Preparing for a Root Canal: Know Before You Go (Part 1)

If you’ve been told you need a root canal or are scheduled for one soon, you’re in the right place. This is your guide to everything you should know before getting a root canal.

What is a root canal?

A root canal is a procedure to preserve (not save) a dead tooth.

We say “preserve” and not “save” because it’s like mummification. It’s taking a dead pharaoh and stuffing him — it’s not saving the pharaoh’s life.

By the time you need a root canal, it’s too late to save the life of the tooth because it’s already infected and dying.

Why mummify a dead tooth? You do this because you want to keep the tooth in your mouth. It’s a dead tooth that’s mummified.

Why not pull the dead tooth out? Well, you can, and then you would have to replace the dead tooth with an implant to fill the hole left behind in your jaw along with a new, artificial tooth — and actually, the new school of thought is that going straight to an implant is the right thing to do.

The main reason for getting a root canal instead of an implant is that it’s simpler to keep your old tooth, even though it’s dead, because you can still benefit from having the structure of the dead tooth to chew food and help you speak properly.

Ever seen a movie where someone’s leg gets infected and it has to be cut off? A root canal is like that — you have to cut out the infected tissue inside the tooth to prevent infecting the rest of your body and killing you.

But there are consequences. Having a root canal done makes the tooth brittle and prone to fracture — think of the mummified pharaoh. The inside of the tooth has been scraped out, leaving the outer shell of the tooth dry, brittle, and prone to breakage.

That’s why a root canal procedure requires a second procedure shortly afterwards: A crown.

A root canaled tooth needs protection because you’ve carved out the tissue inside it. Enter: the crown, which is a rigid covering that is stronger than enamel that preserves the structural integrity of the tooth and prevents it from breaking.

What are the pros and cons of a root canal?

Root Canal Pros:

You don’t have to extract the tooth.

You can keep the tooth.

You don’t lose the bone around the tooth.

Root Canal Cons:

There’s no such thing as a 100% clean root canal.

It can be hard to sit with your mouth open for a few hours during the procedure.

What is the procedure like?

You’ll sit in the chair for a few hours with your mouth open the entire time — this part is tough for most people. Load up your phone with a great audiobook or an addicting podcast to distract yourself.

During the procedure, your dentist will remove the inflamed or infected pulp, carefully cleaning out and shaping the inside of the tooth, and then filling and sealing the space so it’s closed off to infection.

After that, you’ll need to come back to the dentist to get a crown placed on the tooth to protect it so that you can once again chew on it and use it like the rest of your teeth.

After that, your tooth will function just like any other tooth would — you’ll be able to bite on it, chew on it and use it normally.

What to ask before agreeing to treatment

  • Is a root canal absolutely necessary?
  • Is it possible the tooth will recover and not need the root canal?
  • Why did the pulp die?
  • What are my options?
  • What if I don’t do the root canal?
  • Should I skip the root canal and go right to the implant?
  • Will my infection spread to other teeth or to my bone?
  • How predictable is the treatment?
  • And perhaps most important: Should I have this done by a specialist or can you do as good of a job as a specialist can?

How does my dentist know I need a root canal?

For other conditions, a doctor can give you a blood test and the results will come back either positive or negative. It’s not so cut and dried with root canals. Diagnosing whether you need a root canal does have a scientific basis but it can be a bit of an art form to find out how diseased the pulp of the tooth is.

This is why you really need someone who is experienced. A practitioner who rushes this process could choose the wrong treatment of the tooth.

To diagnose whether or not you need a root canal, your dentist will need to determine if the pulp inside the tooth is dead or dying or if it’s possible that the pulp could recover.

Data points your dentist uses to decide if you need a root canal

Lingering pain: Your dentist will ask you about how your tooth responds to hot and cold. When you drink cold water, does your tooth get sensitive? How long does the pain last? This is a way of figuring out if you have “lingering” or “non-lingering” pain. “Lingering” means the pain sticks around. Non-lingering pain goes away. If the pain goes away, the pulp inside your tooth might be alive enough to recover from the hot and cold, indicating that the tissue could potentially recover. If you drink cold water and you’re sensitive for the next hour or more, that’s “lingering” pulpitis (infection of the pulp) which means your tooth isn’t recovering and the nerve is likely dead.

