Root canal treatment / Endodontic therapy:
When might root canal treatment be required?

It will take an examination by your dentist to determine if root canal treatment is indicated for your tooth. Not only must your dentist determine if the treatment can be an appropriate solution for your situation but also that the overall condition of the tooth in question warrants the time and expense involved.

Here are some symptoms that suggest that root canal therapy might be required:

• A tooth is currently causing you pain or else has a history of being painful.
  
  
• You have noticed the presence of gum tenderness and/or swelling in an area adjacent to a tooth.

Not all of the teeth that are in need of root canal therapy will have produced readily observable symptoms (no swelling or pain has been experienced).

A) Problem teeth identified by x-rays.

The death of a tooth's nerve is not always a painful experience. The nerve tissue inside a tooth can degenerate and become necrotic without producing overt symptoms.

In these instances a tooth's need for root canal treatment can remain undiscovered, even for some years. This is because the virulence of the infection inside the tooth is low and your body's defensive mechanisms, while not being able to clear up the infection totally, are able to keep it in check.

Dentists often discover teeth that need root canal treatment during routine x-ray evaluations. In the most obvious of these cases the dental x-ray will show a dark spot at the tip of the tooth's root. This dark spot indicates that there has been a reduction in the density of the bone surrounding the root's tip. This bone damage is a result of components of the infection harbored inside the tooth leaking out and your body's response to them.

B) A persistent or recurring pimple on your gums.

Sometimes a tooth whose nerve has died will produce a pimple like lesion on a person's gums. The presence and/or size of these pimples (dentists call them fistulous tracts) can come and go. Because they are literally drains for pus from an infected tooth, a person might notice that they discharge a bad taste (the pus). It is possible that a dentist will discover this type of lesion while performing a routine examination, even though the patient hasn't noticed it at all.

C) Exposure of a tooth's nerve.

There can be times when your dentist will find that your needed dental work has resulted in the exposure of your tooth's nerve. The term "exposure" used here simply means that your dentist, while performing your dental work, has literally been able to visualize your tooth's nerve tissue. Sometimes a patient will feel a little prick of pain when the exposure occurs. However, many times a patient is totally unaware of the event.

An exposure can lead to the degeneration of a tooth's nerve tissue. Your dentist may determine that in your situation it is best to go ahead and perform root canal treatment on the tooth now so to avoid possible problems and complications with the tooth later (such as a painful tooth abscess).

D) Teeth which have been traumatized in an accident.

The nerve tissue in teeth which have a history of having been traumatized (such as being bumped in an accident) can deteriorate, thus leading to the need for root canal treatment.

Immediately after the traumatic event the outlook for the nerve's health can be difficult to predict. Sometimes traumatized teeth do quite well, even for many years.

It is always possible however that at some point the health of the tooth's nerve tissue will degenerate and subsequently die (often without symptoms). A tip off that the nerve tissue inside a tooth is undergoing degenerative changes is that the tooth, in comparison to its neighbors, appears darkened.