What is Root Canal Treatment?
Root Canal Treatment is the process of removing the dead or dying nerve tissue within the tooth and filling the space with a rubber-like material.
Why is this treatment needed?
Root Canal Treatment (RCT) is mainly indicated when the nerve of a tooth begins to die. Normally this will cause a great deal of pain.
When this is the case the tooth can either be extracted or saved by performing the RCT.
Occasionally it may be necessary to perform this treatment on a healthy tooth when a complex treatment is necessary such as making over dentures or a cast-post crown (the dentist will explain this in more detail if necessary).
Why does the nerve die?
The nerve of a tooth will die when it is infected by micro-organisms (which cause decay). The infection may occur due to an open lesion, after a traumatic injury, or after a deep filling has been placed on a tooth.
When the nerve of the tooth starts to die it is extremely uncomfortable.
• a dull throbbing pain
• toothache which wakes you at night
• severe pain from contact with hot or cold
• severe pain when pressure is applied to the tooth
• abscess formation from around the tooth
When this occurs you will probably make an appointment to see the dentist due to the toothache.
The dentist will take a x-ray and discuss with you the most suitable treatment. The x-ray may also show that the tooth has an unusual root shape or a very limited life expectancy.
Often it will be best to simply extract the tooth.
Root Canal Treatment Procedure
Removal of the nerve- pain relief appointment.
The nerve space is filed out
The dentist will apply anaesthetic to remove the toothache.
A cavity will be cut into the tooth so that the contents of the nerve can be accessed. When good access is obtained the content of the nerve canal is cleaned out using thin files and chemicals. Then a dressing is placed in the root and a temporary filling applied.
For two to three days after this appointment it may be necessary to take pain relief as it takes time for the tooth to settle down.
You may be referred to a specialist due to the unusual shape or complexity of the root after this stage.
Shaping and filing of the root
This appointment is booked at least two weeks after the initial appointment. This is to give the tooth a chance to settle down.
The second appointment is a long time consuming one. Again anaesthetic is applied.
During this appointment the root of the tooth is cleaned and shaped so that a filling material can be placed into the root space.
The root space is filled with a rubber material to prevent re infection and the tooth is restored.
During this appointment a permanent filling is applied to the tooth.
Sometimes this appointment is not necessary as it can be combined with the second visit.
Why is it so expensive?
Root therapy is a slow meticulous procedure. To successfully perform the treatment you need to locate and remove all the nerve contents. This can be tricky as some teeth have very thin canals, highly curved roots, extra nerves and roots.
The dentist is also working with only visual access to the top part of the canal system. It is often difficult to work out what is happening. The dentist must rely on radiographs and some electrical devices to figure out the root shape.
What can go wrong?
Unfortunately a lot can go wrong during root canal treatment. Many dentists will refer you to a specialist when they are aware of a tooth which could cause problems. Often teeth will simply prove to be troublesome despite all precautions being followed.
Some common problems are
• The canals being so fine they cannot be found
• Unable to get to the end of a canal
• File breaking in the canal- although undesirable this may not lead to a problem
• Infection refusing to go away
Despite being an effective form of treatment, a root canal treated tooth will not last for ever. The process of performing the RCT weakens the tooth. Factors such as the location of the tooth, remaining natural tissue, and how clean the tooth is kept all influence the life expectancy of the tooth.
Does my tooth need to be crowned afterwards?
No, but ideally it should be.
Initially a large filling will be placed on the tooth and the tooth will be monitored for six months.
After six months a crown can be discussed providing the tooth has not had any symptoms and looks fine after an x-ray.
The process of doing a root canal weakens the tooth considerably as the centre of the tooth is drilled out and often the placement of a crown will maximise the strength of the final restoration.
If the large filling is sound and not causing problems it can be fine to leave, however, at this stage if a crown is desired for aesthetic reasons it can be arranged.