Root canal treatment. everything you need to know

WHAT IS A ROOT CANAL?

The root canal treatment is a dental procedure where the dentist might remove the bad and damaged pulp and refill it with an inert material and place a dental filling over it.

The entire treatment is usually divided into 3 steps.

Step 1:

On the first day of the visit, your dentist might do a regular dental checkup to know the status of the painful tooth. He might take an X-ray to see the extent of damage in the tooth.

After confirming and analyzing the damage, he may start the treatment with a local anesthetic jab in the mouth. As a result, the tooth and its surrounding region get numb, and you might not feel any pain.

Once the tooth gets numb; your dentist will remove all the damaged tooth portions and dig into the pulp area of the tooth using an instrument called an aerator handpiece (dental drilling machine).

Then, he uses specialized instruments called Root canal files to remove the bad pulp and clean the vacant area after it.

Step 2:

In step 2, your dentist might increase the canal size and shapes the canal for further treatment. This entire procedure is called Bio-mechanical-preparation (BMP).

During the procedure, the dentist might shape your root canal and enlarge them with root canal instruments.

The entire procedure can be done by hand or can use a specialized instrument called a Rotary endodontic machine.

The rotary endodontic machine simplified the procedure and is a decent gadget to perform root canals fast and effectively.

Step 3:

In step 3 your dentist might fill the empty root canal with an inert material (like gutta-percha) and provides an airtight seal at the end of the root canal. After that, your dentist might place a filling over the material and close the root canal. With this step, the root canal procedure is completed.

HOW LONG DOES A ROOT CANAL TAKE?

The entire root canal procedure would take somewhere between 30 minutes to 3 hours.

The duration of the treatment depends on the type of teeth we treat and the complexity of the root. More complex root anatomies might take a longer time to treat.

But the entire treatment time is divided into two to three dental appointments for the comfort of the patient and the tooth.

Regular treatment

Usually, it takes 2 – 3 days to perform all these steps. Your dentist might divide the 3 steps into 2 to 3 different appointments and can perform the entire treatment. Each appointment usually takes 10 to 20 minutes to perform.

The gap between the appointments helps the tooth to heal and react better to the treatment.

Single-sitting root canal treatment

When all the 3 steps in the root canal are performed in a single day and a single sitting, then it is called single sitting root canal treatment.

The single-sitting root canal treatment is usually preferred by your dentist when:

1. You have limited time to visit your dentist.
2. Intentional root canal procedure: Intentionally your teeth must undergo root canal treatment (In a condition where normal teeth have to get a crown).
3. The pulp in your teeth is not damaged severely.
4. There is an acute infection without any pus in your teeth.

HOW MUCH DOES A ROOT CANAL COST WITHOUT INSURANCE?

The treatment cost for root canal procedures varies from region to region and from one dental office to another.

An endodontist might charge more compared to a regular dentist. Hence it would be wise to call your dentist to know the treatment charges.

The treatment charges usually range between $500 to $1500. The price might be even higher for single-sitting root canal treatments.

The price also depends on the type of teeth. A root canal on the front teeth is relatively cheaper to treat, followed by bicuspids and the molars.

Root canal (Without crown) prices for various teeth without insurance

Teeth	The average cost of root canal
Front teeth	$500 to $800
Premolar teeth or Bicuspid	$700 to $1000
Molar teeth	$1000 to $1800
Re-root canal procedure	$1500 to $2500
Single sitting root canal treatment	$1500 to $2000

Root canal (Without crown) prices for various teeth with insurance

Insurance coverage might reduce the amount you pay. Generally, most insurances cover dental treatments also. You should consult your insurance provider to know the information on dental treatments.

In general, the insurance covers most of the regular dental treatments and part of the special dental treatments.

The root canal comes under special dental treatments. Hence the insurance coverage might range between 30% to 50% of your root canal charges.

It is always wise to choose insurance with high percentage coverage for your dental treatments as the charges are high.

Teeth	The average cost of root canal
Front teeth	$200 to $800
Premolar teeth	$200 to $1000
Molar teeth	$200 to $1500

WHY SHOULD I HAVE A CROWN AFTER THE ROOT CANAL?

Crowns provide strong reinforcements to the weak teeth after the root canal procedure. Here are the 2 main reasons why crowns are important after a root canal procedure.

