The aim of root canal treatment is to get rid of the damaged pulp and the bacteria that are causing the infection. It involves removing inflamed or dead nerves and blood vessels from the centre of your tooth. This is done by drilling a hole through the top of your tooth to the root canal and removing the dead tissue. The empty root canal system is then cleaned, filled and a permanent seal put over the top of your tooth. The procedure may be carried out over one or two visits.
Why have root canal treatment?
Your teeth have a core of blood vessels and nerves at their centre. This living tissue is called the pulp and is in a space called the root canal. The number of root canals varies depending on how far back the tooth is in your mouth. Front teeth often have just one root canal, while back teeth may have three or more.
If your tooth is injured or has severe decay, the pulp can be damaged and the blood vessels may die. This results in a “dead” tooth which is likely to get infected because it’s no longer protected by your immune system.
There are a number of ways that a tooth’s pulp can be damaged. These include:
- Gum disease
All of these conditions can lead to bacteria getting trapped in your teeth. There is then the possibility that the tooth pulp will become infected, causing blood vessels and nerves to die.
Without treatment, a collection of pus (abscess) can form at the root tip. This can lead to pain and swelling and may cause damage to the bone around your tooth. If you don’t have treatment to remove the infected tissue, you may have to have the whole tooth taken out (extracted).
What are the alternatives?
It may not always be able to repair your tooth with root canal treatment. This may be the case if your tooth is very seriously damaged by decay or injury, or if you have gum disease meaning that your tooth isn’t well supported. Extraction of the tooth may be recommended instead.
What is involved?
1. Advanced tooth decay with infected pulp and abscess on the tooth root
2. An opening is made in the enamel and dentine to expose the infected tissue
3. The infected tissue is removed and the canals are cleaned
4. Canals are filled with a permanent material (gutta - percha)
5. Opening is sealed with filling. A post may be inserted for extra support
6. In some cases, a crown may be required to strengthen the tooth
An X-ray image of your tooth will be taken to check whether or not you need root canal treatment. This can help to show how far any decay has spread, if there is an abscess and how many root canals your tooth has.
If you have a dead tooth or one with severely damaged pulp, root canal treatment may be the only way to repair it. However, it’s important to discuss with us what is involved in this treatment before deciding to go ahead with it.
If you do need to have root canal therapy, a local anaesthetic will be administered. This completely blocks feeling from the area and you will stay awake during the procedure. It may not be necessary to have an anaesthetic if your tooth is dead but that option will be discussed with you.
Your tooth will then be separated from the rest of your mouth using a thin sheet of rubber called a dam. This keeps your tooth dry and protects your airway. It also allows effective cleaning of the root canal system and prevents it from becoming contaminated again, which can cause infection later.
A hole in the top of your tooth is then made through which the dead or diseased pulp is removed. The empty pulp cavity is then cleaned and some medication to help get rid of bacteria may be placed within the canal/s.
It may be that this is all that is done at your first visit, after which a temporary filling will be placed on your tooth to keep it sealed until you come back for further treatment. However, we may decide to fill the cavity immediately if the root canal infection hasn’t caused you any serious problems.
If you have had a temporary filling, when you come back, it will be removed and then the root canals will be filled with a suitable material. This is likely to be a putty-like substance called gutta percha. A permanent filling or crown is then placed over the top of the tooth to protect your filled root canal and the vulnerable tooth structure. You will often be recommended a crown made from gold or porcelain. A metal or plastic rod inside the canal to help support the crown may be placed, if necessary.
After the procedure
You may find that you have some discolouring in the tooth that has been treated, although this is less common now as techniques have advanced. However, if your tooth does discolour, you may be able to have treatment to correct it.
After treatment it’s important that you take care of your repaired tooth as you would any other. Brush your teeth at least twice a day and visit us regularly.
What are the risks?
It’s unlikely that you will have any further problems following root canal treatment. However, if your tooth does become infected again, we can repeat the procedure, although the rate of success is reduced with subsequent treatments.
Very occasionally after root canal treatment, you will still have inflammation at the tip of your tooth. You may need to have a procedure called an apicoectomy to remove the root tip.