Root canal treatment – Sounds serious !
Teeth are living parts of the body. They comprise of a hard outer covering enamel, a softer and yellower material under it called dentine and a nerve and blood supply to the tooth located in a little compartment inside called a pulp chamber. This nerve can become inflamed resulting in sensitivity, tooth ache and /or a dental abscess. Root treatments are required when the damage to the nerve is irreversible. It is necessary to clean out the space where the nerve lies and to seal that space to prevent further infection spreading, which can be even a life threatening condition.
Now, dentists know that the root canal treatment is one of the most dreaded treatments patients can think of, often compared with extractions. Please do not fear this treatment. There is really no need o worry. After all you will keep your own tooth instead of loosing it and being left with annoying and not too aesthetically pleasing gap between your teeth. Please forget all these scary stories you may have heard. They are usually based on 30 years ago go-around-gossip, which have nothing to do with today’s development with both, dental anesthetics and techniques.
If your dentist has recommended that one or more of your teeth require a root canal treatment, it is because of one of the following reasons:
- Decay exists and reaches the nerve of your tooth;
- Decay exists and its removal would involve the nerve of your tooth;
- The nerve has been irreversibly irritated following the provision of a deep filling, inlay or crown;
- The tooth is affected by the gum disease, tooth wear, erosion or abrasion.
- Your tooth has an abscess because of decay or trauma; or
- You would like a misaligned tooth to be ‘straightened’ by way of a crown and where in so doing, the preparation involved would reach the nerve.
Root canal treatment can take one or a number of visits depending on how complex the shape of the nerve canal system is or how soon the infection settles. Several x-rays will be taken prior and during the procedure as well as after to monitor successful treatment in years to come.
How do we do root canal treatments ?
First a small tooth x-ray will be taken to check the anatomy of the root (-s), the area surrounding the tooth – we are checking for visible signs of existing infection, a cyst, an abscess etc. We need this initial x-ray also to measure the length of the roots (root canals). Local anesthesia will be offered to make sure that you won’t feel a thing while your dentist and a dental assistant work on your poorly tooth. The treatment is incredibly technique sensitive and often challenging due to a complex nature of root canal system in the tooth, especially in the back teeth called molars. More and more often magnifying loupes or microscope is used to obtain the optimum precision. There are many different techniques used to clean and shape root canals. These involve using multiple fine machine operated metal instruments called files.
There are usually 3 or 4 main root canals that the dentist can get access to, and a very complex dense net of tiny, microscopic wavey, curly root canals, that we cannot reach even with the most advanced machinery. This is why we use lots and lots of strong disinfecting liquids, to rinse out as much bacteria and infected tooth tissue as possible. We want to make sure that we have cleaned the inside of the tooth the best we can.
After we have done that, we dry the inside of the root canals in preparation to fill them with paste like sealer and a rubber -like material called guttapercha. We take a final x-ray, and the most important part of the treatment is completed. Now the dentist will place a liner which will be perfectly sealed onto the cavity, to prevent bacteria from re-accessing root canal treated tooth and re-infecting the tooth.
Okay, now the root canal is done, what next ?
Now the crown or a filling will be placed to strengthen the tooth and extend its longevity in your mouth.
The success rate of root canal treatment (endodontic therapy) is about 80-95%. However, despite the best techniques being used, success cannot be guaranteed, especially in teeth with complex nerve canal anatomy (molars which failed root canal therapy reaches 25% of all failures).
Many factors affect the success of the treatment: your general health, condition of the nerve and the root canals(s), bone support around the tooth, strength of the tooth (fracture lines), etc.
If the treatment spans several appointments, you will have a temporary filling placed on the tooth to protect the canal(s). If the filling should come out, please call the practice so the dentist can quickly replace it. You shall not be charged for this.
Please remember, once treatment has begun, it is absolutely necessary that the treatment is completed, and the patient must diligently follow any and all dentist’s instructions.
Root canal treated teeth have no nerve but they can still decay, cause abscesses, diffused infection that apart from pain can cause far reaching general medical complications. It is important to take care of root canal teeth just as you would of any other tooth.
What do I need to know before having Root Canal Treatment ?
