Myths About Root-Canal Treatment

           Fish is brain food. Eating carrots helps you see. Getting a root canal hurts.

They're called myths or "old wives' tales" and often, they contain a grain of truth. Fish contains zinc, and a marginal lack of zinc can impair mental functioning. Carrots (and many other veggies) contain beta-carotene, which can help prevent an eye disease called macular degeneration. And root canals " well, they used to hurt — sometimes.

"People who have had root canals done several years ago may have had bad experiences, but times have changed greatly," says Samuel I. Kratchman, D.M.D., a professor of endodontics and assistant director of postgraduate endodontics at the University of Pennsylvania School of Dental Medicine. "New local anesthetics, improved techniques, faster-spinning drills, and better post-procedure medications make root canals today virtually painless," he said.

When people claim that root canals are painful, they may actually be referring to the toothache before the procedure, caused by infection of the tooth's pulp. "A lot of people are in a lot of pain to begin with," Dr. Kratchman explains. The procedure itself — which involves local anesthetic and possibly a sedative, such as nitrous oxide — should cause little, if any, discomfort.

         Visiting a dentist inexperienced with root canals could make things worse. "If you have someone who hardly does any root canals and they're drilling and stopping, drilling and stopping because they don't know how deep to go, it's like ripping off a Band-aid one hair at a time," Dr. Kratchman says. "It should take only a few seconds to get into the tooth, so at worst you'll feel something for a second."

                                           Other Myths About Root Canals:

         The tooth's nerves are removed, so I won't feel any pain.
"People often say, 'I had the root canal done so there's no nerve in the tooth — so it won't hurt afterward.' That's a misconception," Dr. Kratchman says. "You will not have hot or cold sensitivity, but the tooth is surrounded by a ligament that has many nerve endings, so for the first few days you'll be sore. Anti-inflammatories will make you feel better." You should also avoid chewing on the affected side for a couple of days, and avoid hard foods until the tooth is not painful to bite on.

         Why bother getting a root canal done when I'm just going to need the tooth taken out eventually?
"No procedure is 100-percent successful, but root canals are 92 percent to 95 percent successful," Dr. Kratchman says. A second root canal or surgical repair can solve most problems. "You have a very high chance of holding onto the tooth after a root canal, unless there's a lot of bone loss around the tooth or the tooth is cracked," he says.

          I'm not feeling any pain, so I don't really need a root canal.
Root canals are necessary when a tooth's pulp becomes damaged or infected. An infected tooth will hurt as the infection spreads. Sometimes, Dr. Kratchman says, the swelling from the infection comes to a pimple-sized head, or fistula, in the gum, and then drains into the mouth. Then, he says, "you're no longer in pain, but the infection still exists and you do need the root canal. If it's not treated, you run the risk of the infection spreading, and losing your tooth."

          A root canal means I'm having the roots of my tooth, or my whole tooth, removed.
"A lot of people think they're having the whole tooth taken out," Dr. Kratchman says. "Actually, the dentist removes the pulp — nerves and blood vessels — from inside the tooth. The roots of the tooth, and the tooth itself, are not removed."

         After I get the root canal I won't have to go back to the dentist for a while.
"After a root canal, the tooth needs to be permanently restored," Dr. Kratchman says. "On front teeth a filling is often sufficient, but back teeth should receive a crown. If the root canal is done by an endodontist [a dentist specializing in diseases of the tooth's pulp] the canal system will be permanently filled, but the tooth itself will have a temporary filling. You should then make an appointment with your general dentist for a permanent restoration or crown. If you don't go get that permanent restoration, you could run the risk of fracture because the root canal weakens the tooth. Probably the number-one reason of root-canal failure is when people don't get a permanent crown and the tooth cracks."

                                           Restoring The Tooth After Root Canal

             The tooth may be restored with a composite filling material if it is a front tooth, but back teeth in most cases will require a crown.

             To prepare the tooth for a crown, your dentist first will have to build up a foundation to strengthen the tooth and support the crown.

           The most common material used for this purpose is amalgam, which is placed in the canal. This commonly is used for back teeth.

            Front teeth usually are not large enough to support an amalgam foundation. Instead, for front teeth your dentist may use a post-and-core restoration. In this procedure, your dentist will remove some of the gutta percha — the plastic material in the pulp chamber and root canals — to make room for the post, which is a metal rod. The core surrounds the post. It mimics the inner part of the missing tooth structure and forms a foundation for the crown. There are different types of posts and cores. In one type, composite filling material is used to build up the core around the post. The composite core is used when there is a significant amount of tooth structure remaining. A cast post and core is used when less tooth structure remains. In a cast post and core, the post and core are both made of metal and are created as one piece. The cast post and core may be used when one or more of the tooth's root canals are oddly shaped so that the post can be made to fit it exactly. The cast post and core is stronger, but its insertion takes two dental visits to complete — one to prepare the tooth and create an impression of the post space, and the second to cement the post into the tooth.

The crown, which is made in a dental laboratory, is composed of either porcelain, metal, or a combination of the two. It is cemented onto the foundation.