Endodontic Treatment

Endodontic treatment removes infected or damaged tissue from inside a tooth.

This tissue is called the pulp and contains nerves and blood vessels that help nourish the tooth. After the pulp is removed, the pulp chamber and root canals are cleaned, disinfected, filled and sealed.

The main aim of endodontic treatment is to save and preserve the tooth (or teeth) in question.

FAQs

What is root canal therapy?
Root canal therapy is a sequence of treatments performed to remove the pulp from the centre of your tooth.

Why do I need root canal therapy?
Your dental surgeon has recommended that you have root canal therapy because the soft tissues within your tooth have become infected and must be removed to prevent further infection.

How did my tooth become infected?
The infection is caused by the bacteria that live in your mouth, which then invade the tooth. This occurs by either tooth decay, leaking fillings or trauma.

How is a diagnosis made?
Usually, patients present with clear symptoms that root canal therapy is required. Some of these symptoms include pain when eating or drinking hot or cold foods and drinks, pain when biting or chewing, the tooth becomes loose, swelling on the gum and/or exterior facial swelling, pus coming out of the affected tooth, and sometimes the tooth becomes darker in colour.

If the patient does not present with clear symptoms, further tests are carried out by the dental surgeon to establish the vitality of the tooth. A small X-ray is commonly taken to assist in the diagnosis.

Root canal therapy

What is the standard process of root canal therapy?
If not already carried out at the diagnosis stage, your dental surgeon will take an X-ray to establish the anatomy of the affected tooth. This will allow him to assess the extent of the damage caused by the infection and gain a clear picture of your root canal system. A local anaesthetic is used to ensure you are comfortable throughout the procedure. A rubber sheet (rubber dam) is then placed around the tooth.

This helps to ensure that the tooth remains dry and you do not swallow any debris. Your dental surgeon will then enter the tooth from the crown section to gain access to the soft chamber within the tooth: the pulp chamber. Any infected pulp is then removed. If you have an abscess, your dental surgeon will allow this to drain. Once the pulp has been removed, your dental surgeon will then clean and widen the root canal so that it can easily be filled. A series of files are used to clean and reshape your root canal/s.

Depending on which tooth is affected will vary the length of treatment. Your front teeth, incisors and canines have just one root, whereas your chewing teeth, and molars, have two or three roots, which all contain root canals and will need to be treated. Once all of the canals have been cleaned, the root canal is filled and sealed. A temporary filling is then placed in the crown aspect of the tooth.

Recent studies have shown that the temporary filling should be left in place for a minimum of three months. This is called an evaluation period. This will allow for easier access if further treatment is required. Once the evaluation period is completed, a permanent restoration can be performed. This is usually a filling, crown or onlay. Permanent restorations are a separate course of treatment from your root canal therapy. Your dental surgeon will always provide you with a written treatment plan and estimate before treatment commences.

Will I feel pain during or after the procedure?
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anaesthetics, most patients report that they are comfortable during the procedure.

For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter painkillers. Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatments are completed. However, if you have severe pain, pressure or pain that lasts more than a few days, do call the practice.

Results

Root canal therapy has a high percentage (90%) of successfully saving the tooth. If you practice good oral hygiene, you should be able to successfully keep the tooth for a long time. The survival of the tooth depends mainly on three factors:

• How much of the natural tooth remains.
• Biting forces on the tooth.
• How well you keep your teeth clean.

However, if the infection does remain, it may be possible to have it re-treated, or if the therapy was already carried out to a high standard, a small operation may be recommended, known as an apicectomy.

Can all teeth be treated endodontically?
Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost.

Alternate treatments

Although modern dentistry has come a long way over recent years, currently, the only alternative to root canal therapy is removing the tooth.

Once the tooth has been removed, the following options may be available to you:

• Leave as a gap
• Denture
• Bridge
• Implant

Your dental surgeon will recommend the most suitable options to you if you do not wish to save your tooth.