A root canal is a dental procedure to remove dead or inflamed tissue, called pulp, from inside a tooth. You may need a root canal if you have symptoms such as temperature sensitivity, pain, and swelling, which may be signs of an infection that can happen with cavities or if you have a broken or cracked tooth.
Other treatments also share the goal of treating infected or inflamed pulp, and they may be suitable alternatives to a root canal in some cases.
Dentists and endodontists, dentists specializing in tooth pulp and roots, have several options for treating tooth decay and injured or inflamed dental pulp.
Pulpotomy
Dentists or endodontists use pulpotomy mainly to treat primary teeth (baby teeth) or permanent teeth (adult teeth) that aren’t fully formed. It can sometimes stop complications like apical periodontitis, infection at the tooth root, in fully grown, permanent teeth.
Similar to a root canal, a pulpotomy involves removing pulp from inside a tooth. It’s a more conservative approach, taking out inflamed tissue and leaving your tooth’s root canal and nerve tissue. After pulp removal, the dentist applies specialized materials, such as mineral trioxide aggregate (MTA) or ferric sulfate, to support recovery.
After filling the tooth, the dentist puts a dental crown on the tooth to support it and prevent infection.
Generally, pulpotomy treats:
- Exposed healthy pulp
- More minor infection
- Reversible pulpitis (dental pulp inflammation)
Pulp Capping
Pulp capping may be indirect or direct, both designed to protect your tooth pulp.
Your dentist may use indirect pulp capping when the pulp is not exposed yet, but it’s at risk for exposure and decay. It seals the tooth.
Direct pulp capping can help treat exposed pulp due to tooth decay or damage. A dentist or endodontist directly applies materials like MTA or calcium hydroxide to form a seal over the pulp, which promotes tissue healing and prevents infection. Afterward, the dentist restores and repairs the damaged tooth.
Direct pulp capping may be useful for:
- Mild cases with only a small amount of exposed pulp
- Cases without signs of inflammation or pulp decay
- Baby teeth as well as permanent teeth
Tooth Extraction
Tooth extraction involves removing and replacing the entire damaged tooth from the gum and jawbone. It’s typically reserved for severe tooth damage and decay, when other treatments, including a root canal, aren’t likely to succeed. This treatment is generally more expensive than a root canal.
For an extraction, dentists or oral surgeons use specialized forceps to grasp and pull out the affected tooth. With more complex cases, oral surgeons may need to make incisions (cuts) in the gum to help remove the tooth.
Several options for replacing the removed tooth, including:
- Dental implant: A dental implant is a medical device that an oral surgeon attaches to the jawbone. It helps to support crowns, false teeth (dentures), or bridges.
- Bridge: A dental bridge also replaces a missing tooth. Instead of anchoring the false tooth to the underlying bone, the false tooth is connected to a crown on the neighboring tooth.
- Dentures: These are appliances you wear during the day and take out at night to replace a missing tooth or teeth. Depending on how many teeth you’re missing, you may need a complete set or an overdenture, which fits over your remaining teeth.
Apicoectomy
Commonly called root end surgery, apicoectomy is a surgery that removes infected or inflamed tissue surrounding the tooth root. Your oral surgeon reaches the area using incisions in the gums, then removes the tooth root’s apex (tip). They may use fillings to seal off the root canal, supporting tooth recovery along with stitches to promote gum healing.
Most often, apicoectomy is used in teeth already treated with root canal as an alternative to tooth extraction if you have complications, like ongoing infection.
Endodontic Surgery or Retreatment
Endodontic surgery and endodontic retreatment are needed when there are problems after a root canal. They treat complications such as:
- Inflammation at the root
- Tooth abscess
- Root canal failure
Endodontic retreatment involves removing the crown as well as the restoration from the canals. The endodontist then cleans and disinfects the tooth, seals it off, and adds a temporary filling. In a second appointment, they install a permanent crown. This is a nonsurgical procedure.
As part of retreatment, you may need endodontic surgery if the canals are abnormal or too narrow. Surgery typically involves accessing and sealing off canals through an incision in your gums.
If you have tooth pain or other symptoms, it’s important to talk to a dentist or endodontist about your options. Consider talking to them about the following:
Why is treatment important? Without treatment, tooth decay and pain may get worse, and you could lose the tooth.
How common are root canals? Root canals are one of the most common and effective dental treatments, with a success rate of 82-92.6%.
What are the side effects and complications? A root canal typically requires multiple appointments and can cause side effects like tenderness, pain, and swelling. It can also cause complications, including:
- Tooth abscess, an infection at the root of the tooth
- Pain, numbness, and tingling related to nerve damage
- Tooth fracture, cracking, or loss
- Tooth discoloration
How can you decide? If you’re concerned about root canals and curious about alternatives, it’s important to talk to your dentist or endodontist. They can talk to you about your treatment goals and help you make the choice that’s best for your case.
A root canal is a dental procedure that involves removing injured tissues inside the tooth to save the tooth. Dentists and endodontists have other options for treating tooth or pulp decay. These include pulp capping (sealing off exposed areas) and pulpotomy (removing just the affected pulp). Tooth extraction can remove the entire issue, but it’s more expensive and just as invasive.
Root canals that have failed or are causing complications may need endodontic retreatment or apicoectomy. Your dentist or endodontist can talk with you about treatment options.
