Endodontics (Root Canal Therapy)

In the past you would probably lose a tooth if the tooth had a diseased or injured nerve. Today you may save that tooth with a special dental procedure called root canal therapy. Inside each tooth is the pulp which provides nutrients and nerves to the tooth. It runs like a thread down through the root. The pulp tissue dies when the pulp is diseased or injured. If you don't remove this pulp tissue, your tooth will get infected and you could lose it. The root canal is cleaned and sealed off to protect it after the dentist removes the pulp. Then a crown may be placed over the tooth to help make it stronger.

A root canal is a procedure with little or no discomfort involving one to three appointments. Most patients report that having root canal treatment today is as unremarkable as getting a filling. The best news is that it can save your tooth and your smile!

What is root canal therapy?

Root canal therapy is used to save the damaged or dead pulp inside the root canal of the tooth by cleaning out the diseased pulp and reshaping the canal. Years ago, teeth with diseased or injured pulps were removed. Today, root canal therapy provides a safe way of saving teeth.

By integrating with the jaw, they enable restorations that range from replacement of one single tooth to an entire arch of bridgework, or as stabilizing elements for overdenture applications. Dental implants are manufactured from titanium, which is both biocompatible and strong.

Why do I need root canal therapy?

Unfortunately, your tooth will not heal by itself. The infection will spread and the pain will worsen without treatment. The only alternative is usually extraction of the tooth. Though an extraction is cheaper, the space left behind may concern you later on. If you have the choice, it's always best to keep your original teeth.

What causes pulp nerve damage?

There are two common causes of pulp nerve damage:

  1. Physical irritation generally brought on when tooth decay reaches the nerve of the tooth resulting in infection.
  2. Receiving a blow to a tooth can also cause damage to sensitive nerve tissue within the tooth.

What are the symptoms of pulp nerve damage?

There are several common symptoms of pulp nerve damage. Each individual may experience the symptoms differently. These symptoms may include:

  • pain in the tooth when biting down
  • tooth pain while chewing
  • oversensitivity of the teeth with hot or cold drinks
  • facial swelling

Why do I feel pain?

Pulp can die when it becomes infected due to a deep cavity or fracture. The pulp can also die because of injury due to trauma. Damaged or dead pulp causes increased blood flow and cellular activity and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

What happens if the pulp gets injured?

The pulp dies when it is diseased or injured and can't repair itself. The most common cause of pulp death is a cracked tooth or a deep cavity. Both of these problems can let bacteria enter the pulp. Germs can cause an infection inside the tooth. Pus builds up at the root tip in the jawbone when not treated and forms an "infected-pocket" called an abscess. An abscess can cause damage to the bone around the teeth.

What does treatment involve?

Treatment often involves from one to three appointments. Your dentist will remove the diseased pulp during the treatment. The pulp chamber and root canal(s) of the tooth are then cleaned and sealed.

Root Canal Therapy

How your tooth is saved through treatment

Appointment 1:

  1. An opening is made through the crown of the tooth into the pulp chamber.
  2. The pulp is then removed.
  3. The root canal(s) is cleaned.
  4. Medications may be put in the pulp chamber and root canal(s) to help get rid of bacteria and prevent infection.
  5. A temporary filling will be placed in the crown opening to protect the tooth between dental visits. Your dentist may leave the tooth open for a few days to drain. You might also be given medicine to help control infection that may have spread beyond the tooth.

Appointment 2:

  1. The temporary filling is removed and the pulp chamber and root canal(s) are cleaned and filled further.
  2. The root canal(s) is shaped to a form that can be filled.
  3. Medications may be put in the pulp chamber and root canal(s) to help get rid of bacteria and prevent infection.
  4. A temporary filling will be placed in the crown opening to protect the tooth between dental visits.

Appointment 3:

  1. The temporary filling is removed
  2. The pulp chamber and root canals are filled and sealed.
  3. A filling is placed in the crown opening to protect the tooth.

The final step may involve a porcelain crown placed over the tooth

How long will the restored tooth last?

Studies show that 90% of RCT teeth, which have been restored with a crown, are still present 10 years later. Despite this, treatment can still fail.

Your restored tooth could last a lifetime assuming you continue to care for your teeth and gums. Regular checkups will be necessary. Your tooth will remain healthy as long as the root(s) of a treated tooth are nourished by the tissues around it.

Are there any risks?

If root canal therapy is suggested then is important to have a tooth treated as soon as possible. An infection that is allowed to continue may lead to destruction of the underlying bone tissue. The infection can also spread and could result in fever, swelling in the face and neck and a general ill feeling.

File Separation

File separation occurs when one of the small nickel-titanium files we use to clean the inside of the tooth becomes lodged within the canal. It is not dangerous and presents absolutely no health risk to patients. There is some evidence to show a reduced prognosis in RCT treated teeth with file separation. Your dentist will discuss further if this occurs.

What happens after treatment?

Natural tissue inflammation may cause discomfort for a few days. This can be controlled by an over-the-counter analgesic. You may wish to avoid biting down hard or chewing hard foods as the inflammation resolves, from then on you should be able to return to your regular diet.

Should I see a specialist Endodontist?

Specialist endodontists are dentists who have specialised in root canal therapy, your dentist will inform you if you require a referral to an endodontist.