If you have questions about root canals, we can help! Take a look at our Q&A session with Dr. Karen Potter of San Clemente Endodontics to get the answers to all of your root canal questions.
Ask the Endodontist: Dr. Karen Potter
Question: What are the main root canal symptoms patients should be aware of?
Answer: There are two main diagnoses that require initial endodontic treatment due to a diseased pulp or root canal system. The first is called irreversible pulpitis, which is when the nerve space is inflamed. The main symptoms for this diagnosis include:
- Lingering pain to cold
- Spontaneous toothache
- Pain to biting or pressure
The second diagnosis that requires endodontic treatment is pulp necrosis, which is when the nerve has died. These teeth usually don’t have pain to cold but instead you’ll notice:
- Spontaneous toothache
- Severe pain to biting or pressure
- An area that drains pus on the gum
Some root canal problems, though, are asymptomatic, so your dentist or endodontist may find the issue on an x-ray or see it clinically—and it may not be related to pain at all.
Question: What can occur if a patient decides to delay having treatment done?
Answer: Delaying treatment or deciding on no treatment can lead to:
- Increased pain
- Bone loss around the tooth
All of these things can decrease a patient’s ability to heal, so it’s important to not delay treatment if you’re experiencing any symptoms of infection.
Question: If patients are nervous about getting a root canal, what should they be aware of that may help them relax?
Answer: Standard root canal treatment is done thousands of times every single day all over the world—and new technologies in anesthesia and instruments used during a root canal make it a painless experience. Patients should also know that being anxious about a dental procedure is very common, and they are not alone in their feelings.
"While there are many horror stories about root canals from the past, most of my patients leave the office saying, 'Wow, that was so easy!' A patient should remember that we are here to help, not hurt."
Question: If a patient is diagnosed with a root canal system infection, what are the primary considerations he/she should focus on when choosing between root canal options?
Answer: When facing this diagnosis, a patient generally has two options: a root canal to try and preserve the natural tooth or extraction.
The main factors that a patient should consider when deciding between these two options are the endodontic, restorative and periodontal prognoses for that individual tooth. It’s best to try and save the natural tooth if it’s reasonable for the patient to do so.
If the root canal has a questionable or unfavorable prognosis, the patient may decide to extract instead of investing time and money into a tooth that may not last; however, root canals have a high success rate and should be considered as the primary option, if possible.
Question: What are the advantages of a patient keeping his or her natural tooth?
Answer: It’s so important to save our natural teeth because that’s the best way to maintain strong chewing function and aesthetics. While it costs less money to extract a tooth than to save it with endodontic treatment, it starts to get much more costly when you consider placing a dental implant. Studies have shown great survival of endodontically treated teeth with less postoperative cost and complications than what occurs with tooth replacement with dental implants.
For a tooth with a favorable prognosis, it’s better to do a root canal, retreatment or apical surgery to preserve it for as long as possible before resorting to extraction and a dental implant.
Question: What are the differences between a dentist and endodontist?
Answer: A dentist is a doctor who goes to dental school for three to four years after college and is able to perform a variety of oral health procedures. Dentists are trained in performing root canals in dental school and have varying degrees of comfort completing this type of procedure.
Comparatively, an endodontist is a dentist who attends two to three years of additional training to narrow his or her area of expertise to a specific part of dentistry related to the roots of teeth. This additional training provides extensive knowledge about specific anatomical variations and complexities of roots, as well as offers experience using the best technology. Endodontists also have a great deal of knowledge in dealing with failed root canal treatments and working to properly save the tooth.
Question: What are the advantages of choosing an endodontist over a dentist for a root canal?
Answer: A root canal is a highly complicated procedure that can be challenging. It’s up to the dentist to decide if he or she feels comfortable performing the specific root canal.
A primary advantage of choosing an endodontist over a general dentist, though, is the use of technology like Cone Beam Computed Tomography (CBCT), dental operating microscopes (DOM) and the GentleWave® Procedure. It’s also advantageous to work with an endodontist when facing a failed root canal, as endodontists are well trained in retreating failing root canals. They even sometimes perform surgery on these types of teeth to help preserve the natural tooth structure.
