Frequently Asked Questions
A root canal is a treatment process where the center of the root of a tooth containing the pulp tissue is cleaned and shaped to a larger diameter and that space is filled with gutta percha which is a rubber-like seal. A simple analogy would be comparing the process to removing the center lead out of a pencil and replacing the center space with a filling material. The root(s) of a tooth is not actually removed, that would be when a tooth is “pulled” or extracted.
View a short, step-by-step video here.
Usually when the pulp of the tooth is too inflamed, infected or necrotic (“dead”), placing a new filling or crown on the tooth will not change anything. The root canal process removes the inflamed, infected or necrotic pulp within the center of the root and when filled internally with gutta percha and a sealer, the tooth and the injured bone around the tooth’s root will heal and become comfortable again. At this point any needed filling material or crowns can be placed successfully.
A root canal will actually relieve your tooth pain. Modern local anesthetics and with an Endodontist’s advanced training in local anesthetic techniques will make your treatment experience pain free. It is the policy of our office that we never proceed forward with treatment until your tooth is completely numb. Often an antibiotic and/or anti-inflammatory medications are prescribed in advance of treatment to prepare the local environment of the tooth and surrounding tissues for the procedure. These medicines will calm the tooth down prior to treatment so that the local anesthetics work better and profound anesthesia can be attained.
It’s often that the issue with a patient’s tooth is that getting them numb and pain free is not the only problem. Fear and anxiety of the procedure can be often overwhelming to a patient due to a previous bad dental or life experience. Claustrophobia, a bad gag reflex, emotional or developmental issues like Autism, Downs, ADHD, or PTSD can be controlled with sedation or general anesthesia. Certain medical conditions, allergies, the very young or very old can often be managed better with sedation or general anesthesia.
In the majority of cases, most patients experience little to mild discomfort for a few days after the procedure. Hot and cold pain will be completely absent, biting pain may occur when using the tooth, and a dull ache or jaw soreness can occur. These symptoms are quite manageable with alternating doses of ibuprofen and acetaminophen postoperatively. In cases where severe infection and/or inflammation was present prior to the procedure, often a pain rx will be prescribed for a short duration as needed. It is important that the bite is correctly adjusted, often readjusted so the tooth gets a chance to rest and heal. Injectable rx’s for pain control are also given post operatively for pain control.
Yes, many times you can, especially as an established patient where we are already familiar with your case and medical/dental history. Dental emergency visits often have to be seen and treated that same day to get the patient out of pain. Most new patients, especially with a complex medical or dental history or a difficult diagnosis are better served with a separate exam visit, especially when their pain is intermittent or low intensity, but chronic in nature. This gives us ample time to correctly identify the source or cause of your pain. Often multiple periapical, bitewing, panoramic or cone beam CT scan imaging and repetitive pulp testing are necessary to correctly diagnose the case. Once a diagnosis is established, preoperative medications may be prescribed to “ready” the case and treatment will be scheduled typically for a one visit procedure. A separate exam can also screen for teeth that are non-restorable, cracked, or just need a little time to settle down (if it had a recent filling or crown) and a root canal would not be indicated. First time sedation/anesthesia cases also require a separate exam-office visit to assess the patient’s health/prescribed medications/airway status prior to performing the procedure for patient safety.
Dental benefits for most endodontic procedures are fairly predictable in what they will pay as per the dental coding submitted to the insurance carriers. Some exceptions to this would be cosmetic procedures (i.e. bleaching of an Endodontically treated tooth), but for the most part; if our office is an “in-network” provider, submitted diagnostic or treatment procedures fee schedules are known in advance by checking online, via fax or by telephone conversation with the insurance carrier almost immediately. Anesthesiology procedures are somewhat different for the following situations:
1) There may not be insurance coverage for the patient’s anesthesia dental services.
2) A predetermination of benefits in advance is often required in writing.
3) A statement of “Medically Necessary” is often required to be approved in advance. Many endodontic patients are in pain, and cannot wait weeks for a written insurance preauthorization to be approved. Since our procedures are performed in an “outpatient facility” and not in a hospital by an in-staff hospital anesthesiologist, our fees are hundreds if not thousands of dollars less than a hospital setting. Unfortunately, medical or dental insurance companies often perceive an “outpatient” anesthesiology procedure as an option, not a requirement as in a hospital setting even at a lower fee. Preparing for an anesthesia procedure requiring deep sedation/general anesthesia requires a lot of preparation of the treatment room both dentally and medically. Extra staff, equipment is required and many expensive drugs and sterile IV supplies have to be opened, prepared for use, are not reusable and must be discarded if the patient would not show up for treatment or cancels at the last minute. It has been studied in the outpatient anesthesia literature that a patient will be more likely to show up for their procedure if the patient has a financial commitment to their scheduled appointment. If a patient needs financial help in securing payment for an endodontic procedure utilizing deep sedation/general anesthesia by an anesthesiologist, our office participates in interest free loans via Care Credit and Lender’s Club and approval is quite rapid so scheduling and treatment can progress. Our anesthesiologists are not employees of Dr. Russin, but are independent contractors that provide their services to our patients. If your dental or medical insurance does provide some coverage to your anesthesia services, our anesthesiologists will provide the necessary insurance codes, letter of “medical necessity” and any help in filing your insurance reimbursable to you. Pediatric patients should look at the PDAA website or contact Maria at (813) 489-9165 for further helpful information.
