Teeth that are crowned, due to deep decay and substantial missing, natural, coronal tooth structure, may require endodontic root canal treatment after some time (variable).  As a conservative dentist interested in your overall dental health, s/he may have not recommended unnecessary treatment at the time you received your permanent (or temporary crown).  It is likely your dentist warned you of the need for possible, future root canal therapy, but as dental professionals, we cannot always predict what will happen biologically, and therefore recommend waiting and watching until noticeable symptoms arise, before pursuing definitive treatment, if former symptoms are not clear.  

Dental tooth pain related to endodontic disease may come in 2 major waves, if at all.  Most calcified teeth throughout the entire length of the root, may be asymptomatic, but present with boneloss at the end of the radiograph, warranting endodontic therapy.  Many endodontically diseased teeth with nerve damage from recurrent decay or pulp nerve exposure during caries removal, may become excrutiatingly painful for a number of days.  This pain may cause interrupted sleep on spontaneous pain, be sensitive to cold temperatures, and will require emergency endodontic treatment.  If no treatment is pursued and the nerve becomes “necrotic” or dies, the pain may temporarily subside, causing patients to assume treatment is no longer necessary.  Unfortunately, if left alone, the necrotic nerve inside your tooth will become symptomatic again after some time (variable, usually 2-3 months), sensitive to hot temperatures and biting, and will likely form an abscess or intense, painful swelling around the infected tooth root, bone and gum tissues.  Endodontic treatment would then be recommended again at that time. 

Endodontics is the branch of dental medicine that focuses on preserving your natural nerve and tooth structure.  When bacteria infect your tooth and migrate into your nerve (which is encased by your tooth enamel and dentinal tissues), symptoms may arise to temperature, pressure, biting and/or may become spontaneously painful, especially in the early morning (e.g.- 2am-4am).  The bacteria that invade the nerve inside your tooth, irritate the tooth nerve with bacterial toxins, which leach out the apex or bottom of your tooth root, into your jaw bone.  The infection is localized, and if your immune system is functioning properly, it will recognize the bacterial infection and precipitate an inflammatory response in an attempt to fight off the infection.   

The history of endodontics is interesting and useful in moving the profession forward.  In the early 1900’s, the materials available for filling root canals were limited to wood chips, bird feathers, and cork material.  Today, and since the middle of the 19th century, medical grade gutta percha (from the Tabin tree, also used in golf balls) has been a successful, biocompatible, inert non-surgical root filling material.  Though filling root canals with appropriate material is important in achieving healing, the chemical disinfection and mechanical “cleaning and shaping” of the infected tooth-root anatomy is of prime importance in maximizing healing potential.  Appropriate disinfection of infected root canals can aid in decreasing bacterial levels below disease threshold, and prevent further bacterial multiplication by sealing off and filling the cleaned internal root structures.  Generally, after endodontic therapy, a timely permanent build-up and crown (as needed) is recommended to protect the endodontically treated tooth.  Permanently restoring your endodontically treated tooth will also prevent future, new bacteria from invading the internal root cavity space again.  By following associated treatment recommendations, this will increase your chances for a successful outcome. 

I would imagine that since it is impossible for dental professionals to remove 100% of the bacteria in patients’ mouths (at least with the materials and medicaments we have available to us today), the below threshold bacteria may have multiplied to above disease causing levels, causing a persistent or reinfection of your tooth.  This situation will likely require a secondary or retreatment of your previous root canal to help preserve your natural external tooth and root structures.  

Although implants can replace missing teeth, like many medical and dental therapies, they are not fail-proof.  If your goal is to save your natural tooth, implants should be considered as a last resort treatment option, not an alternative therapy to endodontics.  Otherwise healthy, natural teeth that can be saved by endodontic root canal treatment, are recommended for preservation, in the context of full-mouth dental occlusion, function, rehabilitation and on-going oral hygiene.  There is no better tooth than your natural tooth.  Through modern endodontic therapies available today, Dr. Helen Chiao's goal is to bring your infected teeth back to health, so that you may preserve your natural dentition, long-term, when possible.  

The greatest predictor of post-treatment pain is pre-operative pain.  If you have a severe tooth infection and intense pain prior to your scheduled appointment, the likelihood of experiencing post-operative pain is greater.  If you have what is referred to as a “hot tooth” or one that is severely inflamed, this type of situation may be more challenging to numb with local anesthetics during your appointment.  Receiving regular check-ups and cleanings with your primary dentist may help minimize the chance of experiencing a “hot tooth,” though they may be unpredictable.

Generally, no, since a small hole is created to gain access into your internal tooth-root structures for disinfection.  If, however, there is recurrent decay beneath a current crown, or it has broken off, then yes, a new crown may be needed after endodontic therapy. 

Appointment times depend on endodontic treatment needs.  Generally, it takes at least 30 minutes for proper endodontic disinfection, and with additional proper cleaning and shaping, appointment times can range from 1.5-2 hours by endodontic specialists, but usually no longer than 2 hours for one-visit treatment procedures.  More complicated procedures may take longer or be broken up into 2 separate appointments.  If a retreatment endodontic procedure is required, treatments are completed in 2 visits, which range from approximately 3-4 hours, total.  Endodontic surgeries generally range from 30 minutes to 2 hours.

1 year follow-up exams are generally recommended to check the status of healing.  In some situations, especially after endodontic surgeries, a 1 week suture check and 3, 6, 9, and 12 month follow-up may be recommended to evaluate for healing.  

After endodontic therapy, you will be referred back to your restorative dentist for appropriate permanent restoration of your endodontically treated tooth.  “Liberty Endodontics” practice is limited to endodontics.  If you currently do not have a restorative dentist, we are happy to refer you to one of our exceptional dental colleagues we work closely with for restorative dental care.  Please call us to inquire. 

Regular visits to your dentist and hygienist for cleanings, exams and periodic radiographs are recommended to keep your dental oral healthcare up to speed.  The 1 year endodontic treatment follow-up is also recommended to evaluate for healing. 

Choosing the right dental healthcare provider is a personal choice and should be pursued with thoughtful consideration in who you feel comfortable with and confident in seeing for your dental diagnostic and treatment needs.  It is generally a good idea to stick with the same restorative dentist and dental hygienist, long-term, as they may be the dental professional team, who become more familiar with your comprehensive dental needs.  If you are in search of a new dentist because you recently moved to the area or your previous dentist has retired, we are happy to make a referral to one of our excellent colleagues in restorative dentistry.  We are also happy to meet referral requests for other dental specialists.