What is Root Canal Treatment?

Root canal (endodontic) treatment is a dental procedure which is aimed at removing the inflamed and/or infected pulp tissue from within the core of the tooth.

This treatment is carried out in 2 stages; firstly, the root canals are disinfected, and secondly the disinfected root canals are sealed with a root filling material.

What is the purpose of root canal treatment?

The aim of root canal treatment is to keep the tooth healthy or to return the tooth to health, therefore allowing it to be functional. The only other viable option for a tooth requiring root canal treatment is extraction. The resulting gap may be left alone or replaced with an implant retained crown or a bridge. We like to preserve teeth when we can, and this is an opinion that we share with the Dental Implant Practitioners in our multidisciplinary practice.

Untreated inflamed and/or infected teeth which are which are not painful will eventually give rise to symptoms such as pain and swelling. The chances of success may also reduce the longer an unhealthy tooth is left untreated.

How do I know if I need root canal treatment?

Root canal treatment is usually required when the pulp tissue within the core (root canal) of the tooth has become inflamed and/or infected with bacteria. This is commonly a result of decay, repeated dental procedures and/or hairline cracks or chips on the tooth (which may not be readily detectable to the human eye). The soft pulp tissue contains nerves, blood vessels and connective tissue which is encapsulated by a hard outershell of dentine and enamel.

You may have symptoms such as pain (for example a localised throbbing ache) sensitivity to hot/cold, discomfort when chewing, swelling and/or tenderness of the gum localised to the region of the tooth.

However, it is not unusual to find that there are no symptoms at all, and the need for treatment is determined from a clinical or X-ray examination.

How is the treatment carried out?

At your appointment Shanon will take a detailed history, after which he will examine the problem areas and associated tooth, take X-Rays and possibly a specialised Cone Beam CT 3D scan of the tooth under investigation. He will then discuss the benefits, options and any risks involved in your treatment after which treatment (when appropriate) will be carried out. The majority of treatments are carried out in a single appointment. However, more challenging cases may require additional appointments, the final decision can only be made once treatment has commenced and we have an idea of the nature of the root canal problem.

Treatment is carried out under local anaesthetic administered into the gum adjacent to the tooth being treated. The tooth is then isolated with a rubber sheet, (rubber dam) which has two roles; firstly, it prevents the tooth being contaminated with saliva (which contains bacteria), and secondly, it improves patient comfort.

A very small opening is then prepared on the biting surface of the tooth under high magnification using a dental operating microscope to allow identification of the root canals of the tooth. The root canals are then enlarged gradually with very flexible nickel titanium files - this creates space for disinfectant solutions to be fed into the enlarged root canals to disinfect the internal tooth structure and flush out the inflamed/infected pulp tissue.

Once the root canals have been adequately disinfected they are filled with a rubber-like biocompatible root filling, this prevents re-infection of the disinfected root canal. The opening is then sealed with a temporary filling. The tooth will then need to be permanently restored with by your refering dentist.

Will the treatment work?

The success rate for root canal treatment is over 95%.

However, as with any medical procedure success can never be guaranteed no matter how straightforward the treatment is to perform. This is because healing is ultimately dependent on the response of the individual patient to the treatment carried out. The tooth may also fail because of small cracks in the root, or because there simply is not enough structure remaining to restore. In these cases we may advise an extraction of the tooth.

Can all teeth be treated?

Occasionally it may not be beneficial or even possible to root treat a tooth. Examples of teeth that have a poor prognosis are root canals that are not accessible (e.g. blocked by previous attempts of root canal treatment), root fractures, insufficient tooth left for a post-endodontic filling/crown.

Once the tooth has been examined and low-dose digital X-rays or a specialised 3D Cone Beam CT scan taken, a decision can be made as to whether or not the tooth can be treated. However, there are some cases when a decision on the viability of root canal treatment can only be made once treatment has been started.

Will the treatment hurt?

No! The treatment is usually painless.

However, as with most dental procedures it is not uncommon to have a degree of discomfort and possibly swelling for 1-2 weeks after treatment has been completed. This pain is usually resolved with analgesics (painkillers) available over the counter at your local pharmacist. The tooth usually requires 1-2 weeks to completely settle down once treatment has been completed.

Can't I take antibiotics instead?

No. Antibiotics do not eliminate infection from the tooth, they only give temporary relief. The only way to predictably eliminate infection is to carry out root canal treatment. Furthermore, repeated doses of antibiotics may result in them becoming less effective as you may gradually build up resistance to them.

How long does root canal treatment take?

Due to the intricate nature of root canal treatment it usually takes 1-2 appointments, each appointment is 60-90 minutes long. The amount of time required depends on the number of root canals identified in the tooth and the complexity of the root canal anatomy (e.g. how curved the root is, how narrow the root canal is). These factors can only be confirmed once treatment is underway.

Who performs root canal treatment?

All dentists receive basic training on root canal treatment in dental school. General dentists perform most aspects of dental treatment including root canal treatment, but sometimes refer more complex cases to Specialists in root canal treatment (Endodontists). Endodontists spend a further 3 years in postgraduate specialising in root canal treatment. Thus allowing them to manage all types of types of root canal problems efficiently using the most up to date evidenced based techniques.

What happens after root canal treatment?

It is essential that once root canal treatment has been completed, the tooth is fully restored to finally seal and protect it. Root treated teeth generally require restoration with crowns, sometimes retained by posts cemented into the root canal. This treatment would be carried out by your own dentist.

You should use your root treated tooth with care until it has been permanently restored by your dentist. Root treated teeth are susceptible to fracturing, so it is essentially to see your dentist as soon as practically possible to have the tooth permanently restored with a hard wearing filling or crown to protect the underlying tooth structure from fracturing thus allowing the tooth to be completely functional again.

Is there an alternative to root canal treatment?

Untreated inflamed and/or infected teeth which are not painful usually eventually give rise to symptoms such as pain and/or swelling. The chances of successful outcome from endodontic treatment may also reduce the longer an unhealthy tooth is left untreated.

A viable alternative option for a tooth requiring root canal treatment is extraction. The resulting gap may be left alone, or restored with an implant retained crown or a bridge. However, the best implant is your own natural tooth! The scientific literature supports the fact that root canal treatment carried out to a high standard has a similar success rate to a dental implant retained crown, so why extract a potentially healthy tooth?

We will only recommend root canal treatment when we feel that the long-term prognosis for the tooth is good. Of course, if we feel that the your tooth has a poor prognosis we would recommend an extraction, and when appropriate replacement of the tooth with an implant retained crown.

Root canal treatment, and the subsequent restoration of the tooth with a crown usually takes fewer appointments and less time to complete than extracting a tooth and replacing it with a dental implant retained crown. In most situations we carry out root canal treatment in 1 visit, then when indicated we advise that the tooth should be prepared and impressions taken for a crown 1 week later, then after another 1-2 weeks the permanent crown will be placed on your toot treated tooth, thus from start to finish treatment will take 3 appointments, over a 3-4 week period.

If you decide to have the tooth in question extracted and replaced with a dental implant retained crown there are usually more appointments required, and the duration of treatment is significantly longer. Once the tooth is extracted it is usualy advisable to wait at least 8 weeks before placing the implant, then after the implant is placed, it is customary to wait another 8-10 weeks before impressions may be taken for the implant crown, finally, after another 3 weeks the crown may be attached to the dental implant. Therefore, treatment usually can take 5-6 appointments over the course of 4-5 months for an implant retained crown. In addtion implant treatment is more invasive.