The most inner part of a tooth is the pulp (also known as the "nerve"). In a normal, healthy tooth, the pulp is living, healthy tissue, just as it is in any other part of your body. If a tooth is traumatized, the pulp can degenerate, become infected or actually die. Sometimes there is pain associated with this decomposition, but sometimes it is not significant enough to cause the patient to seek dental evaluation. Dead tissue decomposes, and when this happens inside the tooth, the decomposed remains (decomposition by-products) leak out the tip of the roots into the jawbone. To illustrate this process, leave a piece of hamburger out for a few days and you will observe what I mean by decomposed. This drainage of decomposed remains (by-products) from the inside of the tooth to the jaw creates an infection (abscess) that cannot be resolved with antibiotics. In order to eliminate the infection, the decomposed remains (which are the source of the infection) must be removed from inside the tooth, and the space which the nerve once occupied must be filled with a sterile material. A seal at the tip of the tooth is required to prevent leakage of bodily fluids into the tooth, which can perpetuate the original abscess. This treatment is referred to as endodontics (endo= inside & dont = tooth) or more commonly known as Root Canal Treatment (RCT). Teeth can have one or more roots, each with a tract of pulp (root canal) and each root can have one or more openings at the tip.

     There is one other indication for root canal treatment. Some teeth are so mechanically weak from decay or cracks that in order to build a strong crown we must use a post, or countersunk buildup, anchored down into the roots to provide stability between the root and the man-made crown. These anchoring procedures require that a root canal treatment be done first.

     Root canal treatment is actually a complicated process which is performed by both general dentists and specialists (endodontists). All dentists are taught to do root canal treatment in dental school, but because of the potential complexity, some general dentists refer some or all of the root canal procedures in their practices to the specialists. In the hands of a skilled general dentist, many root canal procedures can be completed with the same results one would expect from a specialist. But everyone's skill level (including a specialist's) varies, so this is a consideration. Not all teeth can be successfully treated with root canal therapy. There are several complications that can make success unlikely or questionable and these are covered in the Appendix.

     The Biggest Secret Truth in RCT is that, in some offices, the canals are not cleaned and filled all the way to the tip (underfill) on a regular basis. Oddly, twenty years ago dental schools were teaching to underfill root canals by 0.5 - 1.0 mm. It was taught that if the root canal filling extended beyond the tip of the root (i.e. if some filling material extruded out the root tip) that the world would come to a screeching halt… and the canal would fail. The current thinking is that it is not correct to leave this terminal segment untreated and that small overfills are not problematic, and are in fact, preferable. In fact, an overfill is the only accurate way to know that the canal is truly completely filled because on an x-ray you can see a small overfill, but you can't see a small underfill! The success rate of RCT is dependent upon the skill of the practitioner, and this can be easily illustrated by the fact that some offices have very high long term success rates and others have very poor rates. But root canal treatment brings in revenue, so sometimes they are done for BUSINESS reasons regardless of the skill level of the practitioner.

     When you are deciding whether to have your general dentist do your root canals or go to a specialist, there are several questions you should ask:

1. What is the approximate success rate both long and short term for that doctor?

2. Are overfills common? This is a trick question because the answer you are looking for is that "we strive for small overfills."

3. What are the office policies in the event that a failure or complication arises?

     This should be asked even of a specialist, as some specialists don't resolve their own failed cases, but instead ...

(Much more information provided on this topic in the complete book!)