Weak teeth

A root canal-treated tooth will be fragile. Hence it cannot bear heavy occlusal forces.

During the root canal, the vital region of the tooth is removed. As a result, the tooth becomes devoid of any nutritional supply for its maintenance. As a result, the tooth becomes brittle.

Such teeth tend to break easily and should be protected.

Biting force danger

Have you ever observed that when some hard substances come into your food, your jaw suddenly stops biting to remove the thing? This phenomenon is called protective co-contraction.

This reflex helps us save our teeth from damage. If we continue biting irrespective of analyzing the substance, sometimes, we may end up losing our teeth.

The reflex is supported by the sensory information supplied by our teeth. The sensory information is provided by the nerves in our dental pulp.

But in root canal treatment, we remove the pulp and nerves which are present in the pulp. As a result, the teeth will lose their sensory stimulus. As a result, the teeth now become neutral. It will not send any sensory stimulus to the brain.

Moreover, the teeth become brittle after root canal treatment. As a result, the teeth fail to provide stimulus and the protective co-contraction mechanism stops working. As a result, the person bites food even, he finds some unknown hard substance in it. It might result in permanent damage to the teeth.

ROOT CANAL AND CROWN

A crown acts as a protective barrier to the root canal-treated tooth. It helps in distributing the occlusal forces evenly over the teeth and bone.

A root canal treated teeth discolor fast. The color of the tooth may change from white to dark brown or grey after a root canal. Hence crowns also aid in providing aesthetics to root canal-treated teeth.

Such teeth when capped with a crown would appear lively with more aesthetics.

SHOULD I HAVE A CROWN AFTER ROOT CANAL?

ROOT CANAL CROWN COSTS

As mentioned previously, insurance coverage helps in minimizing your send on the entire treatment procedure.

The cost of a root canal crown also varies from area to area and from one dental office to the other. Moreover, the price also changes on the type of crown you choose.

The crowns are made of various materials. As a result, their cost also ranges wider.

Metal crowns

The metal crowns are the cheapest and are not aesthetic. They are black and are usually preferred for back teeth. The use of metal crowns has almost come to zero these days. The cost ranges between $200 to $500

Porcelain fused to metal crowns (PFMs).

The crowns have a metal base and porcelain facing over the metal. As a result, the crown appears in tooth color. Most of the mid-range dental crowns are PFMs. The cost ranges between $800 to $1000.

The PFMs are the ideal crowns that prefer aesthetics and economical treatments.

Full ceramic crowns

The full ceramic crowns provide high aesthetics and comfort. Moreover, they are heat resistant and are not sensitive to temperature. All-ceramic or full ceramic crowns cost more compared to all the other crowns available. They usually cost between $2500 to $3000.

Zirconia crowns

Zirconia crowns are the best alternative for people who want to prefer full ceramic crowns. The Zirconia crowns produce superior aesthetics like full ceramic crowns. Moreover, they are cheap but stronger compared to full ceramics.

The Zirconia crowns range between $1000 to $3000 per crown.

How much does a crown cost without insurance after root canal treatment?

Type of crown	Cost
Metal crowns	$200 to $500
Porcelain fused to metal crowns	$800 to $1000
Full ceramic crowns	$2500 to $3000
Zirconia crowns	$1000 to $3000

WHAT IS THE COST OF ROOT CANAL AND CROWN TOGETHER?

Many dental offices provide discounts when you choose crowns along with the root canal procedure. It is a best practice to reduce your treatment costs.

We are trying to provide a gross outlook over the combined prices of root canals and crowns. But remember, the prices might change from place to place and from one dental office to another.

The cost of the combo treatment (Root canal & crown) will be a lot cheaper if you prefer a metal crown. Usually, the cost ranges between $1000 to $2000.

The cost of both treatments would be ranging between $1000 to $3000 when you choose PFMs with a root canal. It is the ideal and economical treatment option available.

But the cost goes even higher to $5000 when you choose Zirconia or full ceramic crowns along with the root canal treatment.

HOW LONG DOES A ROOT CANAL LAST?

I think this question boggles you the most. When you are paying so much for the treatment, your expectations also will be higher.

Root canals usually last longer, even for a lifetime. It all depends on how the dentist has treated you and how you maintained it.

But root canal failures are not uncommon. It is very difficult to predict the future or prognosis of the treatment as no one can judge how your body reacts to the treatment.

