We get a ton of people that come to us concerned about root canals and there is some good information and a lot of bad information that you’re going to read on the internet. So let’s start at the beginning. There’s two main reasons a tooth can need a root canal. One is an alive tooth that is sick. The nerve is inflamed. Either a bad cavity or trauma has created a hyper response or spontaneous pain, so cold or hot really hurts and lasts for a long time. Or you lay down and go to bed and the tooth throbs on its own. That’s an alive tooth. That is not going to get better on its own, but it’s not infected. It’s still alive. So there’s no bacteria problem yet in the nerve of the tooth. The other reason a tooth can need a root canal is the nerve is already dead. So there’s no blood flow to the tooth. The nerve doesn’t function. It can’t feel hot and cold, but there’s an infection at the base of the root of the tooth in the jaw bone, called an abscess that we’ll often find on a CT scan — a 3D image of the teeth in the jaws where we can identify any sources of infection, like, abscessed teeth. So, a root canal is a procedure that removes the either inflamed or dead blood supply and nerve inside the root of the tooth. All right, so we can be treating pain or it can be trying to treat infection. Your tooth and the roots are still there, but the vitality is removed from inside. So if a tooth is infected, it may heal. We’ve removed a lot of the bacteria from inside the tooth, but we can’t remove all of it. So, sometimes, we’ll see non-healing or something that gets better for a while, and then we’ll see an abscess return later. So unfortunately, no one can guarantee that an infection is removed by doing a root canal. A lot of times, it works, but there’s always the risk and we don’t know how much bacteria is still in the tooth, potentially, creating a subclinical level of residual inflammation, or systemic effect, without creating an actual visible abscess. So, unfortunately, the only way to give someone certainty that the bacteria and the infection are gone is to remove the tooth. If that tooth is extracted, we know the bacteria is dealt with. We know the infection can’t recur, we know that it can’t erode or destroy more bone and then we begin the conversation of, “What, if anything, do you want to do to restore or replace that missing tooth?” Our first line of choice is always going to be a dental implant because it’s replacing the one thing that we’ve lost. Something like a bridge can be an option, which is a crown on either side of the missing tooth and all three teeth at that point are connected. The downside there is if you have healthy neighboring teeth, you’ve now just ground all the enamel off of them to replace one missing tooth that those two teeth had nothing to do with. Furthermore, if anything goes wrong with that bridge, or the neighboring teeth. Now, you potentially lose an additional tooth or have to replace a whole bridge. So, a implant side steps increasing the risk, or letting that problem potentially snowball down the road. The other two choices for replacement are making something removable that you can take in and out that makes it look like you’re missing a tooth, or not missing a tooth rather, or you simply leave a missing space there, which is not a great treatment choice but is always an option. So hopefully that clarifies some of the questions that you have about what is a root canal, why is it needed and what can I do to avoid one.