by Jeff Vidrine

Created on: July 02, 2008

Getting a root canal? You must be kidding! Seriously, root canal treatment was one of the major advances in dentistry in the mid-20th century. It is responsible for saving untold numbers of teeth that otherwise would have been removed.

What You Need To Know:

There are three major reasons to need root canal therapy:
1. Tooth decay (a cavity) that extends into or close to the pulp (or "nerve") of the tooth.

2. Severe periodontal disesase (gum disease with loss of the bone that supports the tooth) that allows bacteria and their by-products (called exotoxins) to enter the tooth through microscopic openings in the exposed root surface.

3. Trauma that damages the blood vessels that enter at the tip end of the root (called the apex).

4. Your dentist has a college-age son and tuition is due. (Wait a minute, that's four reasons.)

What Is the Pulp?

The pulp, which is the official term for the nerve of your tooth, is much more than nerve tissue. It is soft tissue that initially had the job of producing dentin, the inner portion of tooth structure. In other words, it makes the root portion of your tooth.

As the root forms, the pulp, with nerve, blood vessel, and connective tissues, is surrounded by hard dentin which results in a space inside the root. This space which contains the pulp is called the root canal space and gets its blood and nerve supply through a microscopic opening at the root end.

What Happens to the Pulp?

When something causes an injury to the pulp, like bacteria from decay or gum disease, an inflammatory response occurs within the pulp. Did you ever get a splinter in your hand and had the area get red and painful? That is inflammation and it happens inside your tooth to the pulp. Sometimes the inflammation is reversible, that is, it heals. This is why a new filling might be sensitive at first but feels normal as the pulp heals.

Some pulp injuries don't heal and are irreversible. The pulp tissue actually dies (the official word is necrosis). As the cells die, the toxic by-products of cell death can leak out of the small opening at the end of the root causing inflammation of the area around the root end. Many patients find the tooth painful to chewing or biting at this stage.

If allowed to continue, the inflammation outside the root end begins to destroy the bone at the end of the root. At this point, changes are visible to your dentist on an x-ray. This process, as it continues, can destroy enough bone to make an opening through the gum at the end of the root. Or

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