What Causes Root Canal Treatment to Fail and What You Can Do About It

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Root canal treatment is one of the most successful procedures in dentistry, with 90% stopping the infection of the inner tooth and the pain it causes, especially if performed by an endodontist, who has the training, techniques, and tools to do it right.

But why do a small percentage of root canal therapies fail? For one thing, everyone’s teeth are somewhat different and affected by the individual’s state of overall oral health, so some cases are much more complicated than others. For example:

An complex network that is difficult to clean. The intricacy of a patient’s root canal network makes it challenging to remove every bit of infection, even when viewed through a special high-powered microscope. Afterward, the canal is filled with a neutral material that discourages re-infection, but no procedure will ever be 100% guaranteed because a biological organ like the mouth is almost endlessly variable and complex.

The severity of the infection. If a patient has not been brushing and flossing carefully, a bacterial film will develop on the particles of food and stick around the tooth at the gum line. This soon hardens into what is called tartar, which can only be removed by a dental hygienist using special tools. Soon, an infection sets in and the gums begin to pull away, while the outer enamel of the tooth is eroded by a bacterial acid. The next layer, the dentin, can then be penetrated until the infection reaches the pulp, the core of soft tissue and nerves. That’s when it becomes painful. Eventually, it could even reach the jawbone that supports the tooth. The more severe the infection is, the harder it is to completely remove and save the tooth.

Age of the tooth. Root canal treatment has to penetrate into the inner core of the tooth and scrape out the infection, which can weaken the structure. An older patient has teeth that have experienced a lot of wear and tear and are more prone to fracture. One way to minimize this happening is to place a cap on the top, known as a crown, which will help hold a weak tooth together and also protect against further infection. Additional support can be provided by the endodontist via placement of a biocompatible metal post in the core. 

If pain continues after a root canal procedure for a few days, the gums swell around the tooth, it is sensitive when touched or when you chew on it or when it encounters cold or hot foods and beverages, set an appointment as soon as possible to come in for an examination. When you do, ask for a demonstration on exactly how to most effectively brush and floss, since it isn’t always easy and an ounce of prevention is worth a pound of necessary root canal therapy. New York City Endodontics services the areas of Manhattan, Brooklyn, Queens, Hoboken, Jersey City, Fort Lee, and more – schedule a consultation by contacting our team today.

Recognizing Signs of a Failed Root Canal

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Root canal therapy (aka “having a root canal”) is one of the most successful procedures in all of dentistry, with a 90% chance of removing the infection in the root of a tooth and preventing it from recurring. Root canal treatment, however, is very complex, though minimally invasive process, involving a microscope and tiny tools, ideally deployed by an endodontist, who has years of specialized training and experience: https://www.webmd.com/oral-health/guide/dental-root-canals

Yet once in a while retreatment might be needed for a particularly difficult case. What we think of as a tooth is just the surface enamel that shows above the gum line, which is the hardest tissue in the body and protects the vulnerable tissues inside. The next layer is dentin, which is a calcified material that, unlike enamel, can be continuously formed, but is hard enough to provide further protection for the pulp, the inner core. This consists of soft connective tissue, nerves, and blood vessels, which can become infected. This is what causes pain–not the root canal procedure, contrary to the common saying. Treatment eliminates the cause and the canal is filled with a neutral material and sealed to keep it from being infected again.

After a root canal procedure you should, of course, continue brushing for two minutes after breakfast and dinner and flossing before bedtime, to keep your oral health in excellent condition. This will reduce your risk for cardiovascular disease, diabetes, and even cancer.

However, there are many reasons why a root canal therapy might fail. A crown, the tooth-like top that may be placed to protect a tooth that has been fractured or ground down, could become cracked again and result in bacteria seeping into the pulp. Canals are very complicated systems, narrow and curved, and very challenging to thoroughly clean, with cracks that might not show on x-rays and could harbor bacteria. Occasionally, a seal breaks and exposes the core. 

