Endodontic treatment is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes; deep decay due to bacteria, multiple dental procedures on the tooth, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain, and/or lead to an abscess.
Signs of pulp damage include pain, prolonged sensitivity to heat or cold, discoloration of the tooth, and swelling and tenderness in the nearby gums. Sometimes there are no symptoms.
The first step in the therapy is to remove the blood vessels, nerves, and connective tissue inside the pulp and root canals. The walls of the canal are smoothed with either a hand or rotary file. The canals are then sealed with filling material, and a temporary might be placed if the tooth is not restored at that appointment. The last step is to restore function to the tooth with a core build-up material and possibly a post and either a filling or a crown.
Almost all back teeth will need a crown since teeth that have had a root canal have lost a significant amount of tooth structure, and a crown not only restores full function but it also helps prevent a future fracture. Front teeth are crowned on a case-by-case basis depending upon how much healthy tooth structure remains after the endodontic therapy. If a crown is not indicated on a front tooth, it will be restored with a tooth-colored filling material.