Root canal treatment is a dental procedure that replaces a tooth’s damaged or infected pulp with a filling. Damage to the pulp may be caused by untreated dental decay, decay beneath a filling, tooth damage due to trauma, tooth grinding (bruxism) or gum disease.
Symptoms of tooth pulp damage or disease
A diseased tooth pulp may cause inflammation or infection. The symptoms of a damaged or diseased tooth pulp may include:
- Unprovoked or spontaneous pain
- Sensitivity to hot and cold drinks and foods
- Pain when biting or chewing
- Loosening of the tooth
- Swelling of the gum near the affected tooth
- Oozing of pus surrounding the affected tooth
- Facial swelling.
Causes of tooth pulp damage or disease
There are many events that can lead to disease or damage to dental pulp. Some of these include:
- Deep-seated and untreated dental decay
- Decay beneath a deep filling
- Trauma that damages a tooth
- Habitual tooth grinding (bruxism)
- Advanced gum disease.
Complications of tooth pulp infection
If tooth pulp infection is left untreated, complications could include:
- Spreading infection – once the pulp becomes infected, it loses its ability to fight the spread of the infection. If bacteria find their way into the pulp chamber, the bacteria will multiply unchecked. This can cause a severe infection or an endodontic abscess when it spreads into the surrounding bone (a pocket or ‘blister’ of pus).
- Localised bone loss – the infection may spread around the ends of the infected root canal and cause bone loss in the jaw.
- Loss of tooth – the tooth may have to be removed, which interferes with the person’s ability to bite and chew. Tooth replacements such as dentures, bridges and dental implants may not be possible or may not be tolerated.
Root canal procedure:
- The procedure is usually performed using local anaesthetic. If the pulp is infected, anaesthesia may not always be necessary because the tooth no longer has any feeling.
- The affected tooth is wrapped in thin rubber (called a ‘rubber dam’) to prevent contamination of the root canals.
- The decayed portions of the tooth and any affected filling are removed.
- The pulp or pulp remnants are extracted.
- The dentist uses a special drill and small instruments to thoroughly clean and shape the root canals and to remove bacteria, pus and debris. The root canals may need to be shaped or hollowed out to ensure a smooth interior surface.
- The interior of the tooth is flushed with disinfectants and then dried.
- If the root canal is not infection free, it may be medicated and the tooth sealed with a temporary filling material. You may have to wait a few weeks, or even months, before the pulp canal is filled. If the dentist feels bacteria are still present at your next appointment, the cleaning procedure may be repeated and the tooth once again packed with medication. This stage will continue until the dentist feels the tooth is free from bacteria.
- The infection-free root canal is then sealed with long-lasting barrier materials (the root filling), usually a rubber-based material called ‘gutta-percha’.
- The tooth then undergoes restoration and the biting surfaces need protection – an artificial biting surface for the tooth is fashioned out of regular filling material.
- In many cases, where there is considerable loss of the tooth structure, there may be a need for an artificial crown made from porcelain or gold alloy or other materials.
Is Root Canal Treatment Painful?
Root canal treatment procedures are relatively comfortable and often painless as the tooth is anaesthetised during treatment. After treatment, the tooth may be sensitive or tender for a few days due to inflammation of the surrounding tissues. This discomfort can be relieved by taking mild analgesics or painkillers available over the counter at the pharmacy. However, if the pain persists and is severe, or a swelling occurs, you should contact your dentist.
How Is Root Canal Treatment Carried Out?
Removal of the infected or inflamed pulp is the first step in saving the tooth. Under local anaesthetic an opening is made in the crown of the tooth to get access to the infected or inflamed pulp within.
Using small, specially designed hand or rotary files, the root canals are cleaned and shaped to a form that can be sealed. Debris within the canals is removed by flushing with an anti-bacterial solution.
The canals are finally filled or sealed with an inert material called gutta-percha. The tooth should be restored to full shape and function by either a permanent filling or a crown, depending on how much of the tooth is left. This should be done as soon as possible as there could be a risk of tooth fracture due to biting forces.
All root canal treatment procedures are performed by isolating the tooth with a rubber dam to provide a clean and saliva-free environment. Root canal treatment may be done in single or multiple visits depending on the complexity of the tooth. In between treatment appointments, medicaments may be placed within the canals and the tooth is covered with a temporary filling.
Often, X-rays are taken to determine the length of the root and to monitor the various treatment stages.
Care Of The Root-Treated Tooth
As far as possible, avoid chewing or biting on the tooth being treated until you have it permanently restored with either a filling or a crown. Excessive pressure at this stage may crack or fracture the tooth. Therefore, it is very important to restore the tooth properly as soon as possible. Most endodontically treated teeth last as long as natural teeth following permanent restoration.
Practise good oral hygiene, including brushing and flossing at all times, as root-filled teeth are as prone to decay as natural teeth. It is also important to have your treated tooth reviewed regularly by your dentist.