The most common type of endodontic treatment is root canal treatment. It is a procedure in which access to the hollow interior of the tooth (pulp) is made, in order to remove inflamed, infected or necrotic (non-living) nerve and blood vessel tissue. The root canals are disinfected, enlarged and hermetically sealed to the root tips with a rubbery filling material. Finally, the access hole into the tooth is filled with any of the available filling materials like silver amalgam, composite resin, porcelain or gold (usually at a separate appointment).
Your dentist may recommend that the tooth be crowned following endodontic treatment, especially if it has multiple cusps or multiple roots, and is structurally compromised. Normally the front six teeth in both jaws only have single roots, and many times those teeth don’t need to be crowned after endodontic treatment.
Endodontic treatment is prescribed for teeth that have been diagnosed with an abscess, irreversible pulpitis, chronic apical periodontitis, inflammatory resorption or are necrotic (filled with non-living blood vessel and nerve tissue). Endodontic treatment is also prescribed if the clinical crown of the tooth (the part that is visible protruding through the gum tissues) is badly broken down and would require structural posts to be placed in order to restore the tooth to normal function.
Sometimes a tooth that requires endodontic treatment will be obvious from an X-ray image, if there are obvious changes in the bone near the root tip(s)—even in the absence of symptoms. Sometimes teeth with deep decay (caries) require root canal treatment even though they may not hurt or be sensitive. A tooth that is particularly sensitive to hot temperatures, but is relieved by cold likely has gas from bacteria inside of it, most likely from an infection. Heating the tooth heats the gas, which, constrained by the hard shell of the tooth around it, cannot expand.
The result is that the pressure in the tooth increases and puts pressure on the nerve that you feel as pain. Teeth with such symptoms typically require root canal treatment to eliminate the infection. Teeth that produce continuous dull, achy pain frequently require root canal treatment. Teeth that have a prolonged, aggravated pain response to cold may need root canal treatment.
If you have been taking bisphosphonate medications, and require a tooth to be removed, you may not be a candidate for tooth removal without suspending the medication for a period of time in advance of treatment. In such cases, your dentist may recommend endodontic treatment of the tooth as an option, if it requires immediate treatment.