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 by disinfecting the root canals and then by sealing the disinfected root canals 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 profession as a whole. 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 covered by a shell of dentine which in turn is covered by a hard shell of 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 and an X-ray examination.
How is the treatment carried out?
At your appointment we will take a detailed history, after which he will examine the problem areas and associated tooth, take X-Rays. We 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 and ensures safety since chemicals are used to disinfect the root canal system and small instruments are used to clean the root canal system. A very small opening is then prepared on the biting surface of the tooth under high magnification 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 root canals to chemically disinfect the root canal system. Once the root canals have been adequately disinfected they are filled with a rubber-like bio-compatible root filling, this prevents re-infection of the disinfected root canal.
The opening is then sealed with a temporary or permanent filling or core. The tooth will then need to be permanently restored usually with a crown.
Will the treatment work?
The success rate for root canal treatment is over 80 -95% depending on the complexity of the root canal system and the infection present. 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 clinically and with low-dose digital X-rays, a decision can be made as to whether or not the tooth can be treated. However, in many cases 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 the bacteria present will gradually build up resistance to them.
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. You should use your root treated tooth with care until it has been permanently restored. Root treated teeth are susceptible to fracturing, so it is essentially 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 usually painful may 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 your tooth has a poor prognosis we would recommend an extraction, and when appropriate replacement of the tooth. 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.
We advise that the tooth should be prepared and impressions taken for a crown after we are sure the treatment has been successful and the tooth is asymptomatic, usually after 2-6 weeks of healing.
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