Root Canal Treatment
Root canal treatment, also known as endodontic treatment, is a dental procedure performed to save a severely damaged or infected tooth. During the treatment, the infected pulp inside the tooth is carefully removed, the tooth is cleaned, disinfected, and filled with a rubber-like material, ultimately relieving pain, preserving the tooth, and restoring its function.
WHAT IS ROOT CANAL TREATMENT?
This is a very common dental procedure and can be performed by specialist endodontists and general dental practitioners. It is a very skilled and time consuming procedure. Root canal treatment (also called endodontic treatment) is required when the blood and nerve supply of the tooth is infected through decay or injury. All our teeth contain soft tissue, called the pulp. When this pulp becomes diseased or damaged it needs to be removed to prevent infection and unnecessary pain.
HOW DOES IT WORK AND DOES IT HURT?
Most patients are filled with fear if they hear the term Root Canal Treatment. Treatment can be carried out over 2 visits to make the treatment more comfortable. If you are in a lot of pain when you attend for treatment then you may need more than one local anaesthetic in order to numb the tooth sufficiently to carry out pain free treatment. You will usually be asked to have a seat in the waiting area for 10-15 minutes as the local anaesthetic may take longer to work. You may also need further local anaesthetic during the treatment if the tooth is still uncomfortable. In order to relieve your pain the dentist needs to relieve the pressure that has built up inside the tooth. In severe cases or where infection is present the local anaesthetic may not take effect sufficiently to allow treatment to be carried out. This is because infection stops the anaesthetic from working, in this case you will be prescribed a course of antibiotics to reduce the infection and another appointment will be booked a few days later for treatment. The best way to reduce your pain is to have treatment rather than antibiotics.
If pain arises from a tooth it may have become infected and require root canal treatment (RCT). Tests will include vitality tests, to check whether the nerve in the tooth is alive/dead, percussion tests to check for any infection around the root of the tooth and digital xrays to check for any signs of infection around the tooth. The results of these tests will decide whether the tooth requires an RCT. This treatment can be done over 1 or 2 visits and for complicated teeth may require further visits. During the first visit the infected tooth tissue and dead nerve of the tooth is removed so that it stops the toothache. Any abscesses that may be present can also be drained at this time. A temporary dressing is placed and the tooth is left to settle. During the second visit the canals are cleaned and disinfected and then filled with a root canal filling to prevent re-infection.
DETAILS OF THE PROCEDURE
The tooth is anaesthetised to ensure that the treatment is carried out comfortably and without any pain. The tooth is then isolated with a rubber dam to ensure that the field is kept as sterile as possible and free from bacterial contamination from the saliva in the mouth. Wearing a rubber dam will feel strange at fist but most patients feel reassured that nothing is going to drop into the mouth during the treatment.
Flexible, titanium, rotary files are then used along with specialist rotary motors to ensure that the tooth canals are cleaned and shaped efficiently. These files are only used once in order to minimise the risk of fracture and reduce the risk of cross infection. We use high tech equipment such as apex locators to establish the length of the canals accurately and to reduce the radiographic dose to patients. The canals are thoroughly cleaned with powerful disinfectants to destroy the majority of the bacteria colonised within the root canals. Finally the cleaned root canals are filled with gutta percha root canal filling material to prevent re-infection of the tooth.
The tooth is then restored with a direct filling and will require a crown soon after root canal treatment to prevent the tooth from fracturing or root canal leakage. This is because after root canal the tooth becomes structurally weaker. You may experience some post operative pain which usually settles down with painkillers.
The alternative to a root canal treatment is to have the tooth extracted. Once the pulp is destroyed, it cannot heal and it is not recommended to leave an infected tooth in the mouth. Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible. If the tooth is very badly broken down or loose then it may be better to have the tooth extracted. Your dentist will discuss the options with you and each case needs to be assessed individually, taking all factors into account.