When the nerve of your tooth becomes infected, a successful root canal treatment lets you keep the tooth rather than having to pull it out. Keeping your tooth helps to prevent your other teeth from drifting out of line and causing jaw problems. Saving a natural tooth avoids having to replace it with an artificial tooth.
Root canal treatment is a dental procedure to treat infection at the centre of a tooth (the root canal system). Root canal treatment is also called endodontic treatment.
The infection is caused by bacteria that live in the mouth and invade the tooth when:
- tooth decay occurs
- fillings leak, or;
- teeth are damaged by trauma, such as a fall
When bacteria (germs) enter your tooth through deep cavities, cracks or flawed fillings, your tooth can become abscessed. An abscessed tooth is a tooth with an infection in the pulp. If pulp becomes infected, it needs to be removed. An abscessed tooth may cause pain and/or swelling. Your dentist may notice the infection from a dental x-ray or from other changes with the tooth. If left untreated, an abscessed tooth can cause serious oral health problems
A tooth is made up of two parts:
- The crown is the part of the tooth that is visible in the mouth.
- The root extends into the bone of the jaw, anchoring the tooth in position.
These are composed of the following structures:
- Enamel is the hard outer coating of a tooth.
- Dentine is a softer material that supports the enamel and forms most of the tooth.
- Cementum is a hard material that coats the root surface.
- Dental pulp is the soft tissue at the centre of the tooth.
The root canal system contains the dental pulp and extends from the crown of the tooth to the end of the root. A single tooth can have more than one root canal.
The symptoms of a pulp infection include:
- pain when eating or drinking hot or cold food and drink
- pain when biting or chewing
- the tooth may become loose
As the infection progresses, these symptoms often disappear as the pulp dies. Your tooth then appears to have healed, but in fact the infection is spreading through the root canal system. Eventually further symptoms occur, such as:
- pain when biting or chewing
- swelling of the gum near the affected tooth
- pus oozing from the affected tooth
- facial swelling
- the tooth becoming darker in color
It is important that you see your dentist if you develop toothache.
It is important to look after your teeth when recovering from root canal treatment. You should also avoid biting on hard foods until all treatment is complete. Most people can help prevent the need for further root canal treatment by:
- maintaining good oral hygiene
- being careful to avoid too much sugary food in your diet
- quitting smoking, if you smoke
After a root canal treatment, your tooth has to be restored(fixed) to look, feel and work as much like a natural tooth as possible. If an endodontist performed your root canal treatment, he or she will fill the opening of the tooth with a temporary filling and send you back to your dentist or prosthodontist for tooth restoration.
A prosthodontist is a dental specialist who restores and replaces teeth using crowns, bridges, dentures and implants. Your dentist or specialist may use a permanent filling or a crown to restore your tooth. The choice of restoration will depend on the strength of the part of the tooth that’s left. A back tooth will likely need a crown because chewing puts a great deal of force on back teeth. If there is not enough of the tooth left, posts may be used to help support the crown.
Local anesthesia is administered via injections to numb the tooth to be treated and the surrounding tissues. If the pulp in a tooth is acutely inflamed, and therefore very painful, it may take a while to get it numb, but your dentist will not start the treatment until it is.
A small access hole is drilled through the biting surface of an affected back tooth or from behind a front tooth, allowing access to the pulp chamber and root canals for treatment.
The diseased and dead pulp tissue is removed from the tooth with specially designed instruments used to clean out the root canals and pulp chamber. This is not painful; the area is numb and the tissue being removed is either dead or dying. Once the pulp, along with the nerves contained in it, is removed, the tooth itself can no longer feel pain.
The canals are disinfected with antiseptic and antibacterial solutions.
The canals are then shaped with tiny flexible instruments to allow them to receive root canal fillings and sealers. The canals are washed and cleaned again to remove root canal debris prior to sealing them.
Root canal fillings are selected that will exactly fit into the freshly prepared canals. Usually a rubber-like material called gutta-percha is used to fill the canal space. It is a thermoplastic material (“thermo” – heat; “plastic” – to shape), which literally is heated and then compressed into and against the walls of the root canals to seal them. Together with adhesive cement called a sealer, the gutta-percha fills the prepared canal space. Sealing the canals is critically important to prevent them from becoming reinfected with bacteria.
A temporary or permanent filling material will then be placed to seal the access hole that was made to treat the canals, and the dental dam is removed. If the tooth lacks sufficient structure to hold a restoration (filling) in place, the dentist or endodontist may place a post (either metal or a very strong plastic) in one of the canals inside the tooth to help retain it.
Your tooth will need a permanent restoration — a fillingor a crown — to replace lost tooth structure, and provide a complete seal to the top of the tooth. Your endodontist will send you back to your general dentist to determine which type of restoration is best for you. This step is of particular importance since many studies show that if the filled root canals are recontaminated with bacteria from the mouth, there could be a recurrence of infection around the tooth.
After the procedure, an antibiotic may be prescribed to treat or prevent infection. Be sure to follow the instructions of your dentist or endodontist carefully. After-effects of treatment are minimal, generally lasting from a couple of days to about a week. It is normal to have some minor discomfort after treatment including slight soreness that can usually be managed with over-the-counter (aspirin, ibuprofen) medications or prescription (codeine-type) drugs, or a combination of the two.
Would it be better just to have my tooth extracted?
Saving your natural teeth, whenever possible, is the very best option. An endodontically treated tooth, along with appropriate restoration, has many advantages for the patient. It is the best functional unit for chewing and speech. Endodontics is also a cost-effective way to treat teeth with damaged pulp and is usually less expensive than extraction and replacement with a bridge or an implant.
Why do I need endodontic treatment?
Sometimes the pulp inside your tooth (AKA the “nerve”) becomes inflamed or infected. This can be caused by deep decay, repeated dental procedures on the tooth, a crack or chip in the tooth, or a blow or traumatic injury to the tooth. The inflamed or infected pulp tissue needs to be removed in these circumstances.
Does root canal treatment hurt?
Root canal treatment doesn’t cause pain, it relieves it. Most patients see their dentist immediately when they have a severe toothache. Such toothache can be caused by damaged tissues in the tooth. Root canal treatment removes this damaged tissue from the tooth, thereby relieving the pain you feel. In other cases, root canal therapy is indicated when the patient has no symptoms in order to prevent problems in the future and save the tooth.
I didn’t have any problems until after my dentist placed a crown/filling. Why do I need a root canal now?
It is not necessary or desirable to perform root canal treatment on each and every tooth that needs a crown or a filling. However, in a small percentage of cases, root canal treatment is needed after a crown or a deep filling is placed in order to save the tooth, when the pulp tissue becomes inflamed.
Is root canal treatment usually successful?
Endodontic treatment has a very high success rate. Many root canal treated teeth last a lifetime. Millions of healthy endodontically treated teeth serve patients all over the world, years and years after treatment.
Those healthy teeth are helping patients chew efficiently, improve patients’ speech, maintain the natural appearance of their smiles and enhance their enjoyment of life. Through endodontic treatment, endodontists enable patients to keep their natural teeth for a lifetime.