The symptoms of a failed root canal treatment, which might occur weeks or years later, include:

  • A cleaned root canal should heal in a few days, but if severe pain continues in that tooth, call for an immediate appointment.
  • Swelling of the gums around the treated tooth.
  • A discharge around the tooth due to an abscess forming.
  • Increased sensitivity of the tooth to touch, chewing, just pressure when you close your mouth, or hot or cold foods and beverages.
  • A boil or pimple on the gums in that area that does not go away quickly.
  • Darkening root.

Serving the areas of Manhattan, Brooklyn, Hoboken, Jersey City, and Fort Lee, New York City Endodontics can help assess your individual case and determine the best course of treatment. Call us today to schedule an appointment.

Dental Pulp: What is it and Why is it Important?

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Most people think of their teeth as hard pieces of bone-like material that enable anyone in good oral health to chew effectively, cutting and grinding different types of food. Those who have lost teeth know that they also have a function in pronouncing words clearly–and wearing dentures does not entirely solve that challenge.

Many will be surprised to know that teeth are much more complicated than they appear. Wikipedia needs 19 pages to summarize their structural complexity  and why dentistry is such a challenging medical specialty to keep them and their supporting tissues and bone healthy.

There are four types of permanent teeth, which usually erupt from age six months to two years: incisors that cut food, canines that tear it, and molars and premolars that crush. Their roots are embedded in the jawbone and the teeth remain firm and upright, supported by the gums, if oral health is maintained. An endodontist is a highly-trained specialist in addressing infections inside those roots, which can not only cause pain, but lead to the death of the tooth and the need to remove it.

But let’s dig in deeper and share what very few patients know about their teeth, so you can understand why we need to take great care of them. What we see as a teeth is the hard outside surface called the enamel, a highly-mineralized tissue that protects the innermost tissue, the pulp.

The next layer is the dentin, a yellowish porous tissue that is made up of 70% inorganic substances, 20% organic, and 10% water. It is softer than enamel and more at risk of developing cavities, but it provides further protection of the vulnerable pulp and support for the crown (top) of the tooth, which is enamel. 

Another layer covering the roots is called cementum, which is a permeable combination of inorganic material, water, and a protein called collagen (which has been getting a lot of attention for its role in maintaining healthy bones, nails, skin, and hair). Cementum’s role is to enable periodontal ligaments to attach to teeth to give them stability.

That brings us to the pulp, the soft connective tissue at the core of a tooth that contains blood vessels and nerves, which enter the roots from a hole at the bottom of each. If a tooth is cracked from an injury, dental decay reaches the root, or extensive dental procedures cause bacteria to infect the pulp, we will use special equipment and tools to thoroughly clean it out and fill it with material that will help prevent further problems. Often, a crown made of tooth-like porcelain or other material will be placed on top to protect the root. Root canal therapy is 90% successful, making it one of the most successful procedures in dentistry.

Symptoms that the pulp has become inflamed may be sensitivity to hot or cold beverages or food, pain when chewing, and swelling or redness of the gums around that tooth. Fortunately, we can stop the pain and further damage that could lead to the tooth being lost if you come into our office as soon as possible. NYC Endodontics services the areas of Queens, Manhattan, Brooklyn, Jersey City, Hoboken, and Fort Lee. We look forward to seeing you soon.

Your To-Do List Before Your Endodontics Appointment

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Many people have the wrong impression about what having root canal surgery is: it is commonly mentioned in association with something giving extreme pain, such as, “I’d rather have a root canal than do that.” The truth is, a root canal procedure cleans out the infected canal of a tooth’s root and it actually stops the pain. Any fear or problems can be avoided by creating a to-do list for your endodontic appointments:

°For your first appointment, you may be referred by a general dentist, since this is a therapy that should be done by a specialist, an endodontist. But if you are unsure about the diagnosis, check out the symptoms of an infected root canal https://www.nycendodontics.com/root-canal/, which can include sensitivity to cold or hot temperatures, a severe toothache, pain on the tooth when chewing, discoloration of the tooth, or tenderness in the gums around the tooth. Surgery might also be needed if a tooth has been fractured or the root’s nerve is dead. Be sure to bring an x-ray of the area from your dentist, otherwise we will have one when you arrive (digital x-rays involve very little radiation.