The most interesting part is, I have seen the worst root canal treatments which have not provided even the slightest of discomfort to the patient. On the other hand, I have also seen the best root canal treatments done, yet the patient comes to you the next day after the root canal with pain.

Hence no one can judge the longevity of your root canal treatment. There are a ton of factors that might influence the life of root canal treatment. And the most important part is none of these factors are in your hand.

There is no specific guarantee or warranty for any medical treatments. Hence if anyone asks me the question “How long does the root canal last”, I will rather say with a smile that “EVEN GOD MIGHT NOT KNOW”.

But a research study published in the Journal of Clinical oral investigations has said that the median survival rate of root canal-treated teeth is 21 years.

On the other hand, the cumulative success rate of root canal treatments is more than 80%. With the use of advanced treatment modalities like rotary endodontics & advanced sterilization protocols, this success rate may reach even higher.

PAIN AFTER ROOT CANAL? WHAT TO EXPECT?

Do root canals hurt?

Yes! Some patients might experience mild pain after the root canal. They might experience an increase in pain while biting or eating. This could be due to the residual infection left below the teeth after root canal treatment.

Root canal treatment is done only in the teeth, but not beyond the teeth. The infection present beyond the teeth must heal on itself and it takes time.

But usually, the root canal treatment, in general, is a painless procedure.

Also read:

PAIN AFTER ROOT CANAL. WHAT DOES IT INDICATE?

Root canal recovery time

Many patients ask me how long does a root canal take to heal? I would rather answer them that it may take a few days to a week to heal.

Some patients might feel slight pain even after the root canal. Usually, the pain will be mild and can be manageable using over-the-counter pain medications.

The pain usually stays for a week after a root canal and may subside slowly. Hence the recovery time for a root canal usually ranges between a few days to weeks.

What if the pain is persistent even after the root canal?

Severe pain even after the root canal is a sign of root canal failure or root canal infection. The pain will be much more severe or unbearable. The patient might not be able to eat. A slight increase in occlusal force might elicit severe pain in teeth.

Such pains are difficult to treat and should be managed by your dentist. Hence visit your dentist for the same. If possible, get an X-ray and find out the correct cause of the pain or root canal infection.

Sometimes your dentist might advise a re-root canal or complete extraction of the tooth.

Also read:

Throbbing pain after root canal. What to expect?

what are the old root canal infection symptoms?

If not maintained properly, root canals once treated might get re-infected after some time. Re-infected root canals are difficult to treat.

The bacteria from the saliva can easily enter the sub-surface of the fillings and can further enter the root canals if they are not sealed properly. As a result, the bacteria might infect the patent canals and produce re-infection.

Here are a few symptoms by which we can identify infection in root canal-treated teeth.

1. Sudden pain several days or years after the root canal treatment.
2. Presence of a gum boil around the root canal treated teeth.
3. Pus discharge in and around the root canal treated teeth.
4. Pain while biting teeth.

Also read:

SIGNS OF INFECTION AFTER A ROOT CANAL

ROOT CANAL AFTERCARE?

Maintaining the teeth after a root canal procedure is a vital step. Many people neglect this and finally end up with re-infection or root canal failure.

Things to remember during root canal procedure.

During a root canal, do not bite hard foods with the root canal treating the tooth. It may result in a broken tooth which may lead to root canal failure.

Complete your root canal procedure in the prescribed time. Many people neglect their root canal treatment once the pain subsides. I have often seen patients skipping their 2^nd or 3^rd appointment for a root canal once the pain subsides. It is not a good practice.

A patent canal during a root canal procedure is more prone to re-infection. As a result, the treatment becomes a failure.

Things to remember after a root canal.

After a root canal, the pain usually subsides in a few days. If pain is severe consult your dentist for an opinion.

After the root canal procedure waits for one week. Check how the tooth responds to the root canal. If the post-treatment period appears to be comfortable, then consult your dentist for a crown.

Do not be in a hurry to place a crown over your root canal-treated tooth. Until your teeth are protected by a crown, it’s better not to eat hard foods with that tooth.

Any sign of severe pain, consult your dentist for an opinion. Early diagnosis can lead to a better prognosis.

Any high points in the filling or the crown should be rectified. High points can break your teeth as the teeth are more brittle after a root canal.

Have a dental check-up regularly and find out how your teeth are performing after root canal treatment.