Positional pain: Does your pain get worse when you lie down or stand up suddenly or run in place? This can be the sign of an abscess and, likely, a dead tooth.

Spontaneous pain: If pain is brought on by a stimulus like a hot or cold drink, it’s possible that the pulpitis is reversible, but if you’re sitting there doing nothing and get a wave of pain, that’s probably a dead tooth.

Fistula on the gum: A fistula is a little white, yellow, or red pimple-looking thing that shows up your gum. What this tells your dentist is that there is an infection because there is pus, blood, and infectious materials trying to get out and the body is trying to vent it. The problem is that it doesn’t always go alongside the tooth that is infected — a fistula can mislead the dentist as to which tooth it is.

Abscess: An abscess is typically seen on an x-ray. It is essentially a hole in the jawbone that shows up as a dark spot on the x-ray because the bone doesn’t want to grow in that area. Bone won’t grow in the area around an infection and an infection typically comes from the tip of the root, which is where everything is spilling out from the dead tissue inside of the tooth.

Referred pain: I weigh this one heavily. If the pain is not only in your tooth but also referring to another part of the body, like your jaw, ear, or surrounding teeth, this could mean you have an abscess. What I try to do is ask my patients in such a way that they don’t know what I’m asking so that I get the right answer.

How long can I wait before I get my root canal done?

Once you find out you need a root canal, it’s like a ticking time bomb, because the infection will eventually blow up. You’ll get more pressure and more swelling if you wait. You might get a bad taste in your mouth or might start to go numb. The infection could spread to more vulnerable tissues, like your heart. This is why people used to die of tooth infections hundreds of years ago.

Your dentist will prescribe you antibiotics for the infection. Once you start taking antibiotics, you’ve bought yourself four or five weeks. If you get on the antibiotics before the root canal is done, you’ll have less pain during the procedure because this will make it easier to get you numb.

As soon as you find out you need a root canal, you need antibiotics right away. Don’t delay! It could turn into a life-threatening condition if you don’t. Yes, a tooth infection can kill you!

Should I get a root canal or an implant?

A big question now in dentistry is: do you go right to the implant because it’s more predictable than a root canal?

To make this decision, you need to ask your dentist about the predictability of success of a root canal. This is something that you and your dentist have to decide together, after you consider all the options for your unique case. If you talk to an endodontist, she will want to do the root canal. If you talk to the oral surgeon, she will want to do the implant.

Also consider that if you talk to an endodontist, she will recommend doing the root canal. If you talk to an oral surgeon, she will recommend doing an implant. All healthcare professionals tend to recommend things that we know more about and are more skilled in or comfortable with. Always keep in mind this inherent bias.

Root canals are never “100% clean”

Essentially, the concept of a root canal is this: inside of this enclosed space inside the tooth, there’s a lot of infected tissue with bad bugs. It’s up to the dentist to go in and remove 100% of that infected tissue. The cartoon above is simplified to show just one canal, but in real life, a root has several canals that all twist and turn, making it impossible to remove perfectly 100% of this infected tissue.

After the infected tissue is removed, your dentist has to seal it off to make sure no bacteria can get back in there. There is no way to make a perfect seal because there are so many accessory canals, which are canals running off the main canal. (Imagine a vein in a leaf, with lots of little “accessory” veins running off of the main vein.)

Given these two points, they say a root canal is 95% effective, which I would say is optimistic.

People that are proponents of implants see this as a con for root canals because, with an implant, you’ve removed the source of the infection completely — there are no sealing or removal issues and you’re placing something sterile into the jawbone.

This is why, if you decide to get a root canal, it’s essential your dentist is very skilled, because the procedure is so technique-sensitive, and that your dentist has assessed there’s a good chance of success of the root canal. You want someone who’s a perfectionist. I have an all-or-none philosophy when it comes to root canals; either you get everything and you really clean it out, or don’t bother and go with the implant.

A word on DUI (deciding under the influence)

A lot of the time, people are in a lot of pain when they have to make the decision about whether to get a root canal. When you’re in pain and you’re desperate, I call this making decisions under the influence of pain. You’ll do anything to get rid of that pain.

Here’s where it’s important to still be wary. Make sure your dentist has your best interest at heart and is helping you make the right decision, instead of taking advantage of the state of pain you’re in.