A root canal treatment, or endodontic therapy, is a procedure designed to remove infected or inflamed tissue from the innermost part of a tooth, known as the dental pulp. The pulp is a collection of blood vessels, nerves, and connective tissue residing within the tooth’s root canals. When bacteria penetrate this space, typically through deep decay, a crack, or a chip, the resulting infection, called pulpitis, cannot heal on its own. Delaying this treatment allows the active bacterial infection to continue its destructive progression within the tooth structure and beyond.
Escalation of Pain and Internal Damage
The initial consequence of an untreated pulp infection is a significant escalation of discomfort within the tooth itself. This stage, known as irreversible pulpitis, is characterized by intense, lingering pain that persists long after the removal of a hot or cold stimulus. The pain can become spontaneous and throbbing, sometimes severe enough to wake a person from sleep. Continuous inflammation eventually causes the soft pulp tissue to die (necrosis), which can temporarily cause the pain to subside, giving a false sense that the problem has resolved.
Even if the pain decreases, the bacterial colony continues to multiply within the dead tissue inside the root canal system. The infection then spreads past the root tip and into the surrounding bone and ligament, a condition known as periapical periodontitis. Over time, the body’s attempt to fight the bacteria causes the gradual erosion and destruction of the alveolar bone that holds the tooth in place.
Progression to Dental Abscesses
As the infection breaches the boundary of the tooth root, the immune system attempts to contain the bacteria by creating a localized pocket of pus, known as a periapical dental abscess. This accumulation of pus causes severe, localized swelling, tenderness, and often a return of intense pain, especially when biting down.
When the pressure becomes too great for the bone to contain, the infection attempts to find a path of least resistance to drain. This drainage often manifests as a small, pimple-like bump on the gums near the affected tooth, called a fistula or sinus tract. While a fistula can temporarily relieve pressure and pain, it signifies an active, chronic infection continually draining into the mouth. In severe cases, the infection can spread aggressively through the facial tissues, leading to cellulitis, which causes widespread swelling of the face or neck and can make swallowing difficult.
Systemic Health Complications
An untreated dental infection is not confined to the mouth; the bacteria can enter the bloodstream (bacteremia) and travel to distant parts of the body. This spread poses a risk to overall health, especially for individuals with compromised immune systems or pre-existing conditions. The chronic inflammation also elevates the body’s overall inflammatory burden, which can complicate the management of systemic diseases like diabetes and cardiovascular issues.
In rare but life-threatening situations, the infection can progress to severe systemic conditions. Sepsis, a life-threatening response to infection, can occur when the immune reaction spirals out of control, leading to organ dysfunction. Bacteria can also spread to the heart lining or valves, causing infective endocarditis, or travel into the brain, resulting in a brain abscess or cavernous sinus thrombosis. These severe complications require immediate hospitalization and intensive medical intervention.
The Final Outcome: Extraction and Replacement
If the bacterial infection progresses unchecked, continuous bone loss and structural degradation can make the tooth non-restorable. At this point, the tooth cannot be saved with a root canal, and extraction becomes the necessary final treatment to halt the infection. Extraction removes the source of the infection but results in the irreversible loss of the natural tooth structure.
Removing the tooth creates a gap in the dental arch, which can lead to adjacent teeth shifting and potential bite problems over time. To restore function and aesthetics, the missing tooth must be replaced, typically with a dental implant, a fixed bridge, or a removable denture. While extraction may have a lower initial cost, the subsequent replacement procedures can make the long-term cost significantly higher than the initial root canal therapy.