Question: Which of the root canal options would you consider more beneficial for patients in terms of long-term results? Which would you recommend to your patients?
Answer: Research shows that root canal protocols that activate and agitate the irrigation solutions within the tooth give us the best long-term results, which includes the GentleWave Procedure.
Based on my personal research, I choose to use the GentleWave Procedure for my patients because I believe it delivers the cleanest canals possible—and cleaner canals will ultimately lead to better outcomes and improved longevity.
Question: Is there typically pain associated with standard root canal treatment? What about with the GentleWave® Procedure?
Answer: During a root canal—whether standard root canal treatment or the GentleWave Procedure—your tooth is numbed, and you shouldn’t feel any pain. Following the procedure, it’s typical to have two to three days of mild to moderate tenderness with some pain to biting as your body begins to heal the ligament and bone that supports the tooth. Typically, this postoperative tenderness can be easily controlled with over-the-counter ibuprofen (Advil) or acetaminophen (Tylenol).
I believe that the GentleWave Technology seems to be able to more thoroughly clean the canal space, which leads to less inflammation following the procedure. I personally call all of my patients the evening following treatment and have noticed more patients reporting to me that they are experiencing no discomfort or minimal discomfort. In general, my patients who undergo the GentleWave Procedure are noticing less postoperative tenderness.
Question: Have you noticed any changes in recovery post-GentleWave Procedure as compared to standard root canal treatment?
Answer: With the GentleWave Procedure, I’ve noticed decreased postoperative pain during the short-term recovery and have seen great success in bone healing in patients who have attended their more long-term recall visits.
Question: What is the biggest benefit of the GentleWave Procedure for your patients?
Answer: The biggest benefit of the GentleWave Procedure is achieving a cleaner canal system while removing less dentin. We believe that this will ultimately lead to a better success in saving natural teeth—hopefully for a lifetime.
Question: What can cause a root canal to fail? If retreatment is needed, which treatment option would you recommend for better long-term results?
Answer: A root canal can last a lifetime—as long as bacteria never get back in. Bacteria can re-contaminate the root through a faulty restoration, a crack in the tooth or root or leakage through initial root canal filling material. Root canals can also fail if bacteria or tissue are left behind the first time around. Additionally, some root canals fail due to the presence of a cyst or other type of infection in the bone surrounding the tooth.
Typically, endodontists retreat teeth in two visits, which will require the use of additional medicine in the tooth for a week or more to try and kill the bacteria. Comparatively, the GentleWave Procedure can handle this in a single visit; this is currently how I handle my retreatment cases. I believe that the cleaner canals provided by the GentleWave Procedure will translate to higher success rates.
"The GentleWave® Procedure allows us to clean the deepest parts of the canals better."
Question: What can patients do after any oral procedure to help ensure long-term success of the treated tooth? Are there specific instructions that you provide your patients?
Answer: My best recommendation to patients following endodontic treatment is to avoid chewing on the treated tooth for at least three days while also keeping it clean and taking any medications the dentist or endodontist has instructed.
I provide my patients with a postoperative instruction card that includes the regimen of anti-inflammatories that I recommend and follow-up instructions of how to promptly restore the tooth back into function, helping ensure a better recovery.
Question: Is there any additional information that would be beneficial for patients to know?
Answer: If you ask any endodontist about which tools and techniques they use to perform endodontic treatment, you’ll get many different answers. There isn’t one right or wrong way to successfully perform this procedure.
That being said, the GentleWave Procedure helps us do the best work we can do. I believe it does a better job than any other technology we have available to us at this time. In an environment where we want to minimize risk of exposure to COVID-19, it allows us to thoroughly perform irrigation within the tooth in an aerosol-free environment* and also permits single-visit treatment to avoid having to return to the endodontist's office a second time.
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*Data on File TR20-0027