Teeth are living tissues. The part of the tooth that is alive and has feeling is the inside part of every tooth. We call it ‘the nerve’, but it is really a complex arrangement of nerves, blood vessels, and cells that extend toward the surface. Whatever happens to a tooth causes a reaction in this tissue from which the tooth must heal. Having cavities repaired and fillings placed is surgery. We don’t often think of it that way, but an operation on living tissues is surgery, and the healing process is not always predictable.
Teeth have a very limited ability to heal. Decay is a trauma to teeth. It is a bacterial infection of the tooth. Bacteria can penetrate the tooth and grow toward the nerve. Tooth clenching and grinding is a trauma. It can cause cracks to form that allow bacteria deep inside the tooth. Chewing ice and getting hit in the mouth are also traumatic to teeth. These traumas accumulate, and the nerve inside the tooth becomes less and less healthy.
It’s like a bag of groceries. You put more and more groceries into the bag; you take it to the car. By the time you get home, the bag is pretty weak. You pick it up to bring it into the house and it tears. It didn’t tear because you picked it up, and leaving it in the car isn’t the answer. Whenever the bag gets too full or what’s in it is too heavy, there’s the risk of spilling your goods all over the garage floor. It’s kind of like that with teeth. As new decay forms and fillings get bigger, as other traumas occur to the tooth, the chances of the nerve remaining healthy become less.
Sometimes it takes just one more thing, a filling, a hard pretzels, a tap with the back of your baby’s head, to start the downward spiral that means a root canal is needed. When the nerve is finally injured beyond its ability to heal, it usually (but not always) causes symptoms. The tooth starts to hurt.
Root canals and crowns often go hand in hand. Teeth most often need crowns because of some structural weakness. This is usually because of a large filling or fracture. The fact that the tooth is in this condition tells you it’s been traumatized, either by a fracture or large cavity, sometime in the past. We try to make crowns for teeth before they get too bad, but sometimes making the crown is that one more thing that causes the bag to tear. It brings to the surface a problem that has been lying there quietly, but lying there none the less.
We do everything we can to make our treatments as kind as possible to the teeth. Avoiding treatment pretty much guarantees problems down the road. As gentle as we are, it’s not always possible to avoid the need for root canal therapy. Sometimes it’s predictable, sometimes it’s a surprise. Just try to remember, it’s not the dental treatment that caused the need for it, it is the problem that necessitated the treatment that’s to blame.
Yours in health,
Dr. Greenberg