Ask the Dentist: A Helpful Guide to Root Canal Treatment
Ask the Dentist: A Helpful Comprehensive Guide to Root Canal Treatment
It’s one of the most dreaded dental procedures that a lot of our patients hate. But its important to know that if done properly and well, its no more difficult or painful than any other dental procedure. Lots of patients ask what is root canal treatment?, Why do I need root canal treatment?, How do I know if I need root canal treatment? What do you do during root canal treatment? And lots more. So I thought I’d shed some light from a dentist’s perspective to provide a helpful step by step guide into root canal treatment. So what is root canal treatment? Root canal treatment is a dental procedure that is required when the tooth becomes badly decayed and the nerve and root canal of the tooth is infected. Also known as root canal therapy (RCT for short), the procedure involves cleaning, and medicating an infected nerve or root canal of the tooth and then filling it with a root filling. Without treatment the blood vessels and nerves inside the tooth become severely infected and that’s when pus and abscesses form. After root canal treatment is can be quite common also for your dentist to recommend placing a crown on the tooth to give it maximum long term protection.
Why do I need root canal treatment?
You often come to the dentist with a toothache and in pain and your dentist tells you your tooth needs root canal treatment. Why? The purpose of root canal treatment is to eliminate the bacterial infection inside the tooth and to minimise the risk of future reinfections. Even though it is a long and tedious treatment, each stage of root canal treatment is performed to ensure that the risk of reinfection is as low as possible.
Before we can full appreciate what root canal treatment is and why we need it, we first need to understand that there are different parts to the structure of a tooth
Enamel - the hard layer that covers the top part of a tooth. The enamel is really hard and dense and protects the dentine and pulp from the external environment.
Dentine - this is the layer underneath the enamel and the dentine makes up the majority of the tooth structure.
Pulp - this is the middle or inside of the tooth that contains the nerve and blood supply. NOTE: The root canal are the tunnels inside the roots of the tooth that extend from the pulp
If a decayed or broken tooth is left untreated, bacteria enters the root canal and causes an infection of the nerve. Sometimes the infection of the nerve is so severe that an abscess forms inside the mouth. Other times, you may not even notice any pain or discomfort from a tooth that requires root canal treatment. When your tooth needs root canal treatment, it means that the bacteria from tooth decay has gone so deep into the tooth that the nerves and blood supply in the root canal of the tooth is compromised. There is a bacterial infection in the pulp (nerve and blood supply of tooth).
Once a tooth’s pulp and root canal have been compromised by bacteria, there are only 2 options to manage the tooth
Remove or extract the tooth
Perform root canal treatment on the tooth to keep it and save it
What happens if I don’t treat the tooth?
Severe pain and discomfort is going to be one of the problems of not treating the tooth. Without treatment the blood vessels and nerves inside the tooth become severely infected and that’s when pus and abscesses form. An abscess is swelling full of pus usually located at the end of the root canal because of the build up of the infection. The abscess can be so serious that it causes swelling around the face, eye or the neck. In these circumstances you may need to go straight to the hospital. Other problems to not treating the tooth include bone loss around the roots of the tooth
An abscess is swelling full of pus usually located at the end of the root canal because of the build up of the infection
What are the common signs and symptoms of a tooth needing root canal treatment?
abscess forming or pus coming out of the gums adjacent to the tooth that is infected
severe soreness and pain specific to a tooth
you can’t eat or chew on the tooth
high sensitivity to both hot and cold foods and drinks
spontaneous pain that isn’t triggered by just eating and drinking
What can I do to prevent root canal treatment?
brush 2 times and day and floss daily
visit your dentist every 6 months for regular check up and cleans. Regular maintenance avoids the major breakdown
if your dentist tells you there’s tooth decay on a tooth that needs a filling, please book yourself in to get the filling done. The longer you leave the tooth decay, the higher the chance the bacteria spreads and infects the nerve which leads to root canal treatment
It is important to understand that the cost of a root canal is what you’re going to value in saving and keeping your natural tooth in your mouth.
Brushing your teeth regularly, flossing regularly and visiting your local dentist every 6 months for regular cleans is going to cost A LOT less than having a root canal
Can I take antibiotics to fix a tooth requiring root canal treatment?
Taking antibiotics is not an option to fix an infected nerve because the tooth is in its own small ecosystem and so the antibiotics that we take can’t reach into the root canal and pulp to heal the tooth from the bacterial infection. The only situations where antibiotics can help are in really deep infections where there may be an abscess associated with the infected tooth or if you experience fevers. If there are any situations where your breathing is compromised or the swelling is very large and painful, please contact your dentist or doctor immediately.
Another reason why antibiotics aren’t always used during root canal treatment procedures is because the process of root canal treatment is what should primarily remove the bacteria from the inside of the tooth.
What happens during root canal treatment procedures?