°Once the treatment appointment is made, consider whether to take the day off. Since only a local anesthetic is used and you will have pain-reducing medication (or just a double-dose of ibuprofen) prescribed afterwards, you do not need to have someone drive you or take public transportation. You can even go to work. However, you will need to bite down on gauze for at least an hour and use a cold compress (or bag of ice, frozen veggies, or cold washcloth) for five minutes every 15 minutes for at least an hour to reduce swelling. You should plan to eat just soft foods and avoid chewing on the side where the root canal was done for a couple of days (and do not smoke or use your mouth vigorously).

°If you have certain types of systematic health issues, your may need to take antibiotics in advance to avoid having oral bacteria enter the bloodstream. Discuss your full medical history at your diagnostic appointment. Do not take any pain medication in advance of treatment. Do keep taking your normal medications, such as for high blood pressure, thyroid, and diabetes.

°Be sure to eat a full, healthy breakfast or lunch in advance, as appropriate. Do not fast. You need the protein and complex carbohydrates to heal and these may help offset any negative effects of surgery.

Most important, be prepared to be pain-free again!

How do Teeth Become Sensitive?

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If you frequently have pain or discomfort in your teeth when you eat or drink, you share this experience with 40 million other Americans. Fortunately, it is something that can be avoided or treated.

This often occurs just because of using a toothbrush that has bristles that are too stiff or from brushing too hard. Try one that is labeled soft or medium. Some toothpastes have irritating ingredients (such as charcoal or abrasives for an aggressive clean). Switch to one that states that it is made especially for those with sensitivity (the formula may also include some desensitizing agents).

Teeth can also become sensitive when the gums become inflamed from inadequate or improper brushing and flossing habits, which leads  to gum recession and that exposes the nerves of the roots.

If you develop cavities, these can be sensitive to the touch of anything, including foods or toothbrushes. You should seek early treatment to keep them from becoming larger and more painful.

There are many foods and drinks that are too cold or too hot, or they have ingredients, such as acids or sugars, which irritate the nerves of any teeth that are exposed. Prime offenders are ice cream, coffee, tea, sodas, sticky candy, tomatoes, and citrus fruits such as pineapple, grapefruit, lemons and limes. Hard candy can chip teeth, exposing their sensitive inner tissues. If you can tolerate ice in drinks, just don’t chew on it.

Drinks with high alcohol content can dry the mouth, which encourages bacteria to breed (more saliva fights bacteria).  If they have a high sugar content, this also allows bacteria to flourish. The better options would be light beer, gin and tonic, and brut champagne. Alternating drinking alcohol or soda with water will help limit the negative effects.

The protective outer surface of the tooth, the enamel, can also be worn away not only by acidic foods and beverages and harsh brushing, but acid reflux. There are many over-the-counter remedies to stop it and digestive aids that can help prevent this.

If you find yourself tensing your jaw during the day, you may be grinding your teeth at night. This is known as bruxism, which results in the protective surface being reduced.  The damaged teeth can be treated with onlays (like big fillings) or protective crowns for any that need more coverage. We can also create a customized night guard, similar to a sports mouth guard, that you will wear comfortably at night to prevent further damage.  

Set an appointment today with NYC Endodontics, serving the Manhattan, New York City, Brooklyn, Queens, Hoboken, and Jersey City areas, for an examination of the health of your teeth and how we can help you decrease any sensitivity.

Questions to Ask Before Getting a Root Canal

Questions to Ask Before Getting a Root Canal

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“I’d rather have a root canal!” is meant to be a joke referring to what is supposed to be the ultimate type of pain. A root canal (aka root canal therapy) is performed to alleviate an infection of a tooth’s root, which itself is painful. But the therapy relieves the pain, it doesn’t cause it. Since there are so many misconceptions about the procedure, we want to provide answers to common questions about endodontics, the science of treating an infected root canal:

Why does root canal pain hurt so much?

