Root canal therapy (also known as endodontics) is the treatment involving the removal of blood vessels and nerves from a tooth which may be infected and/or damaged. It may also be required to remove a “live” nerve from a tooth (sometimes known as “elective root canal therapy). Root canal infection can be caused by a number of factors including decay, injury and possibly also gum disease. Root canal therapy may be the only way to repair your tooth if it has been badly damaged by infection.
Why is root canal therapy necessary
Your teeth have a core of blood vessels and nerves at their centre. This living tissue is called the pulp and is in a space called the root canal. The number of root canals in each tooth varies depending on how far back it is in your mouth. Front teeth often have one root canal, while back teeth may have three or more. If your tooth is injured or has deep decay, the pulp can be damaged and the blood vessels may die. A “dead” tooth is likely to get infected. Without treatment, a dental abscess (collection of pus) can form as the bacteria multiply and are forced beyond the end of the root. As the collection of pus is trying to expand within the bone, the tooth may rise slightly out of its socket and feel tender when you bit down.
If left untreated, the infection may spread to the nerves and surrounding tissues and cause nausea, fever and difficulty in swallowing.
What are the alternatives to root canal therapy?
Once the nerve of the tooth is infected or damaged, root canal treatment becomes the only means of retaining the tooth. Antibiotics will only treat the effects of the problem and not the cause; therefore, they are only a temporary solution. However, if the tooth is symptom free, it can be left untreated if preferred, at the risk of future pain and possibly loss of the tooth. If your tooth is seriously damaged by decay or injury, or the support of the tooth is compromised by gum disease, then it may be advisable to extract the tooth. The tooth can then be replaced by means of a denture, bridge or dental implant. In some cases the tooth may not be replaced at all.
The diagnosis will be made on the basis of your dental history, clinical examination and dental X-ray(s). The treatment is carried out under local anaesthetic. In certain instances, a sheet of thin plastic called a rubber dam (which is held on with a metal clamp) is paced over your tooth to separate it from the rest of your mouth. This helps to keep the tooth dry and to stop bacteria from your saliva getting onto the root being treated. Most patients find the rubber dam comfortable. If the tooth is in an accessible area, isolation of the tooth can be achieved with cotton wool rolls.
At the first appointment, the nerve space of the tooth is accessed through a small opening in the biting surface of the tooth (even if the tooth is covered by a crown or bridge). With the aid of magnification and a series of fine files, canal(s) are located. At the second appointment, the space in your canal(s) created by cleaning out the pulp will be filled using a rubber like substance called gutta percha. In very simple cases the root canal treatment can be carried out in a single visit. This permanent root filling will be sealed with a temporary top dressing, ready for your dentist to place a new filling. It is recommend that the molars and premolars (back teeth) should be covered by a crown if they are not already so.
Deciding on treatment
Root canal therapy is often the only way to repair your tooth when the pulp has been severely damaged. The success of root canal depends on a number of different factors and can vary considerably. For example the success rate of a first time root canal treatment is up to 98%; whereas if the root canal treatment has been carried out before the success rate is less than 80%.
Complications are unexpected problems that can occur during or after the procedure. Most people are not affected and they are quite rare.
In rare circumstances the complications of root canal therapy include:
- It is possible for a bit of an instrument to break in your root canal. Since we use new instruments for each patient and they are used only once, the chances of this occurring are very slim. In most cases it can be taken out again or bypassed. The files are titanium based (inert metal, like any implant material) and they do not have any side effects if left in your tooth.
- Infection due to a canal not being cleaned or filled at all due to complex anatomy.
- Certain bacteria may not respond to root canal therapy, so it may fail.
What to expect after root canal therapy
If you are being treated over more than one visit, it is advisable that you avoid chewing or biting down on the tooth, especially on hard foods, until your treatment has been completed.
When your treatment is finished you should not feel any pain in your tooth but it may feel quite sore as if it is bruised for a couple of weeks or even start to be uncomfortable after several days. Painkillers such as those you would normally take for a headache should relieve any discomfort. Alternating Ibuprofen (400 mg) with Paracetamol (1g) every 4 hours is usually very effective. The intensity of the discomfort should start to decrease. Please ensure that you arrange a follow-up appointment with your dentist in order to replace the top temporary dressing with a new filling or a crown on the tooth. Failure to seal the tooth permanently in time could jeopardise the success of your root canal treatment. If you feel that your post-treatment discomfort is increasing or you notice a swelling of the area, please do not hesitate to contact the surgery for advice.
If you follow the recommended instructions and look after the tooth along with the other teeth, a root filled tooth should continue to function very well for many years.
I hope this explanation has sufficiently answered most of your questions. If you like more information or would like to discuss any issues further please contact the surgery and we will try our best to assist you with your enquiry.