Root Canal Treatment

Saving teeth from extraction with root canal treatment Endodontics - what is that?
Endodontics is the field of dentistry that deals with treating disease inside the tooth. If a tooth has been badly decayed or traumatized the pulp inside the tooth can become infected. When toxins and bacteria leak out the openings at the tips of the root a dental abscess can form. In order to treat or prevent this dental abscess the dentist cleans out all the necrotic pulp tissue from within the pulp chamber and root canals through the required dental treatment.

The healthy tooth	The diseased tooth

Once the tooth is sufficiently cleaned out and as sterile as possible, the root canal system is sealed off. Bacteria are prevented from infecting the tooth again in most cases (a small percentage of root treatments do fail, especially if they are only done long after the abscess develops. However, many teeth are successfully saved from extraction, and root treatments are a valuable treatment option against teeth extractions)

Steps in completing a root canal treatment

Access opening is done in the root canal treatment
      First the dentist will remove any decayed and weak tooth structure. A suitable opening into tooth's pulp chamber is prepared to allow access to the openings of the root canals in the pulp chamber floor.

Instrumentation used for root canal treatment
 The root canals are identified and then cleaned out with special root canal instruments. Some are used by hand, others rotate in a hand piece. They all have the function of removing debris from the canal and smoothing and shaping the walls of the canals to create a smooth, clean surface along the entire length of the tooth root canal. The canals are constantly rinsed to aid in debris removal and canal sterilization. In some, but not all root canal cases, the canals may be dressed with various medications and sealed with a temporary filling material to allow time for the infection to clear.

Sealing is done in root canals
Once the tooth root canals are suitably cleaned and shaped and infection free they can be sealed off. A root filling material (usually a rubbery material called guttapercha) is placed into each canal with a special sealer.

Final restoration becomes important in root canal process
Placing a suitable final restoration is almost as important as the root treatment itself. If the restoration leaks bacteria can migrate down the side of the root sealer and re-infect the tooth. A suitable permanent filling is placed into the access opening. Teeth with large amounts of damage may need a post (a metal or fiber reinforced resin rod) down one or more canals to anchor the filling securely onto the root of the tooth.

However the access opening is closed, root treated teeth will always be weaker than natural teeth and prone to cracking or splitting. A serious fracture could mean removing the tooth that was so carefully saved with the root canal treatment. A good way to ensure against such a disaster is to crown the tooth.

Risks and complications in the root canal treatment
Despite the best efforts of a dentist, a small percentage of root canal treatments do fail, especially if they are only done long after the abscess is developed in the tooth root. The failure rate increases if the root canal treatment is a repeat treatment of a previously failed root canal, or if some damage has occurred to the root during reaming. However, many teeth are successfully saved from extraction, and root treatments are a valuable treatment option.

We use very delicate instruments during treatment to clean and shape the tooth. Very occasionally these root canal instruments can separate (break) in the canals. This does not necessarily mean the entire root treatment is a failure. Most often the fractured piece can be removed or by-passed, and a normal root filling placed. Sometimes the root treatment is completed leaving the piece of instrument in the root. Most often this is not a problem. If the treatment does fail one can consider an alternate surgical solution: either extracting the tooth or doing an apicoectomy (cutting off the tip of the problem root and sealing it from the outside).

Because of the infected nature of the abscess there can be some discomfort or swelling. This will be controlled with antibiotics and anti-inflammatory as needed.

What happens if I don't have a root canal treatment?
If a tooth has an abscess it can firstly cause severe pain, but not always. Some abscesses can be surprisingly painless. Nevertheless, the infection at the root tips can spread into the surrounding bone and soft tissues and cause more serious infections there that could cause swelling and pain. Bacteria also enter the blood stream and can infect other parts of the body. Prosthetic hip and knee joints and heart valves are particularly prone to infection. Patients with other health problems could also be at higher risk.

Root canal treatment is too costly. What alternative dental treatments are there?
Unfortunately, usually the only alternative dental treatment that a dentist can suggest, is to remove the infected tooth. Often teeth requiring root canal treatments are weakened from the large tooth decay cavity and cannot easily be simply extracted. Many require surgical removal. Initially the removal of the tooth may save costs, but in the long term replacing the missing tooth is far more costly than root treating it and restoring it with a suitable restoration, usually a crown. Dentists advise against leaving gaps.

Following Your Root Canal Treatment

Our dental care clinic wishes to inform our patients of what to expect following root canal treatment. When a tooth is in the process of healing, there are many factors to consider. Every tooth is different, some are more infected than others and some are more difficult to treat. Therefore, there will be some sensitivity and the tooth will require some time to heal.

It can take up to two weeks for a tooth to settle completely. There will be some sensitivity to pressure, in which we advise to avoid the area. Sometimes patients experience swelling in the area, either from infection or traumatization. It is not unusual for a patient to develop more sensitivity or swelling or both in the treated area three to four days following treatment. This increased sensitivity in the tooth root is considered normal. Please continue to take your antibiotics, if prescribed, and pain medications as needed, as they will both assist in the healing process. Our dental surgeons recommend that you to take your antibiotics with food. There is no need to wake up in the middle of the night. Just take them with breakfast, lunch, dinner and a snack at bedtime.

With lower teeth you may experience a stiff jaw and or some soreness upon opening and closing. If this occurs, apply heat and massage the jaw joint area. The freezing injection is given in the joint area and can sometimes cause stiffness. It may take up to a month for the jaw to get back to normal.

PLEASE BE AWARE THAT THERE IS A TEMPORARY FILLING IN PLACE WHICH ONLY LASTS FOR APPROXIMATELY ONE MONTH. Therefore, it is important that you see your dentist to have a permanent restoration placed. This is of extreme importance in order to protect your tooth.