The hard outer surface of a tooth is called the enamel. Just underneath it, the bone-like dentin surrounds and protects the tooth. At its core is the pulp, which consists of nerves, blood vessels, and soft connective tissue. If a tooth is cracked (such as due a sports injury), if tooth decay has gone untreated, or if a patient has had extensive dental procedures (even orthodontics), bacteria from the mouth might leak into a tooth’s pulp. Once it becomes infected, the tooth will become increasingly painful until treated. Other symptoms can include a tooth’s sensitivity to hot or cold beverages or food, pain while chewing or just putting pressure on the tooth, darkening of the appearance of the tooth, and swelling or redness of the gums in that area.

Will having root canal therapy itself be painful?

 A virtually pain-free local injection of an anesthetic assures that you will not feel pain during the root canal procedure itself. The discomfort will be no more than having a filling done. The endodontist, a specialist in doing root canal therapy, is highly trained and experienced and will use tiny instruments and special equipment to clean out the infection thoroughly, then fill the canal with a special material that will prevent future problems. You will be given a prescription for pain-reducing medication afterwards and instructed on how to use cold packs. 

How successful is having a root canal procedure?

About 90% of root canal therapies stop the pain and infection, making it one of dentistry’s most successful procedures. However, the inside of the tooth is very complex and should be operated on only under a microscope. That is why it is important to have this therapy done by an endodontist, who has the equipment, tools, training, and experience to make it most likely to be successful. Occasionally, however, problems may develop. If you still have pain in the tooth after the third day, call our office to set an appointment for a reexamination.

root canal helps preserve teeth

Root Canals are Valuable for Preserving Teeth

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The team at New York City Endodontics places the utmost pride in offering valuable, long-lasting care for patients. Treating dental conditions and preserving teeth are among our primary goals. As part of our core specialties, root canal is one of the most important solutions you have to preserve and maintain healthy teeth.

Located underneath the outermost tooth layer is the dental pulp. If decay or injury affects a tooth, then bacteria can enter and infect the dental pulp. You may experience symptoms such as toothaches when this occurs. If these symptoms occur, then it is important to contact our office immediately. We can promptly and accurately examine your teeth, gums and their supporting bone structure to determine if a root canal is needed.

Root canal can help treat a dental infection and alleviate any effects to your oral health. Through a root canal procedure, you will be informed throughout the process. After the procedure, it is recommended to place a dental crown over your treated tooth to protect it and to restore function and appearance. A root canal can be valuable for helping you preserve your teeth over your lifetime.

Whether you need a root canal or any kind of endodontics service in New York, Manhattan, Jersey City, Hoboken, Brooklyn, or Queens, it’s important to find a team who can complement your goals and meet your specific needs. At New York City Endodontics, we provide the highest quality care and make it easier for you to keep your teeth healthy and preserved. Contact us today to schedule an appointment.

gum disease hoboken

Is Gum Disease a Result of Genetics?

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There are instances where patients are more vulnerable to gum disease than others. In several more cases, patients may cite their family history as a possible reason for developing gum disease or periodontal problems. Some studies may indicate this correlation, but it is important to note that your family history does not mean that you are destined to develop oral health problems or gum disease in the future. There are a number of other factors that play a role in gum disease.

What Other Factors Cause Gum Disease?

Insufficient Oral Hygiene: This is the most common cause of periodontal disease. inadequate brushing and flossing habits can allow plaque to develop on the teeth and harden. This causes the gum tissue to become infected, which contributes to other oral health conditions.

Tobacco Products: Smoking increases your risk of disease and also makes successful treatment more difficult.

Diabetes: If diabetes continues to progress and develop, you may be more susceptible to infections of the gums and bones.

Dry Mouth: A dry mouth allows bacteria to grow, which can lead to the development of periodontal disease and other conditions.

How Can I Prevent Periodontal Disease?

Regular daily brushing: Removing food debris and plaque is important for reducing the chances of gum disease. In addition, flossing each day can help remove the plaque that appears along the gumline that most toothbrushes cannot reach.

Regular mouthwash: Use a mouth rinse each day to clean out any remaining food particles and eliminate bacteria in your mouth. helps to wash away remaining food particles and kill bacteria in the mouth.

If gum disease is prevalent in your family history and you have questions about whether you might be affected by this condition, contact your dentist or endodontist today. A root canal can also be a solution to treat teeth affected by a disease.

