. Choose a dentist who is meticulous: Root canals are detailed work, and you want a detailed dentist doing them. Root canals are not the job for anyone who paints with a broad brush.
4. Choose a dentist who knows his or her limits: I have lots of experience doing routine root canals. With the help of my microscope, I can even handle complex cases. However, I will refer cases with oddly curved roots or suspected root fractures. I won’t retreat a tooth myself if I can’t figure out why it failed. A dentist who knows their limits is a dentist who puts patients first.

Broken Down Tooth? Root Canal Treatment + Post & Core to the Rescue!

Sometimes cavities decay so much that tooth doesn’t have enough healthy area left to support a crown. In these cases, often the only way to save the natural tooth is to perform a root canal treatment. By removing the nerve, as well as all the decayed tooth, the dentist can fit the tooth with a post & core that extends down the tooth roots and provides an anchor for a crown. Without proper support, crowns leak, loosen and fail. This eventually leads to the need for extraction as the only option. To place the crown on a severely decayed tooth without first performing a root canal treatment and placing a post & core would be to invest money in a guaranteed failure.

What!? How Can I Need Another Root Canal Treatment on the Same Tooth?

Sometimes a root canal treated tooth gets re-infected and needs another root canal treatment or ‘retreatment’ in order to save it. An endodontic retreatment (or second root canal) goes over the inside of the tooth with the high powered microscope to insure that the tooth is crack-free, completely clean and properly re-filled.

Why would you need a second root canal treatment? Here are the most common reasons:

1. Bacteria normally found in the mouth has found its way through the tooth.
2. A tooth may also get re-infected if trauma or wear causes cracks that allow bacteria to get inside the tooth.
3. Root canal treatments fail if the infection or any live material was not completely removed during the first attempt. This can happen due to hidden canals, tooth defects, calcified tooth roots or oddly curved tooth roots.
4. Root canal treatments completed in foreign countries with generally lower skill and technology have a higher risk for failure.

Endodontic Surgery: Healing Stubborn Bone Infections

Sometimes the bone around a tooth root remains stubbornly infected even after a root canal treatment. These periapical infections (peri – around, and apical – end of tooth, so periapical means around the tip) normally recede due to the work of the immune system after a root canal. However, sometimes periapical infections persist and require endodontic surgery. This micro-surgery goes into the bone and removes the infected bone, as well as the affected end of the tooth root. The dentist then re-seals the tooth root with a small filling to prevent infection from traveling up into the tooth. With the infected bone removed, the area can heal and will re-grow healthy bone around the tooth root.

Endodontic surgery can also detect and treat root fractures and damaged root surfaces. Additionally, it can remove calcium build up from canals. Endodontic micro-surgery is possible thanks to advances in digital imaging and operating microscopes. Because of this, developing countries or rural areas that lack the technology for surgical procedures cannot easily perform this type of treatment.