ARE ROOT CANALS SAFE? WHAT ARE THE ROOT CANAL DANGERS?

People are often afraid of having root canal treatment out of myths that they hear from their neighbors. There are many false information websites and YouTube channels boasting about the harmful consequences of root canal treatments.

Root canals are safe. We have developed from the ages of inappropriate sterilization procedures to an era of stringent sterilization protocols and state of art treatment equipment. The present-day setups are ideal and successful in preventing infections in the root canal from outside.

The materials used in root canal treatment are developed from robust research and practice. For more information, you can read this article.

ROOT CANAL CAUSES CANCER? THE TRUTH BEHIND THE MYTH

WHAT ARE THE ALTERNATIVES TO ROOT CANAL TREATMENT?

There are several alternatives to root canal treatment. But the decision should be made by your treating dentist.

Alternative treatments might not work all the time. Here are the treatment alternatives to root canal treatment.

Direct pulp capping

Direct pulp capping is a procedure done when only the superficial area of your pulp is infected and most of the remaining pulp is healthy and vital.

Indirect pulp capping your dentist might place material over the exposed pulp. The material usually stimulates the pulp to produce a barrier layer helping to close the exposed pulp.

As a result, the exposed pulp will heal to normal & healthy pulp, while forming a barrier. The most common material used is calcium hydroxide.

On the other hand, if the pain persists or increases after direct pulp capping, your dentist might prefer to go for an immediate root canal treatment.

Pulpotomy

Pulpotomy is a similar procedure to direct pulp capping. In pulpotomy, the dentist might remove the superficial pulp which is damaged leaving the healthy and vital pulp behind.

Following it, the dentist might place a calcium hydroxide base and fill it with a temporary filling over it.

Pulpotomies are the most preferred treatments for primary teeth in children. They are rarely used in adult teeth. The treatment is mostly done in patients who want to postpone root canal treatment.

But, when the pain becomes severe, your dentist might again prefer to do an immediate root canal.

Root canal vs Extraction

I always tell my patients that extraction or pulling teeth should be their last choice of treatment. How much you pay or how well the extraction or treatment is done, we will never get the comfort of natural teeth again when once the tooth is extracted.

Hence my opinion is to save the tooth to its last resort.

An extraction can provide immediate relief from the pain, but the tooth once lost cannot be regained.

Opting for a root canal treatment is a wiser choice as the treatment cost to restore the missing teeth will be much higher compared to the cost of root canal and crown combined.

Also read:

DO I NEED A FILLING OR ROOT CANAL?

ROOT CANAL VS IMPLANT

Implants are the best teeth replacement solutions but are inferior when compared to natural teeth. The comfort produced by natural teeth is way superior to any other teeth replacement solution.

When a patient is confused about whether to go for a root canal or implant, I would prefer root canal treatment. A root canal treatment preserves the natural tooth and its comfort.

If the tooth is treatable, I would prefer root canal treatment. But in case the tooth is not treatable and should be extracted, then I would prefer implants to a dental bridge.

Implants have more advantages than bridges. In dental bridges, your dentist might reduce or reshape the adjacent teeth on either side to bear the crowns. On the other hand, implants are directly placed within the bone in the region of extracted teeth without disturbing the adjacent natural teeth.

HOW TO AVOID ROOT CANALS NATURALLY?

The best way to prevent root canal treatments is to avoid it naturally. In simple words, we should maintain healthy teeth so that there will not be any need to do root canal treatment.

Here are the 7 important steps to avoid root canals naturally.

1. Brush your teeth regularly. Brushing twice a day before and after sleep is ideal to prevent tooth caries.
2. Flossing prevents the accumulation of debris between teeth. On the other hand, they also help in maintaining healthy gums. Remember! Too much flossing is dangerous and might damage your gums.
3. Sticky foods and sugar candies during the night before bed are the worst habits that should be avoided. Sticky and sugary foods bind to your teeth and provide a good source of energy for the bacteria that were grown in your mouth.
4. A high-fiber diet helps in massaging your gums and increases the blood supply to your gums and teeth.
5. Fluoride-rich foods and drinks can prevent tooth caries.
6. Wear protective teeth guards during playing high-impact games like Rugby and Basketball.
7. Regular dental check-up helps in identifying the caries teeth early and prevent them from further damage.

Also read:

Five mistakes you commonly make during a root canal treatment