Root Canal Treatment
Root canal treatment (also called endodontics) is needed when the blood or nerve supply of the tooth (known as the pulp) is infected through decay or injury. Root canal treatment aims to eliminate the bacteria from the infected root canal, prevent reinfection and ultimately save the tooth.
In many cases you may not feel any pain despite there being an infection present around your tooth. You may however notice one of the following problems:
If root canal treatment is not carried out, the infection will spread and the tooth may need to be taken out.
Prior to root canal treatment, a thorough assessment including a dental xray will be required to diagnose the problem. The aim of the treatment is to remove all infection from the root canal. If a tooth requires root canal treatment, prior to treatment the tooth will be numbed using local anaesthetic. A rubber dam sheet will be placed over the tooth to allow through and safe disinfection. A small hole is made into the tooth to allow access to the infected root which is then cleaned using a variety of specialist instruments. Once the root is disinfected, the root space is filled to prevent any further infection.
Root canal treatment is a skilled and time-consuming procedure. Most courses of treatment will involve two or more visits to your dentist.
Root canal treatment is technically demanding. During root canal treatment there are risks including separating an instrument within the canal, failure to negotiate to the full length of the canal or perforating the side of the root. These risks are generally uncommon and prevented with modern techniques and magnification. If this occurred during your treatment, it may reduce the chances of success and we would discuss this with you at your visit.
Immediately after the root canal treatment there may be some slight tenderness, but usually over-the-counter pain killers alleviate the discomfort. If the tooth had a large infection there is a small risk of a flare up in response to the treatment, which in rare cases requires antibiotics in conjunction with completing the root canal treatment.
Root canal treatment is usually very successful. A 90% success rate has been shown over 10 years. However, if there was a large infection prior to the treatment, the success rate lowers to 70-80%. Problems can occur if the tooth develops decay or the filling/crown on the tooth fails. It is hard to predict which teeth may fail in the future. However, the risk can be minimised by regular attendance to see your dentist and following any advice they provide. It is commonly advised to consider a crown after root canal treatment as the tooth structure can become more brittle. This makes it more prone to tooth fracture. If the tooth breaks in a position it cannot be restored, the tooth will then need to be extracted.
Teeth that have had root canal treatment can last as long as natural teeth, however, in some cases the treatment can fail, and symptoms can persist. This may happen shortly after the treatment has been performed or even years following the treatment. In these cases, it may be possible to carry out the treatment again, a procedure called endodontic retreatment.
The treatment of a root canal infection is primarily with the use of disinfection solutions. If we are unable to disinfect all of the root canal, for example, in narrow or curved canals the bacteria will persist. If the filling or crown on top of the tooth is lost, or decay develops underneath, this can reinfect the root canal space. If the tooth develops microcracks, this can also lead to reinfection and failure of the root canal.
Once the pulp is destroyed it cannot heal, and it is not recommended to leave an infected tooth in the mouth. When this infection is left, you risk developing toothache and/or an acute infection causing facial swelling which may make treatment more difficult.
The alternative to root canal treatment is to have the tooth extracted. Although some people would prefer to have the tooth extracted, it is usually best to keep as many natural teeth as possible as replacement options are never as reliable as your natural teeth. Loss of a tooth could create a functional problem such as chewing or an aesthetic problem. Restoring the lost tooth may involve the provision of a prosthetic replacement such as a denture, bridge or a dental implant.
Root canal treatment is a routine dental procedure, which your dentist will be happy to do for you. However, sometimes your dentist may refer you to an endodontist, who is a specialist in this type of treatment. Re root canal treatment is often undertaken by an endodontic specialist as they are often more challenging and require additional equipment that might not be available in general practice.
Your dentist will be able to advise the fees for having root canal treatment. The cost of the treatment will depend upon the type of tooth to be treated; molar teeth will be more expensive than incisor teeth as they have more anatomy to treat. If your dentist thinks you would benefit from a crown post treatment, this will also be advised at additional cost.
Occasionally a tooth cannot be saved. Root canal treatment can only be performed if the root canals are accessible and can be adequately cleaned and sealed. The tooth must have enough healthy tooth remaining and have sufficient bone support. Root canal treatment will only be suggested where a good long-term outlook can be expected.
Antibiotics are sometimes used to treat a dental abscess in the short term. They are not used to treat infection within the pulp space as the antibiotics do not effectively reach this area. In the long term a tooth with an infection requires root canal treatment or extraction to eliminate the infection.