The NERVE Story

Why do we have a nerve in the tooth?  The purpose of the nerve is to make the tooth.  By the time we are a teenager the nerve has formed the tooth.  As we get older the nerve continues to get smaller in the tooth, but it is still there.  The nerve has a limited blood supply does not heal like other tissue.  If you cut  your finger it heals.  If the nerve is exposed to decay  it becomes inflamed and then infected.  The nerve does not heal like other tissue.  With repeated dental work the nerve is repeatedly stressed and connot always recover. 

Teeth should not hurt.  Teeth should not hurt to bite on and should not hurt by themselves.  If the nerve has a problem and is causing pain, treatment used to be to take out the tooth.  If the nerve is a problem it makes more sense to take out the nerve.  When we do a root canal we take the nerve out of the tooth.  The space where the nerve was is made larger so we can clean and disinfect the space.  The space is then filled.  Root canal treatment is indicated when there is a problem with the nerve.  It can be unhappy because of inflammation or it can be infected because of bacteria.   Treatment is the same.  The cause of the problem is removed and the tooth remains the same.  It just does not have a nerve anymore so the tooth no longer feels cold.  The tooth should be comfortable to bite on.  It no longer feels temperature because there is no more nerve. 
If the nerve has a problem, we diagnose it by symptoms.  The tooth may be sensitive to temperature.  Teeth normally can feel cold.  Cold that hurts or lingers is not normal.  Hot is not normal.  If the nerve is alive it should respond to cold.  If it feels cold that is normal.  If the tooth is more sensitive than the other teeth, or if the pain lingers when the cold is taken away there may be a problem with the nerve.  If the tooth is sensitive to hot there is definitely a problem with the nerve.  Teeth are normally not sensitive to hot.  If the tooth hurts all by itself, or if cold makes the tooth feel better there may be a problem with the nerve.  If the tooth does not feel cold at all it may indicate that root canal treatment is needed because the nerve can be dead or dying.  When the nerve dies inside the tooth bacteria can leak out the end of the root causing pain and swelling outside the tooth.  Antibiotics help with the symptoms, but do not get rid of the cause of the problem.
 Root canal treatment removes the cause of the problem.  We clean and disinfect the canal space inside the tooth were the nerve was.  This is difficult because as we get older, the nerve space inside the root of the tooth gets smaller.  In order to clean and disinfect, we need to first find all of the space.  This requires a microscope and small, delicate instruments.  It is important to take your time when doing root canal treatment so patients are scheduled for about an hour and a half to passively open the small space.  Once clean, disinfected and dry the we seal up the space inside the canal with filling material.  When the cause of the problem inside the tooth is removed the body should heal outside the tooth.
Rich Riehm,
Feb 8, 2012, 10:13 AM