Root Canal Treatment

Why do patients need a Root Canal Treatment?

Root canal treatment (RCT) is an often straightforward procedure to relieve dental pain and save the teeth. Patients need a root canal when there is inflammation or infection in the roots of a tooth.

Generally, Root canal treatment might be required if patients have one of the below problems and the Dentist diagnoses a tooth problem:

• pain when eating or drinking hot or cold food or drink
• pain when biting or chewing
• a loose tooth
• swelling of the gum near the infected tooth
• pus oozing from around the infected tooth
• facial swelling
• the tooth getting darker in colour
• Grossly fractured tooth due to trauma

The treatment alternative to Root canal treatment is the removal of the tooth.

What is involved in root canal treatment?

The RCT procedure will usually involve the following stages:

1. Local anaesthetic (LA) and placing a rubber dam: the LA may not be necessary if your pulp is already dead or was removed at an earlier appointment. All RCT should be completed under rubber dam; this helps to ensure you don’t swallow or inhale any of the small RCT instruments or cleaning solutions. It also prevents saliva and germs (bacteria) from re-contaminating the root canal after it has been disinfected.
2. Tooth disinfection and preparation: bacteria are killed and infected debris is removed by repeatedly flushing the canal, usually with dilute solutions of sodium hypochlorite). It is not possible to remove 100% of the bacteria from an infected canal but the aim is to remove as many as possible. The canals are also prepared using specialised screw-shaped instruments called endodontic files. These may be handheld or used in a slow-speed dentist’s drill. The purpose of shaping is to remove infected dentine and form the narrow canal into a cone shape which is easier to fill.
3. Placing the root filling: the final stage of RCT involves packing the root canal space, usually with a rubbery filling material and cement. This is done as tightly as possible to ensure that any remaining bacteria in the root canal are unable to get to a food source or spread out inside the root. Without food they should die off over time.
4. Final X-ray and tooth filling: An X-ray is taken to assess whether the root filling material has been placed and packed correctly to the apex of the root canal. If necessary, adjustments can be made. A final tooth filling will then be placed to seal off the root filling and restore the tooth.
5. Possible crown placement: if it is necessary to place a crown on the tooth, the dentist will often wait for several months after the RCT was completed. This provides some reassurance that the RCT has been successful before commencing with the crown treatment.

What are the risks of getting Root canal treatment?

In most cases, root canal treatment is successful and the tooth will no longer cause pain. However, there is always some risk depending on the condition of the tooth, how well patients keep their teeth clean, and the biting forces on the tooth.

Common risks and complications include:

• mild temporary pain due to inflammation of the tissues surrounding the tooth
• a darker tooth: there are procedures available which may lighten the tooth if this occurs
• tooth fracture: due to reduced strength and durability of the tooth: –a tooth extraction may be required –this risk is reduced when a crown is used.
• the fine metal files used to clean inside the root canals may break during use and remain in the tooth, and the tooth may need to be removed
• depending on the size and shape of the roots, there is some risk of creating a hole in the side of a tooth root during the cleaning process
• severe or persistent pain: return to your treating dental practitioner
• infection: return to your treating dental practitioner
• treatment failure: the tooth may require further treatment or extraction if it is unable to be saved Death as a result of this procedure is extremely rare.

What if patients don’t get treatment?

If a dead or dying pulp becomes infected with bacteria, they will multiply and spread via the root canal out into the bone. This will make the tooth painful to bite on to. As more bone is destroyed, the infection can pass through the bone to the soft tissues.

if the infection passes through the bone below the level of the gums it can form a spreading soft tissue infection which is more serious. Usually, a spreading dental infection is seen as a painful swelling of the cheek or under the lower jaw; however, in severe cases, it can obstruct the airway, cause total loss of vision or even infect the brain.