Root canal treatment, also known as endodontics, is a dental procedure designed to treat infection or irreversible inflammation of the nerve or pulp of a tooth. This may be caused by deep decay, a fracture of the tooth, or severe periodontal disease. The purpose of it is to allow a tooth, without a living nerve, to remain in the mouth without sensitivity or pain when chewing while retaining function and cosmetic appearance. When a nerve dies in a tooth it is referred to as “non-vital”. Although it can be painless at first, it is still infected and the balance of bacteria could be upset and an abscess (swelling with a collection of pus) can form at any time. Root canal treatment is designed to save the tooth and prevent the spread of infection. The inflamed or infected pulp is removed from the tooth and the root canal is then cleaned of all bacteria. After the bacteria have been removed, the root canal and pulp are filled in using a rubber filling, before being sealed.
Why would I need a root canal?
Your dentist would suggest for you to have root canal treatment for one or more of the following reasons:
-The nerve of your tooth is dying or has already died. This is the most common reason for a root canal treatment to be performed. It is likely to happen because of deep tooth decay or an existing deep filling. More rarely it can happen due to trauma or a cracked tooth.
-An abscess has formed. You most likely have an abscess if you have an existing swelling or if a tooth is very tender to touch or bite on. It may feel that the tooth is raised from its socket or even mobile due to the existing swelling in the bone. This symptom is not necessarily from a tooth as it can also be due to a gum infection and need a completely different treatment altogether. Your dentist will need to assess it to be able to suggest the necessary treatment.
-Significant sensitivity. If severe sensitivity from a tooth is affecting your lifestyle and all other more conservative treatments have failed, root canal treatment can be performed as the last resort.
-A post is required. If you want to have a tooth restored but there is not enough tooth tissue for a restoration to be retentive, a post will then need to be inserted in the root of your tooth and occupy the space of the nerve. The post will act as foundation for a more retentive crown to be placed on top.
-Extensive restorations (Elective root canal treatment). On occasions, when you are having cosmetic dental work done – particularly crowns, veneers or bridges, the shape of the tooth may need to be substantially altered.
-Severe misalignment of teeth When teeth are very misaligned the nerve may be exposed. In this case, a root canal treatment must be planned and performed. Orthodontics should be considered as an alternative to reposition the tooth/teeth thus making the root canal treatment unnecessary and preserving your natural teeth.
-An overdenture. If together with your dentist, you decide that it is best to keep some roots for precision attachments to help hold in your denture or simply to preserve the supporting bone, then the roots of these teeth will need to be root filled and sealed. This will ensure that you can avoid infection, pain and spread of decay that will eventually require them to be extracted.
-Sclerosis (narrowing) of the nerve canal. If you have knocked or banged a tooth then sometimes the tooth responds to the shock by laying down more dentine and making the nerve space smaller. Progressive x-rays will show the space where the canal is position become smaller. At this stage root canal may be considered while the root canal space is still accessible. However, this is case specific as studies have shown that only 15% of these “sclerosed teeth” can potentially cause problems in the future.
What signs and symptoms would suggest that I may need a root canal?
Signs you may notice:
A sinus is a little tunnel or tube that connects the end of the root where the pus collects through the bone and into the mouth as an attempt to drain the pus and relieve the pressure building up. Often this does not cause pain as the pressure from the infection if relieved and according to the bone thickness this track’s outlet may be far from the tooth in question. Once this track gets blocked, the pressure build up and the pain and swelling develop.
A swollen face (an abscess)This indicates a collection of pus has formed and is generally a sign of an infected tooth. Whilst this could be of tooth or gum origin, in our experience a facial swelling is more likely to be associated with a necrotic pulp (a dead nerve).
A large cavity (tooth decay) If you have half of your tooth missing or a large area of decay, the nerve will no doubt be involved to some extent. It may be just that the tooth needs to be restored but there is a risk the the nerve is already dead or damaged beyond repair.
Symptoms you may notice:
- Pain that lasts for minutes or hours (not seconds) after a stimulus such as hot or cold temperature
- Pain that wakes you up at night or disturbs your sleep
- Pain when you touch a single tooth
- Pain not relieved entirely by traditional painkillers
- Pain when you bite down (though a problem with the bite, such as a high filling and a couple of other potential issues must be ruled out)
- Pain that occurs spontaneously with any with/without any stimulus such as hot or cold
- A bad taste in your mouth (when combined with other symptoms above – not in isolation)
What is the success rate of root canal treatment?
The success of a root canal treatment at 10 years is reported to be:
90-95% for an initial root canal treatment (first attempt) if there is no area visible around the end of a the root on an x-ray
80-85% for an initial root canal treatment if the is an area associated with the tip of the root on an x-ray
65% for a re-root treatment (i.e. following an unsuccessful first attempt) or if pus is evident at the start of the treatment.
General dentists perform root canal treatments everyday but there are specialists, called Endodontists, in this field of dentistry. They have additional training and experience, and they specifically treat these conditions with specialised high-tech equipment . As a result the success rate of their root canal treatment would be higher.
What is the clinical procedure for a root canal treatment?
Root canal treatment is a long procedure and our endodontist will complete it in one or two visits.
Each appointment is normally around 90 minutes, depending on the situation. If the case is very simple and the tooth only has one canal, the whole treatment may be completed in just one visit.
On the other hand if a tooth is heavily infected, extra appointments may be needed to dress the tooth.
The specialist will use local anaesthetic to make you numb to ensure you are comfortable, relaxed and pain free. Your tooth will be isolated with a “rubber dam”, a rubber sheet that is stretched over your tooth and secured with a metal clamp for form a water-tight barrier. The endodontist will then gain access to the nerve space. It will feel similar to having a filling. The root canals will be located and any nerve tissue will be removed. The canals will be cleansed, disinfected and measured with the assistance of x-rays and other instruments. If the canals are free from infection the root filling will be placed. If not, the tooth will be dressed with medication and a provisional filling will be placed on top. You may need further appointments to have the tooth cleaned again and re-dressed with medication.
Following a root canal:
- A filling is always needed (referred as a core if a crown is planned)
- If the remaining tooth is weak then a post will need to be placed
- Teeth with posts must have a crown fitted
- Posterior (back) teeth should be crowned to avoid fracture
- Anterior (front) teeth don’t necessarily need crowns
Root canal treatment is commonly perceived as being a painful procedure. In fact, in the hands of a properly trained dentist, root canal treatment is relatively painless, and it should be no more unpleasant than having a filling done.
At The Kensington Dentist, we have a specialist endodontist Dr David Jones who has many years of experience and has completed post graduate education solely in endodontics that his resulted in his being registered in the specialist list of the General Dental Council. He is available for simple or more complex root canal treatments.
At The Kensington Dentist, we make sure that the risk of failure is minimised by using best practice techniques and high tech equipment to locate the ends of the roots, ensuring the filling reaches the entire length of the root canal.