It’s all about safety. An Endodontist like Dr. Russin may many times provide mild to moderate sedation like Nitrous Oxide-O2 and/or oral -IV sedation, but deep sedation/general anesthesia by Florida State Statutes must be provided by a separate, trained and licensed anesthesiologist who has completed an anesthesiology residency after dental or medical school. Complex medical or pharmaceutical histories, pediatric, developmental or geriatric cases, for example are safest when performed by an experienced anesthesiologist. There is no price to your life, and when a case is worked up by Dr. Russin and his Staff and is deemed either inadequate for mild/moderate sedation or to complex to be safely performed by one person, then it is referred to one of our anesthesiologists. It is our strictest policy to not let money or convenience rule the choices of anesthesia…Safety for the patient always rules, or the case will simply not be accepted. Foolish or unnecessary risk to a patient’s wellbeing is not only unethical, but it may have irreversible consequences or outcome.
In most cases, General Dentists are the restorative experts. It is what they do best, and your final restoration whether being a core filling through a crown, or a complete post and core buildup and a new crown or bridgework is best handled by them. It is what they do routinely day in and day out, just like and Endodontist does root canals on a daily basis. There are exceptions, if a General Dentist requests that we place the final restoration, we will place the restoration(s) upon request. Examples of this would be a geriatric patient who has difficulty making multiple appointments due to their declining health status, need for a driver, etc. or a patient who has to leave town soon after their root canal and would not have time to schedule a second appointment at their General Dentist to place the final restoration. In most of our sedation/general anesthesia cases, we usually place the final restoration simply because for what ever reason they required the sedation/anesthesia in the first place, they would often have to be “put out again” for the final restoration.
Sometimes a root canal has to be redone several years later because the restoration leaked, and re- infected the tooth. Also canals can be missed, procedural difficulties may have occurred during the first root canal procedure, a tooth may be fracturing, or the health/immunity status of the patient could be declining and the tooth starts to hurt/the gum swells or infection is picked up on a routine dental checkup. Although the success rate of a root canal is generally 95% or better, failures do occur and a retreatment is required to save the tooth. This involves re accessing or removing the existing restoration, any recurrent decay and first inspecting the tooth for the failure. If the tooth is not found fractured (which usually means extraction), the previous root canal filling material is removed, the canals cleaned, reinstrumented and a medicated dressing called calcium hydroxide is placed in the canals and sealed with a temporary filling. A few weeks later, the tooth is reopened, the canals briefly cleaned, thoroughly irrigated and refilled with gutta percha and a sealer. The tooth would then be restored conventionally by the patient’s General Dentist and followed up from 3-12 months to verify healing. A “surgical” root canal is called an apicoectomy in which, upon confirmation that the restoration is not leaking and the tooth not cracked, an opening through the gum is made to gain access to the root tip(s) of the tooth. Any infection, poorly healed bone and any cystic tissue would be removed. The root tip is inspected by beveling the tip of the root and checking for extra canals, fractures, separated instruments, etc. and a retrofill “plug” filling is placed at the root tip to seal the canal from the root tip into the root. An analogy of this would be like placing a cork into a bottle to seal the root canal closed to any fluids from the surrounding bony tissue. Sometimes a biopsy is taken of the tissues from the root tip area(s) to help diagnose the reason for failure. This procedure along often with a CBCT scan of the tooth can finally confirm if the tooth has fractured, may require biologic materials to aid in soft or hard tissue repair, or requiring its complete removal and the placement of a bridge or implant.
Our office policy is that children under the age of 14 will be treated with IV sedation / general anesthesia with a pediatric anesthesiologist working with Dr. Russin to see that your child receives the BEST and SAFEST treatment possible.
The reasons for this policy are:
1. More time is required for root canal procedures than for general dentistry (fillings, cleanings, x-rays, etc.)
2. Oral sedation which is used by many pediatric offices creates a greater risk for lengthy procedures such as root canal treatment.
3. Nitrous Oxide (sometimes referred to as “laughing gas”) may be used successfully (without oral sedation) in some children ages 14 to 18. Many factors are taken into consideration in deciding whether this is the best form of sedation for your child. We will discuss this option with you and your child at the evaluation appointment. This option will not be considered if there was any question of a “bad dental experience” that happened to your child in the past and will have to be appointed for IV sedation or see another provider for their care.
4. Special needs patients (i.e. Autism, ADHD, underdevelopment, etc.) are generally treated with IV sedation / general anesthesia due to their intolerance of most dental procedures.
It is our desire that your child have the safest positive dental experience in our care, without pain, fear or anxiety.
Monitoring gives the treating Endodontist or Anesthesiologist hard data and facts about the status of the patient’s reaction to administered drugs and how well their airway and breathing is working. This enables the dosages of medications to be adjusted up or down safely. A patent can look calm and rested during a dental procedure with or without a sedative and an underlying cardiovascular, systemic or breathing issue may begin to occur. Corrections to drug dosages, or reversal/antidote medications can be administered in a timely manner to keep the patient from getting into trouble or get them out of trouble and back to a safe baseline. The best way to manage a dental/medical emergency is to prevent it from happening in the first place. As an example, there are situations where our office may monitor a patient as per their blood pressure, heart rate, oxygen saturation and carbon dioxide exhalation WITHOUT any conscious sedation or general anesthesia to see if the patient is handling the procedure and local anesthesia well. Administration of a local anesthetic with epinephrine can “race the heart” on a geriatric patient if administered too fast…proper “real time” monitoring allows for individual tailoring of medications administered, often waiting 20-30 minutes before the second dose…all because the monitors give us the facts. Monitoring of the patient’s vital signs and breathing, when indicated, is included in endodontic or anesthesia fees.