Root canal treatment (endodontic treatment) is required when the living tissue (the pulp) inside the tooth becomes inflamed or infected.
The pulp contains the nerves and blood supply to the tooth and may become damaged by deep decay, trauma or cracks in the tooth structure. When pulp damage occurs, early symptoms are often toothache and sensitivity to hot or cold. In the longer term, the space inside the tooth (the root canals) becomes infected with bacteria. At this stage, pain is frequently experienced when biting or the tissue around the tooth may become swollen (an abscess).
Treatment involves removal of the inflamed or infected pulpal tissue and sealing of the root canals to prevent future infection. This allows the natural tooth to be retained in form and function. In most cases, a natural tooth looks and functions better than an artificial replacement.
Root canal treatment is carried out under local anaesthesia and is normally a painless procedure. Although patients are frequently fearful of having treatment, the tooth is fully anaesthetised prior to treatment and should not feel any different from having a normal filling.
The tooth is isolated with a rubber sheet to prevent infection of the tooth by bacteria from the mouth. An opening is prepared in the biting surface of the tooth to access the root canals. The canals are shaped using fine metal instruments and a disinfectant is used to wash out pulp tissue and kill bacteria. The root canals are then sealed using a rubber-like material, which prevents re-infection of the root canal system.
Treatment is usually carried out over one or two visits of approximately 90 minutes to 2 hours. Treatment takes a long time due to the complexity of the treatment. Most patients choose to watch a DVD to pass the time during treatment.
Extraction of the tooth is the only alternative to root canal treatment. Loss of teeth can sometimes result in movement of adjacent teeth and can cause difficulty when eating. If the tooth has to be removed, it can be replaced with a denture, a bridge or a dental implant.
Root canal systems are often complex structures and root canals may be very fine and difficult to clean effectively. An endodontist has undertaken three or more years of postgraduate training and has the experience and equipment to deal with complex cases. Treatment is carried out under a surgical microscope to aid the management of complex anatomy.
Teeth may need root canal re-treatment for several reasons:
After root canal treatment has been completed, a filling or replacement dental crown is provided to replace the lost tooth structure, prevent tooth breakage and to seal the tooth against bacteria from the mouth. The final restoration is as important to the survival of the tooth as the root filling itself. Molar teeth usually require crowns, to prevent the tooth from splitting, but if minimal tooth structure has been lost, a crown may not be necessary.
It is normal to experience pain for a few days following root canal treatment. Painkillers are usually sufficient to control the symptoms although in some infected cases patients experience a ‘flare up’ after treatment, which is normally helped with a course of antibiotics.
Thanks to our in-house london endodontist for this article.