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When does your tooth need root canal treatment?
            Root canal therapy might be the proper solution if a tooth is currently causing you pain or else has a history of being painful or the presence of tenderness and/or swelling in your gums near a tooth.

There can be times when you are not aware of any problem with the tooth because there has been no swelling or pain. The nerve tissue in a tooth may die quietly. The degeneration of a tooth's nerve is not always a painful experience and on occasion a tooth's need for root canal treatment can remain undiscovered, even for some years.
It is not uncommon that a dentist will identify a tooth which needs root canal treatment during a routine x-ray evaluation. Sometimes a tooth with a dead nerve will produce a pimple (boil) like lesion on a person's gums. They are literally drains for pus from an infected tooth, and you might notice that they discharge pus.
There can be times when carious lesion (decay), cause the exposure of your tooth's pulpal tissues. An exposure can lead to the degeneration of a tooth's nerve tissue necessitating RCT.
Teeth which have been traumatized in an accident can become nonvital, thus making root canal treatment necessary. Immediately after the traumatic event the outcome of the health of the nerve tissue can be difficult to predict. These teeth may do quite well, even for many years. However, it is always possible, that at some point the  nerve tissue will degenerate (often asymptomatically). As a result of the degeneration occurring within the tooth, the tooth may sometimes appear darker in comparison to its neighbors.

What are the individual steps of root canal treatment?

1. Gaining access to the nerve area of the tooth.
   The area around the tooth is made nub by injecting a local anesthesia into the surrounding tissues. A dental drill is used to remove the decayed part of the tooth. An access cavity is prepared to reach the root canals. This is accomplished by using the dental drill and making an access hole which leads to the pulp chamber of the tooth. On back (posterior) teeth this hole is made on the chewing surface of the tooth. On front (anterior) teeth the access hole is made on the tooth's backside.
2. Cleaning the tooth out.
   The next step of the root canal treatment process is for your dentist to clean the interior of your tooth. As we discussed previously, this cleaning process will remove any bacteria harbored inside your tooth and also remove any nerve tissue which is present.
               The bulk of the cleaning process is accomplished by using "root canal files". These objects look like straight pins. Your dentist will work a series of root canal files, each of increasing diameter, up and down in your tooth while simultaneously using a twisting motion. This action will scrape and scrub the sides of the tooth's root canals, thus cleaning them out. Additionally, as part of the cleaning process your dentist will wash your tooth out periodically so to help flush away any debris which is present.
               The goal is for your dentist to clean the entire length of the tooth's root canal(s), but not beyond. So to determine the length of a root canal your dentist may place a root canal file in your tooth and then take an x-ray, so to see if it extends the full length of the tooth or not. Alternatively, your dentist may have an electronic device which can be used to make this determination.
               Traditionally root canal files are manipulated by a dentist by using their fingers. There are, however, special dental drills which can hold and twist these files, and your dentist may choose to use one. There is yet another type of dental handpiece which produces a cleaning motion by way of holding a root canal file and vibrating it vigorously.
3. Placing the root canal filling material.
   Once the tooth has been thoroughly cleaned your dentist can fill and seal up its interior by way of placing root canal filling material. Sometimes a dentist will want to place the filling material the same day that they have cleaned the tooth out. Other times a dentist might feel that it is best to wait about a week before completing the root canal process. In the latter case your dentist will place a temporary filling in your tooth so to keep contaminates out during the time period between your appointments. It may take two to three sittings with the dentist to make the canal dry and totally free from infection. The front teeth usually have only one canal while the back teeth have 2 to 4 canals. 
               The most common root canal filling material being used by dentists now days is a rubbery compound called gutta percha. Gutta percha comes in preformed cones which are similar in size and shape to the files which have been used to clean out the inside of a tooth. Cones of gutta percha are coated with a root canal sealer (a paste) and then positioned into the tooth's root canals. Usually it takes the placement of several cones until the interior of the tooth has been adequately filled. Sometimes a dentist will warm the gutta percha cones (either before or after they are placed into the tooth) so they become softened. This allows the gutta percha to more closely adapt to the precise shape of the interior of the tooth. After your dentist has finished the filling and sealing aspect of the root canal process they will place a filling in the access hole they created at the beginning of your treatment. Later a crown is made over the tooth to protect the tooth from breaking off.

Sometimes the infection may spread to the tip of the root and cause accumulation of pus at the root apex. The infection may break open the bone wall and drain out into the oral cavity, resulting in an abscess (gumboil). In such cases the gums may have to be repaired by doing a minor surgery to remove the infection at the root tip. This is referred to as Apecectomy. In six to eight weeks the tip of the root heals and the tooth becomes as good as a normal tooth.