There are 3 stages involved in performing and finishing root canal treatment on a tooth. Root canal treatment is very detailed and can be a long process, but each step of the treatment is performed to ensure that the risk of reinfection is minimised and so our patients get the best clinical results. A summary of the steps are shown in the table below
|Stage 1 - Extirpation||Rubber dam and clamp are placed. Small files are used to perform an initial clean of root canal to remove nerve, control infection, medicate tooth. It can take 20-45minutes depending on the complexity of the tooth|
|Stage 2 - Instrumentation||Rubber dam and clamp are placed. Detailed clean of root canal to ensure bacteria is controlled and tooth is pain free. It can take 30-60 minutes depending on the complexity of the tooth|
|Stage 3 - Obturation||Rubber dam and clamp are placed. Obturation is performed when the tooth is completely pain free. The root canals are filled with special gutta percha material to seal it up to complete the root canal treatment. It can take 30-60 minutes depending on the complexity of the tooth|
Here are the detailed explanations the 3 stages of root canal treatment
Extirpation: Initial clean to control bacterial infection.
a) Patient comes into our dental clinic at Seven Hills with a bad toothache or abscess in the mouth because the pulp of the tooth is infected.
b) A diagnosis is made for the tooth with percussion, palpation and cold tests and an x-ray.
c) Once it is confirmed that the tooth requires root canal treatment, we will inform you of the steps and costs involved
d) If you proceed with root canal treatment, we begin Step 1: Extirpation
e) Your tooth is numbed and a rubber dam and clamp is placed around the tooth. The rubber dam isolates the tooth and keeps it clean from saliva, but also prevents any risk of the small instruments we use during the procedure from fall down the mouth (See Figure 4)
f) After the rubber dam and clamp is placed, we make a small opening on the top of the tooth to clean the root canal with small files (See Figure 4)
g) We rinse the tooth with antibacterial solutions to eliminate the bacteria
h) We leave medicine inside the tooth and place a temporary filling on top until Step 2: Instrumentation
i) Usually there may be a bit of residual soreness in the first 24 hours after Step 1: Extirpation, but the majority of the pain and swelling should have subsided after 24 hours.
Instrumentation: Thorough clean and medicine
a) Patient usually comes in 1-2 weeks after the Step 1: Extirpation. In some cases, we may perform Step 1 and 2 of Root Canal Treatment in the same appointment but we will inform you if this is possible or not.
b) Step 2: Instrumentation is essentially the same as Step 1: Extirpation but we will be more thorough with cleaning the root canal so that we will eliminate all of the remaining bacteria and infection inside the root canals
c) We will take also take measurements of the length of the root canal and take x-rays to confirm the length. Ensuring that the entire length of the root canal is cleaned and filled will ensure that the
Obturation: Filling the root canal
a) Once we are sure the bacteria and infection are under control (no more signs and symptoms of soreness or discomfort from the tooth), we can place the root filling
b) We place the rubber dam and clamp on the tooth, we irrigate the tooth with antibacterial solutions, we dry the tooth, we place Gutta Percha (rubber points) into the root canals and make sure they’re extending the length of the root canal. Then we heat out the Gutta Percha to seal them inside the root canals
c) Once the Gutta Percha is placed, we’ll either place a temporary filling on the tooth or a permanent filling on the tooth, depending on what the next steps are.
Diagram showing the steps of Root Canal Treatment
Next steps? Are there side effects? What happens to my tooth after root canal treatment?
Does it need a permanent filling and/or a crown? Does it need a post? A post is sometimes used to allow more retention for a filling. This is often the case in situations where the original cavity was really deep and there isn’t a lot of tooth structure remaining. The post is placed inside the root and helps to retain a permanent filling and often a crown is placed as well
There are no real side effects besides the tooth feeling different because the nerve is missing. There is a misconception that you shouldn’t have root canal treatment because it harbours bad infections inside your mouth. But this is not true. There is no scientific evidence to suggest any harmful side effects of root canal treatment.
It is important to know that after root canal treatment, your nerve is no longer inside your tooth and so you won’t have any feelings or sensations to hot and cold sensitivity from that tooth. Because of this, it can often feel funny and different when you bite onto the tooth with root canal treatment
The tooth will feel different. Some patients have described it to be like a dead arm or numb arm or leg, where you feel it but it feels dull and weird.
What about a crown? My dentist told me to put a crown on my tooth after root canal treatment. Why?
Depending on the tooth, it is quite common for your dentist to recommend placing a crown over the tooth within 3 months after root canal treatment, to provide maximum protection for the tooth in the long term.
The reason for this is because a tooth that has undergone nerve infection and root canal treatment is weak and brittle. We put a lot of biting forces on our back molar teeth when we eat and chew, so placing a crown on the tooth provides the tooth the necessary strength and durability it needs to go the distance.
Root canal treated teeth last longer with crowns. In one study by Pratt (2016), one of the remarks made were that ‘Endodontically treated teeth which received an amalgam or composite build up restorations were 2.29 times more likely to be extracted. Compared to Endodontically treated teeth that received a crown.’ The study also said ‘Teeth that received a crown 4 months after root canal treatment were 3 times more likely to be extracted than those that received a crown within 4 months of root canal treatment.’
We hope this article has been helpful for all our patients, especially those in the Blacktown, Seven Hills and Western Sydney. We want to provide you with the best dental and oral health education, so that you know why and how these teeth, gum, mouth and oral health problems can occur and what we can do to prevent it and treat it to achieve the best results for you and your family.
Disclaimer: All information provided on this website is for informational purposes only. This website does not provide medical advice, diagnosis or treatment.