Following a root canal treatment, you may experience some of the following:
Root canal treatment is a very traumatic procedure for a tooth to undergo. It involves the removal of either irritated or infected nerve material. Just like with fillings, a root canal treated tooth can be sensitive both during and after final treatment. Usually this sensitivity disappears in several weeks. If it does not or appears to worsen, please call the practice to let your denist know.
The roots need to be systematically filed and disinfected and the filled to the optimum length. As such, it is common for the area treated to feel ‘bruised’ for up to a month after treatment.
However, severe pain, or pain lasting longer than this should be addressed and it is important to book in with your dentist.
TOOTH OR FILLING FRACTURE
During a root canal treatment, by definition, the nerves and blood supply are removed from the tooth. This coupled with the fact that extensive tooth tissue is removed to find the root canals, may result in chipping or fracture of a filling, or in some cases, of the tooth.
One of the main reasons root canal treatment fail is because of breakage or fracture of the tooth. A fractured tooth (especially a vertical fracture) can require extraction of the tooth. One of the best ways to prevent fracture of a root canal tooth is to have a crown put over the tooth to strengthen it. Other causes of fracture include grinding of teeth, improper bite, trauma, extensive loss of tooth structure, etc. These fractures can occur before, during or after the treatment and often are invisible and/or hard to detect.
A crown is usually recommended for any tooth that has a root canal treatment. This is because root canal treated teeth no longer have a blood, nutrition supply to them and become more brittle than your other teeth. This is especially true of your back chewing teeth (the molars and premolars). A crown goes over the tooth to strengthen it and protect it from breakage (read my article on crowns and bridges). Having a crown put after root canal therapy extends the longevity of the tooth in your mouth for many many years.
Therefore, where possible, a fractured tooth can be strengthened and supported by placing a crown. In fact, clinical trials have shown that 30% of root treated teeth require a crown within 5 years.
Bacteria are minute. Even the tiniest discrepancy in a root treatment may be sufficient for them to harbour, breed and eventually cause an abscess. Sometimes there may be ‘accessory’ root canals, which we are unable to gain access to, or it may be that the root filling is slightly short, or slightly long. Often we can do absolutely nothing to prevent this from happening, but fortunately it is rather rare complication.
If you experience pain or swelling in the gum adjacent to the tooth, pain on biting or pain that keeps you awake at night, then it is likely that you have an abscess. Should this happen, it is important that you see your dentist, who may issue you a prescription for antibiotics, or may elect to re-root treat the tooth, or sometimes remove the tooth.
When the nerve and blood supply are removed from a tooth, a blood protein called haemoglobin gets incorporated into the tooth tissue. This breaks down and can impart a greyish discolouration to the tooth. But don’t worry we are very successful in bringing your tooth to it’s ‘before’ shade using a simple procedure called non-vital bleaching, or crowning if you wish to improve the appearance of such tooth.
Risks associated with root canal treatment
Risks associated with the treatment include the possibility of instruments broken within the canals. Very rarely these files can separate inside the tooth, but if this happens further treatment may be needed or possibly specialist referral to try and remove the fragment. Some circumstances make file separation more likely and your dentist will discuss with you if these apply to your tooth.
Other complications which can arise are perforations (extra openings) of the crown or root of the tooth; damage to bridges, existing fillings, crowns or porcelain veneers; loss of tooth structure in gaining access to canals and cracked teeth.
During treatment, complications may be discovered which make treatment impossible. These complications may include blocked canals due to ‘old fashioned’ root fillings or prior treatment – natural calcifications, broken instruments, curved roots, periodontal disease (gum disease), splits or fractures of teeth. Occasionally, a tooth which has had root canal treatment may require re-treatment or extraction.
In rare cases damage to the main nerve or other structures in close proximity to the tip of the roots can occur. In rare cases, treatment is impossible and an alternative may need to be found. Reasons the treatment may not succeed usually involve curved roots, anatomy of canals, narrow canals, periodontal condition or infection external to the tooth and canals.
Dentistry is a complex art requiring expertise and experience to fulfill our patients’ expectations. At PJS Dental, we aim to deliver an exceptional customer experience that focuses on making our patients feel good about every interaction they have with us. We improve lives by giving our patients confidence in everything that they do.
If you you need advice about a potential root canal treatment, get in touch to find out more.