Inside every tooth is a soft tissue called the pulp, which contains the tooth's nerves and blood vessels. When the pulp becomes inflamed or infected, usually from deep decay, a crack, or an injury, it cannot heal on its own. Root canal treatment removes the damaged pulp so the tooth itself can stay.

After the tooth is thoroughly numbed, we make a small opening, clean and disinfect the canals inside the roots, then fill and seal them. With modern anesthetics and techniques, most patients find the experience comparable to having a filling placed.

You may need this if you have:

• Lingering sensitivity to hot or cold

• Pain when biting or chewing

• A throbbing or spontaneous toothache

• Swelling, or a small bump on the gum near the tooth

• A tooth your dentist has flagged on an X-ray, even without symptoms

What to expect: Some treatments are completed in a single visit of about 1-2 hours. Many teeth require a second, slightly shorter appointment to allow for long-term medication of the canals. Afterward, you will return to your general dentist for a permanent filling or crown to protect the tooth.

Most root canal treated teeth last for many years. Occasionally, though, a tooth does not heal as expected or becomes painful or infected again, sometimes long after the original treatment. Common reasons include narrow or hidden canals that were missed the first time, a crown or filling that was delayed or has begun to leak, new decay, or a crack.

Retreatment gives the tooth a second chance. We reopen the tooth, remove the previous filling material, and examine the canals under the microscope for anything that was not addressed before. The canals are then cleaned, disinfected, and resealed.

What to expect: The experience is similar to a first root canal, though it can take somewhat longer and occasionally requires two visits. A 3D scan is often part of the evaluation, because it shows us the tooth's anatomy and the earlier treatment in detail before we begin.

Sometimes an infection persists at the very tip of a root even after a well-done root canal, or the canals cannot be reached through the top of the tooth because of a post, a crown, or unusual anatomy. In these cases, a minor surgical procedure called an apicoectomy can often save the tooth.

Working through a small opening in the gum, we remove the infected tissue along with the last few millimeters of the root tip, then place a small filling to seal the end of the root. The gum is closed with a few fine stitches, and the bone heals naturally around the root over the following months.

What to expect: The procedure is performed in our office with local anesthetic. Some swelling and tenderness for a few days is normal, and most patients return to their usual routine the next day. Stitches are typically removed a week later at a brief post-op follow up appointment.

A fall, a sports injury, or an accident can loosen a tooth, push it out of position, fracture it, or knock it out entirely. Endodontists are trained specifically to manage these injuries, and prompt care makes a real difference in whether the tooth can be kept for the long term.

Treatment depends on the injury. It may involve repositioning and stabilizing the tooth, protecting an exposed nerve, or root canal treatment if the pulp has been damaged. Children and teenagers need particular care, because their teeth are often still developing and the right approach can allow the root to continue growing.

Injured teeth can also change slowly, so we monitor them with follow-up visits and X-rays, sometimes for several years.

If a permanent tooth is knocked out: pick it up by the crown, not the root. If it is dirty, rinse it briefly with milk or water without scrubbing. Place it back in the socket if you can, or keep it in milk, and call us or your dentist right away. The first hour matters most.

A tooth that has had a root canal or an injury sometimes darkens over time, turning gray, yellow, or brown. Because the discoloration comes from within the tooth, whitening strips and trays applied to the outside have little effect on it.

Internal bleaching treats the tooth from the inside. We place a whitening agent in the upper portion of the tooth, seal it with a temporary filling, and leave it to work for several days. The process is repeated until the tooth blends with its neighbors, and the tooth is then sealed with a permanent filling.

What to expect: The appointments are short and comfortable, and usually no anesthetic is needed. Most teeth reach the desired shade in one to three visits. This is a conservative option, since it preserves your natural tooth where a veneer or crown would require reshaping it. Results vary from tooth to tooth, and some teeth may need a touch-up years later.

Internal bleaching is only appropriate for teeth that have already had root canal treatment. We will perform the root canal treatment along with the internal bleaching. In the case of a tooth that has already had a root canal, we will evaluate to see if the tooth is still healthy or if the root canal needs to be retreated along with the internal bleaching.

When a tooth has lost a great deal of its structure, a dentist may place a post, a small metal or fiber rod, inside the root to help anchor the filling and crown above it. If that tooth later needs retreatment, the post stands between us and the canals and must come out first.

Removing a post is delicate work. Using the surgical microscope and fine ultrasonic instruments, we gently loosen the post and the cement around it while preserving as much of the surrounding root as possible. Once it is out, retreatment can proceed.

Sometimes, like in the case of a fractured post, the prior root canal may still be healthy. In those cases, we can perform only the post removal and get you back to your regular dentist for the new restoration.

What to expect: Post removal is done with local anesthetic, usually at the same visit as the retreatment. Before we begin, we evaluate the tooth carefully, often with a 3D scan, to judge whether the post can be removed safely. When removal would put the root at risk, we will tell you, and we may recommend an apicoectomy as a safer way to treat the tooth.

Resorption is an uncommon condition in which the body's own cells begin to dissolve part of a tooth. It can start inside the tooth, within the pulp, or on the outer surface of the root. It is sometimes linked to a past injury or orthodontic treatment, and often no clear cause is found.

Resorption is usually painless in its early stages. Most cases are discovered on a routine X-ray, or occasionally as a pinkish spot on the tooth near the gumline. A 3D scan is essential here, because it shows exactly where the resorption is and how far it extends, which determines whether and how the tooth can be repaired.

Treatment depends on the type and location. Resorption that begins inside the tooth is generally treated with a root canal, which removes the cells causing it. Resorption on the outside of the root is treated by removing the affected area and repairing the defect with a biocompatible material, sometimes through a small opening in the gum.

What to expect: Timing matters. Resorption found early can often be repaired with an excellent outlook, while advanced cases may not be treatable. If your dentist has noticed signs of resorption, we encourage you to schedule an evaluation soon, even if the tooth feels perfectly fine.

You do not need to arrive with a diagnosis. Many patients come to us knowing only that something hurts or that their dentist saw something on an X-ray. Finding the cause is our job, and we will walk you through what we find and what we recommend before any treatment begins.

Call us at (908) 517-3455 or email office@boutiqueendodontics.com to schedule a consultation. If you are in pain, please call, and we will do our best to see you promptly.