Bacteria on Your Teeth and What to Pay Attention To

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It may be hard to believe, but there are more than 700 types of bacteria in your mouth. Fortunately, most are not only harmless, they can be beneficial to the health of your entire body.

But the harmful ones can cause you a lot of dental pain and other problems. Simple carbohydrates like sugar and sticky foods (candy, cookies, crackers, chips, dried fruit, etc.), as well as sodas, are often left on the teeth. Bacteria thrive in this environment and create a sticky, clear film on teeth called plaque around the gum line. If not cleaned off, this will cause an infection that is not initially painful. Meantime, it also hardens into a yellow substance called tartar on the surfaces of the teeth, which could lead to cavities.

The gum infection is not painful at first, but you will soon notice that your gums easily bleed when you brush. This inflammation can reach the root of a tooth and if it dies, this will result in a throbbing pain that gets worse when you chew and tenderness around the area. You may also experience sensitivity to hot or cold foods and beverages, darkening of the tooth, swelling in your cheek, and chronic bad breath. If you have any of these symptoms, have your general dentist diagnose the problem immediately and if he suspects a root canal is needed to save the tooth, you will be referred to NYC Endodontics.

Prevention of periodontal infection is best, of course. It would lower the risk to snack instead on fruit, raw vegetables, cheese, or plain yogurt and to eat a balanced diet. However, if teeth are not brushed after eating any foods right after breakfast and before going to bed (flossing then, as well), plaque will develop. It’s not always easy to do this process right.

WedMD advises holding the brush (preferably an electric one) at a 45-degree angle to the gum line and moving it across the teeth with a circular motion, without pressing too hard: https://www.webmd.com/oral-health/guide/teeth-gum-care#1. Move the floss up and down against the teeth and around the gum line (we can show you how). This should be followed by an antibacterial mouthwash.

But if your best efforts sometimes are not enough, our endodontics team can get you back to good oral health in partnership with your general dentist.

The Root Canal Experience in Detail

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Don’t believe the stereotype of popular culture that refers to a “root canal” like it’s the ultimate painful experience. Performed by a specialist, it is just the opposite, a painless way to end dental pain.

A painful tooth could start with a cavity, but it could also be due to an accident, infection, or dead tooth nerve. Signs of deeper trouble in the root might include the sensitivity of the tooth to hot or cold, a persistent toothache, pain when you chew on the tooth, or tenderness of the gums around it. Your general dentist will usually do the initial diagnosis of the problem and if it appears to be infection inside the tooth, she or he should refer you to an endodontist (a mouthful that means a highly-trained expert in going to the root of the pain).

The outer shell of a tooth is the hard enamel, all we can see. But underneath is the dentin, which surrounds and protects an inner layer of soft tissue known as the pulp, which consists of blood vessels, nerves, and connective tissue. The pulp provides nourishment through its canals or roots to the tooth while it is growing, but these hollow channels can get infected when they longer have that function.

Step 1: The area receives a topical anesthetic to make it numb enough so that you will not feel the anesthetic injection that follows (there is also the option of breathing nitrous oxide to help relax).

Step 2: A dental “dam” (a thin sheet of rubber or vinyl) is placed over the area to keep it sterile, with the infected tooth poking through.

Step 3:A small hole is drilled into the tooth, to provide access to the pulp and root canals for treatment.

Step 4: Special instruments are used to remove the dead or dying pulp, stopping the pain.

Step 5: The canals are disinfected with special solutions.

Step 6: They are then shaped so that they can be filled with materials to prevent future infection.

Step 7: A plastic material usually is used to fill the space. If the tooth structure seems weak, a post may be placed inside, as well. The canal is then sealed.

Step 8: The access hole that was drilled is filled and the dental dam removed.

Step 9: An antibiotic will be prescribed. If over-the-counter medications for the usual mild soreness do not seem adequate, a codeine-type drug might be prescribed, as well.

Final Optional Step: A crown, which looks like an artificial tooth, may later be placed on top of the natural tooth to protect it and restore functionality.

 If you are in serious tooth pain call today to have its root cause diagnosed and treated.

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