A tooth has its very own blood supply and nerve supply. It resides about 4 mm beyond the enamel. If a tooth has some kind of trauma, such as a fracture or decay, the blood supply can become infected. When this happens, the infection must be removed, either by root canal therapy or extraction of the tooth. Root canal treatment is removal of the nerve/blood tissue supply of the tooth. Once the vasculature is removed, the canals are disinfected and then filled with a stable material that serves to seal the tooth from other microbes. Much like a brittle skeleton that has no blood supply, an endodontically treated tooth is significantly weakened and highly susceptible to fracture.

For this reason, it is usually recommended that a tooth that has had a root canal receive a crown or onlay, to prevent fracture and to ensure a good seal. If a tooth fracture extends into the root of a tooth, the root canal treatment may not cure the problem and the tooth may need to be extracted. As of yet, there is no way to see the extent of a fracture before the root canal treatment is performed.

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