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A root canal is necessary when bacterial decay or trauma affect the pulp or nerve of a tooth. The blood flow in the tooth rushes to the site of inflammation to aid the tooth. What actually occurs is a pressure on the nerve endings, generating pain, which usually occurs at night or when lying down, and can be triggered by something hot or cold.
What occurs is a slow progression of decay traveling through the canal and settling at the end of the root. This results in an abscess (or swelling) at this site.
Other causes of nerve pain can be tooth fractures, excessively large fillings, or constant trauma to the tooth. Occasionally, it is difficult to diagnose which tooth may be the culprit. New technology uses motorized files made of nickel-titanium that shape and cleanse the canals. What used to take two to four visits can now be accomplished in one visit. Biocompatible cements are used with this material to seal any smaller openings.