Myths about root canal treatment: Only teeth that have caused pain require endodontic therapy.

In some cases, the signal that indicates that a tooth is in need of root canal treatment is the presence of pain and/or swelling (severe, moderate or even just mild). And with these cases dental patients usually have little difficulty comprehending that endodontic therapy is needed. There can be other instances, however, where there has never been a history of a sign (at least one perceivable to the patient) that suggests that there is a problem with their tooth's nerve. And with this type of case the dental patient may have difficulty understanding why root canal treatment is required.

Root canal therapy is used as a solution for a number of different dental scenarios.

The process of root canal treatment is one where the nerve tissue space inside a tooth is cleaned, disinfected and then sealed. This treatment (the process) serves as a solution to those situations where a tooth's pulp tissue ("nerve tissue") has experience insult (of whatever type) that will eventually lead to nerve tissue degeneration and its subsequent death.

Not all types of insult or all of the stages of tooth nerve degeneration are associated with pain and/or swelling. However, teeth experiencing these events may display other types of (painless or near-painless) characteristics that can serve as an indication to the dentist that their nerve tissue does have or has experienced problems. And because these event will ultimately lead to the death of the tooth's pulp tissue (which may be associated with pain and/or swelling), no matter what stage of insult or degeneration the tooth's nerve is currently in, the dentist only has one solution to offer and that is root canal treatment.

What type of pain-free evidence might a dentist discover that indicates to them that a tooth may require root canal treatment?

There can be a number of scenarios by which a dentist might discover factors that suggest that a tooth requires endodontic therapy. Here are some of them:

» Pulp tissue exposure.

While performing dental treatment, a dentist may visualize an event that indicates to them that the tooth they are working on will require root canal therapy. During the process of drilling on a tooth, especially in the case where the tooth has a large cavity, the dentist may reach a point where enough tooth structure has been removed that they can directly visualize the tooth's nerve space. It is quite possible that the patient will be unaware that this exposure has occurred.

The dentist may visualize an empty (pulp) chamber, indicating that the tooth's nerve has already died. In other instances the dentist may visualize live pulp tissue. In this latter case the dentist may determine that the nerve tissue's exposure is significant enough that will inevitably lead to the nerve tissue's death, thus necessitating the need for root canal treatment.

» Dental radiographs (x-rays).

A x-ray examination can be one method by which a dentist discovers that a tooth requires root canal treatment. Dental x-rays are used to evaluate the hard tissues of the mouth. Those byproducts created during the degeneration of a tooth's pulp tissue can trigger a course of events that result in changes in the bone tissue that surrounds the tooth. Over time these changes can become apparent on the image of a dental x-ray.

» The presence of an individually darkened tooth.

When a tooth's nerve tissue necroses, the byproducts produced during this tissue's disintegration can penetrate into the hard tissues of a tooth (dentin and enamel) and create a staining effect. It is very common that a dentist will initially become suspicious of the vitality of an individual tooth solely because it, unlike its neighboring teeth, is slightly darker in appearance.