Root Canal Treatment

What is root canal treatment?

iStock_000004537309MediumRoot canal treatment is part of an area of dentistry known as endodontics. It involves cleaning the space inside the tooth called the root canal system then placing an inert rubber based root filling. It is undertaken to treat or prevent an infection occurring both inside and beyond the root of the tooth.

Why is root canal treatment needed?

Treatment may be required when the “nerve” tissue pulp becomes injured or dies due to extensive decay occurring in a tooth, a deep, fractured or leaky filling/crown, repeated replacement of fillings, extensive gum disease, tooth injuries, developmental problems or when a crack affects the tooth structure. These problems allow bacteria to cause inflammation of the pulp resulting in dental pain or if the pulp dies it leaves a space that can allow the bacteria to create a localized infection. If the infected pulp space is not treated, pain and swelling can result, sometimes with abscess formation. Without treatment, there is a risk of progression of infection that could affect the success of treatment. If root canal treatment is not desired or the treatment is not feasible, then thought may need to be given to removal of the tooth.

Does it hurt?

Local anaesthetic is used so it would generally feel no different to having an ordinary filling done. The treatment is much more complex and time-consuming, therefore the appointments are usually much longer. Rarely the local anaesthetic may be less effective if the nerve tissue is significantly inflamed, but there are a number of ways to overcome this. There can sometimes be a degree of post-operative discomfort that can generally be managed with mild painkillers.

What does it involve?

root-canal-treatment-before-after

Following local anesthetic, the placement of a rubber sheet (rubber dam) and metal securing clip over the tooth allows the prevention of contamination and improved safety/efficiency of the treatment. The initial stage of treatment involves gaining access to the root canal system via an opening made in the crown/ filling of the tooth. Negotiation and cleaning of the small spaces within the tooth is carried out with fine instruments and magnification may be required. X-rays are required before, during and after the treatment to gauge progress. The final stage involves placement of the definitive rubber based root filling and a filling to seal the opening. Root canal treatment is a technically challenging and highly skilful and time-consuming procedure. Thus most courses of treatment are distributed into multiple appointments An antibacterial dressing and temporary filling is used between each appointment.  Occasionally, it may be possible to carry out the treatment in a single long appointment.

What are the risks associated with root canal treatment?

The number of risks are minimised by the high standard of care. Sometimes unforeseen problems can occur and may include the followings: Pain during treatment; Discomfort after treatment; Leakage of antiseptic agents into the mouth; Tooth fracture; Failure of canal location and negotiation; Blockage of root canals; Fracture of files in the canal; sometimes fragments may be retained and form part of the root filling; Root perforation (hole in root); Extrusion of antiseptic through the tooth into the surrounding tissues; Failure of the treatment to control the associated infection and acute flare-up.

Can all teeth be root canal treated?

Whilst it is possible to root treat most teeth, if the tooth has a deep crack or there is insufficient remaining tooth structure for the tooth to be predictably re-restorable, then root treatment may not be viable option. Occasionally, internal problems such as severe narrowing or blockage of the canals can compromise the technical result that can be achieved.

What happens if treatment is not carried out?

For a symptomatic tooth that cannot be treated by other means, the alternative is to have the tooth out (extraction). Once the nerve tissue is destroyed, it can’t heal and it is not recommended to leave an infected tooth in the mouth. For some people extraction may be a preference, although generally preserving the natural teeth with root canal treatment if viable is often more desirable.

Can root treated teeth discolour?

A root filled tooth can sometimes darken after treatment. If there is any discolouration, there are several treatments available to restore the natural appearance.

What are the chances of success of the treatment?

When root canal treatment is carried out to high standards it is very successful and we expect this in the majority of instances. However, success of the treatment can never be predicted with certainty or guaranteed.  Failure is a possibility in a small proportion of cases and is usually due to persistent infections. The success rate in those cases where there is no inflammation around the end of the root is of the order of about 96% with specialist care. The success rate for those teeth with inflammation around the end of the root is about 85%. Re-treatment success can range from about 40% – 80%. In case of treatment failure, re-treatment, surgery or tooth extraction may need to be considered.

What happens after my root canal treatment?

On completion of the root canal treatment, the tooth will be restored with a filling. For front teeth this may be the definitive restoration. For back teeth, a separate permanent restoration, such as a crown would be recommended to protect the tooth from fracturing. This would have separate costs associated. It is also important to monitor the tooth, which requires periodic x-ray pictures for comparison. The healing can take anything from six months to four years and sometimes longer.

Will the tooth need any further treatment?

Ideally yes. It is often better to restore the tooth with a crown to provide extra support and strength to the tooth.

Where can this treatment be carried out?

Root canal treatment is normally a routine dental procedure, which your dentist will generally be happy to provide for you at the Practice. The complexity of the treatment can vary significantly and sometimes referral to a Specialist Endodontist is advisable or desired by the patient.

We are fortunate to have Mr. Robert Crawford, Consultant in Restorative Dentistry, based at the Endodontic Unit of the Eastman Dental Hospital & Institute, London, who is a registered Specialist Endodontist, working with us at the Atkinson Brignall Practice. Higher fees for specialist treatment should be anticipated, reflecting the extra level of expertise.

Do I need to treat the tooth any differently?

Root-treated teeth should be treated just the same as any other tooth. Remember to clean your teeth twice daily, preferably with a fluoride toothpaste. If the initial need for root treatment was due to decay, it is best to cut down on sugary snacks, and keep them only to mealtimes if possible. See your dentist for regular check-ups.