Root Canal Treatment
A guide for patients
The aim of root canal treatment (also called “endodontic” treatment) is to save a tooth that has been badly damaged due to decay, disease or injury.
Many millions of teeth each year are saved from extraction by having root canal treatment. Most people prefer to save their tooth because it generally will function better than an artificial tooth. Your own tooth is usually stronger and more efficientfor biting and chewing. Cleaning and maintenance of a natural tooth are much easier. However good an artificial tooth can be, it will never be more than just a substitute for a real tooth.
Problems with biting, chewing and oral health are associated with loosing a tooth. For example, nearby tooth can move out of their normal position and tilt into the space left by a missing tooth. This can make chewing and biting difficult, and can lead to further decay and gum disease around the tilted teeth.
Root canal treatment is successful in most cases. If you take good care of the treated tooth, it may last for many years and possibly for the rest of your life. Your tooth will not be treated unless the treatment is likely to succeed. Root canal treatment may not be appropriate in some cases, and extraction may be the best, or only, option. All general dental practitioners are trained to perform root canal treatment. Some patients may be referred by their dentist to a specialist dentist called an “endodontist” who has special training and qualifications in root canal treatment.
The healthy tooth: The pulp is the soft tissue deep inside a tooth. The pulp contains nerves, blood vessels and connective tissue. It extends from the tooth crown to the tip of each root. The pulp is important for normal growth, development and health of the tooth. However, a fully developed tooth can function normally without a pulp if root canal treatment has been successful.
INFECTION OR INFLAMMATION OF THE PULP
Infection or inflammation of the pulp can be caused by:
- Breakdown of a filling or crown
- A deep cavity
- Trauma
- Gum disease
- Crack or chip in the tooth
- Extreme wear
- Extensive dental work to the root
Symptoms may include pain, sensitivity to heat or cold, tooth discolouration, and swelling or soreness in the gums surrounding the tooth. To save the tooth, root canal treatment is needed when the pulp becomes severely inflamed or infected.
To improve the chances of success, root canal treatment should be started as soon as possible. All root canals in the affected tooth must be treated. The front teeth (incisors) have one or two root canals. Premolars (bicuspids) typically have one or two root canals. Molars usually have three or four root canals.
If the pulp of the tooth is not treated quickly, severe pain and abscesses (infections at the end of the roots) can occur. If an abscess is left untreated, infection can damage the bone surrounding the root. If the tooth does not have endodontic treatment, it will have to be removed.
ROOT CANAL TREATMENT: Your dentist or endodontist will examine the tooth and take a radiograph (X-ray film). A local anaesthetic is usually given to block pain. A sheet of latex, called rubber dam, is used to isolate the tooth and keep it clean and dry durin treatment. To reach the pulp, an opening through the tooth is made with a dental drill. Using special instruments called files, your dentist or endodontist will removed the inflamed or infected pulp.
Each root canal is cleaned, enlarged and shaped. Anti-inflammatory and anti-bacterial medicines may be put inside the root canal to help stop the inflammation and infection. If a severe abscess has formed at the root tip, oral antibiotics may be needed to treat the infection.
You may need to make several visits to the dentist or endodontist to complete the treatment. A temporary filling will protect the inside of the tooth between visits.
Pain or discomfort, if any, usually last no more than a few days, and will not be experienced by every patient. Some people may want to take a mild pain reliever such as aspirin, ibuprofen or paracetamol. Your dentistor endodontist may take several radiographs to check the shape and length of the root canals and the success of the treatment.
After the pulp has been removed, the tooth is not “dead”. The tooth can survive without the pulp because it is nourished mostly by tissues around it.
Removal of the root end: In few cases the end of the root may need to be removed to help treat an abscess. This is called an apicoectomy (or apicectomy). Rarely, a major portion of the root may need to be removed, which is called a root resection. If you need an apicoectomy or a root resection, your dentist or endodontist can provide more information.
COMPLETION OF TREATMENT
To protect the inside of the tooth and prevent further infection, the root canals are filled, and the pulp chamber is sealed. A post may be inserted inside the tooth if it lacks enough structure to support an artificial crown. As the jaw bone surrounding the treated tooth takes some time to heal completely, follow-up visits may be needed to see whether healing has been satisfactory. This is usually checked by examining the tooth and gums and by taking a radiograph. To help the healing process, you should continue to practice good hygiene, including brushing, flossing and regular check-ups.
Fitting an artificial crown: Your dentist may recommend that the tooth requires an artificial crown. If your root canal treatment has been done by an endodontist, then the endodontist will recommend that you return to your dentist for the artificial crown. Usually an endodontically treated tooth has an increased risk of fracture without the protection of an artificial crown, so one should be fitted soon after treatment.
Typically made of porcelain or gold, the artificial crown is needed to:
- Protect, strengthen and further seal the tooth
- Restore normal function and occlusion (the way the upper and the lower teeth contact each other when biting and chewing)
- Restore an acceptable cosmetic appearance.
