Root Canal Fillings

Understanding Root Canal Treatments

What is a Root Canal Treatment?

A root canal treatment, often simply referred to as a "root canal," is a dental procedure that aims to treat and save a tooth that is badly decayed or infected. A root canal is required when the pulp (commonly referred to as the nerve) of a tooth is dying. The procedure involves removing the dead pulp and filling the space that is left behind.

Your tooth has 3 main layers:

• Enamel - The hard white outer layer of a tooth

• Dentine - The softer yellow layer under the enamel

• Pulp - Jelly-like substance in the tooth's centre, which contains nerves and blood vessels keeping the tooth alive.

If your tooth's pulp is exposed to bacteria (either through a crack, cavity or decay), it can become infected and inflamed. If this infection persists, your pulp will start to die. A dying pulp will be really painful and can lead to abscesses.

(The pulp of a tooth can also die after being knocked hard due to trauma as well)

A root canal procedure means that a dentist or endodontist (a dentist who specializes in treating the pulp) will work to save your tooth by removing the infected or inflamed pulp and then filling and sealing the space. This helps prevent the need for extraction, allowing you to maintain your natural tooth.

The root of your tooth contains little canals which connect your pulp to the rest of your body’s blood and nerve systems. This is why the procedure is called a root canal filling.

Delaying treatment for a tooth that needs a root canal can lead to greater problems. The infection can spread, leading to abscesses and even systemic infection. Additionally, the longer a tooth remains untreated, the more complex the root canal procedure may become, as the infection or decay may spread, or the tooth may become more brittle and harder to treat.

The Root Canal Procedure: A Step-by-Step Process

Examination and X-Ray

A dentist will examine the tooth physically to check for decay and cracks and determine what the situation of the tooth is. They will almost certainly take x-rays to see how deep any cavities are and may also carry out some ‘vitality testing’ to check the health of the tooth's nerve. The main things the dentist will be looking to determine are:

• Is a root canal necessary

• Is there enough healthy tooth substance left to fill the canals and restore the tooth with a filling or crown

• Is it best to try and save the tooth or remove it

If there is a chance of saving the tooth, your dentist will almost always recommend a root canal filling. It’s always beneficial to save a natural tooth instead of extracting it and replacing it with something else. However, if you don’t want to have a root canal filling, you can opt to have the tooth removed instead.

Anaesthesia and rubber dam

Before the root canal procedure begins, your dentist will numb the tooth by administering some local anaesthesia. This ensures that you don’t experience any pain during the treatment.

Once the tooth is numb, a small protective sheet called a "dental dam" is placed over the area. The rubber dam stops any of the chemicals the dentist uses to clean the tooth from touching your mouth whilst also preventing bacterial presenting your saliva from entering the tooth and causing a re-infection.

Placing a rubber dam is extremely important and can make the procedure much easier to tolerate, although getting on initially can be a bit fiddly.

Accessing and cleaning the pulp

Your dentist will start the procedure by removing any decay from your tooth and confirming that the tooth is strong enough to last. They will then cut a small hole to open and expose the chamber where the pulp is.

Once the pulp is exposed, your dentist will use special tools (files and drills) and chemicals (Sodium Hypochlorite) to clean the pulp from the pulp chamber and root canals of the tooth. The goal is to remove any nerve tissue and bacteria from the inside of the tooth to prevent the infection from re-occurring.

Filling and sealing the root canals

Once the tooth is thoroughly cleaned, your dentist will fill the canal space with a rubbery material called Gutta Percha and a sealant. This is often done on the same day as cleaning the tooth, or your dentist may bring you back for a second appointment to complete the filling stage. (If they do, they will place a temporary filling in the interim).

Restoring the tooth with a filling, crown or onlay

The final stage of treatment involves restoring the tooth with either a filling or a crown / onlay.

Most back teeth will need a crown / onlay after a root canal filling because these teeth bear the brunt of chewing, and a crown helps to strengthen the tooth and protect it from breaking.

Recovery and aftercare

After the root canal procedure, you might feel some tenderness in the area for a few days. This can usually be relieved with over-the-counter or prescription medications. If your tooth is badly infected, you may have some swelling. Apart from this, you should be able to go about your daily life without issues.

It is important for you to keep your tooth clean as it can still decay. Since no nerve is left in the tooth, you won’t feel any pain, and decay can often progress rapidly without realising it until the tooth breaks one day.

It’s also important to make sure that you see your dentist at least once a year so that they can take X-rays to check the status of the root canal filling.

Complexity and Skill Required for Root Canal Treatments

Variability in Complexity

Root canal treatments can range from straightforward to very complex, depending on the specifics of the tooth and your overall oral health. Factors that can influence the complexity include:

• The number of canals in a tooth (molar teeth have 3 canals, premolars have 1 or 2 and front teeth have 1), some teeth, especially upper molars, can have extra canals that are very difficult to find without specialist equipment.

• The shape and curvature of the canals. Curved canals are harder to clean right to the bottom

• Blockages in the canals - Some canals have calcifications that block access to the end of the canal

Root canals are generally easier in younger teeth and harder in older teeth.

They are also generally easier to carry out on front teeth compared to back teeth.

Skill and experience of the Dentist

The skill of the dentist or endodontist is extremely important in root canal treatment, and RCTs are often considered one of the hardest procedures for general dentists to carry out.

General dentists are usually well-equipped to manage most front teeth, but your dentist may advise you to see a specialist (endodontist) for your treatment. Endodontists have a range of expensive specialised equipment, such as microscopes and ultrasonic irrigators, to successfully carry out your root canal.

If you want the best treatment with the least risk of a re-infection occurring, you may wish to see a specialist for any root canal treatment, no matter which tooth it is.

Root canal treatment failure

While root canal treatments have a high success rate, they can sometimes fail. The most common causes of root canal failure are inadequate cleaning and filling of the root canals, missed canals, or a crack in the root of the tooth.

If a root canal treatment fails, there are a few options available:

• Re-treatment: The tooth can often be retreated by a dentist or endodontist.

• Apicoectomy (root-end resection): In this surgical procedure, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

• Tooth extraction: This is considered a last resort if the tooth cannot be saved by other means.

If your root canal lasts ten years or more, that would be considered a successful treatment.

Is a Root Canal Painful?

While the phrase "root canal" may conjure images of a painful procedure, the reality is that most people report that the process is no more painful than having a filling placed. The area is numbed before the procedure, and pain management techniques are used throughout to ensure the patient's comfort.

However, it's normal to experience some discomfort or sensitivity in the area for a few days after the treatment. Over-the-counter pain medication can typically alleviate this discomfort.

Final Words

Root canal treatments are a crucial tool in maintaining dental health, as they preserve natural teeth that would otherwise need to be extracted. With modern dentistry techniques and an experienced dentist, a root canal can be a manageable and worthwhile procedure. Remember, dental health is strongly tied to overall health, so addressing issues promptly for your overall wellbeing is vital.