Root Canal Treatment

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What is Root Canal Treatment?

Root canal treatment or endodontics is designed to save a tooth from needing extraction. This treatment aims to alleviate pain from a damaged pulp, in which the blood or nerve supply has been infected by decay or dental trauma. If you are experiencing moderate to severe tooth pain you may be in need of a root canal treatment. Other causes of pulp damage include: traumatic blows to teeth, leakage around old or loose fillings, excessive wear of teeth, and cracked teeth.

Tooth model for education in laboratory.

Root Canals: What are they?

A root canal is actually the part of the tooth: the living chambers and tubes inside the roots that contain blood vessels and nerves, or ‘pulp’. When you need a root canal treatment, it means that this pulp chamber has become infected by bacteria, and needs cleaning and a mini course of antibiotics to get rid of the infection. A tooth can function perfectly well without a pulp, as it is only required during tooth growth and development. A root treated tooth is ‘pulpless’ and not ‘dead’, it is still attached and supported by living tissue.

Root Canal Procedure: What to expect

During your first visit to assess a toothache, the dentist will take x-rays, and may perform tests to check the health of the painful tooth. If it is deemed that root treatment is a good option for saving the tooth, usually two visits are required- to clean and medicate the tooth so it is soothed; and once healed a second visit to place a final root filling, and external filling (or crown).

If you had a similar infection anywhere in your body, a doctor might prescribe a course of antibiotic tablets; the antibiotics swallowed spread through your bloodstream to the source of the infection, and the bacteria are killed. Unfortunately, teeth are a uniquely shaped part of your body.

When the tooth pulp becomes infected, the blood vessels inside die, so no antibiotics flowing in your bloodstream can actually get inside the tooth. So a root canal treatment aims to open up and disinfect the chamber inside the tooth and place antibiotic cream directly where the infection is. The dentist will place a plastic sheet (called a nitrile dam) over the tooth to keep it dry and sterile, like a surgeon’s sterile green drapes. It will allow you to swallow comfortably, and the water spray from the dental drill will not go into your mouth. The dentist will remove any decay as they would with a filling, but where dental drills will not reach deeper in the roots, sterile files will be used to clean and shape the canals. The canals are rinsed with disinfectants, and then antibiotic cream is placed in the empty chamber. The cream should be left to kill the bacteria for about 4 weeks (just like a full course of antibiotics would be taken over a couple of days), during this time a temporary filling is placed.

Root canal treatment must be followed with a root canal sealant. This is a follow up appointment that involves removing the antibiotic cream, drying the now sterile (bacteria and infection-free) canal inside the tooth, and placing a rubber-like or resin based material. This is to create a water-tight and bacteria-proof seal, with the aim of stopping the infection from coming back again. Next, the dentist places a crown or other restoration over the remaining tooth to protect it. Once restored, the tooth continues to function like any other tooth.

Root canals… do they hurt?

There has been a lot of misconceptions about root canal treatments. Endodontic treatment is a comfortable procedure and it involves little or no pain, as the tooth will be anaesthetised with local anaesthetic during treatment. This is no different from when a tooth is numbed for a filling. However, sometimes you may experience discomfort after an appointment. This may be due to inflammation in the tissues surrounding the tooth. Inflammation may take a few days to settle down and mild analgesics may be required. If you experience severe pain, or if your discomfort lasts for more than several days, you should contact your dentist for advice. (In the past, it is possible that dentists did this procedure without numbing, just like a lot of old-time dentists did fillings without numbing- so some people believe this is always a painful process. Not so! Modern dentistry aims for you to be comfortable, and out of pain. The dentist will always ask you if you do feel any discomfort at any stage to let them know- this for your benefit in case you do need more anaesthetic, please don’t just put up with discomfort because you expect that it should hurt!)

Occasionally patients will arrive in pain at the clinic because a tooth is badly infected and needs a root canal treatment. The dentist will quickly do some tests to work out which tooth is causing the problem. One the causative tooth is identified, the dentist will numb you up ASAP so you are out of pain!