Routine Endodontics Questions

What is a root canal treatment?

A root canal treatment involves removing the damaged or infected pulp from within the tooth. In order to remove it as completely as possible, the internal aspect of the tooth where the pulp is located needs to be accessed and prepared with small instruments (files and drills) and washed through with disinfectants. Once this space has been cleaned and disinfected, it is then filled with a material designed to seal the root and prevent further infection. A temporary filling will then be placed to close the entrance into the tooth through which the pulp was accessed.

Why do I need a root canal treatment?

Root canal treatment is the only means to save a tooth when irreversible pulpal damage has occurred. This commonly manifests as pain or tooth ache. However it may also manifest as an incidental radiographic finding or during a dental examination where a ‘blister’ or fistula has been observed. Occasionally it is an elective procedure which is carried out to prevent potential problems following complicated restorations. This damage may have been caused by deep decay, cracks in the tooth, trauma or repeated dental procedures. If the tooth is not treated the pain may persist, an abscess may develop which can be even more painful and debilitating. In the event where there was no pain, the infection can increase in size making the subsequent treatment more complicated.

Will it work?

Root canal treatment is a very successful treatment when performed to a high standard. In a retrospective review of my own patients over a six year period, I found that 90% of my root treatments were successful applying stringent assessment criteria (Outcome of root canal treatment in a dental practice, Thesis, School of Dentistry, Wales College of Medicine, Cardiff University, 2004).

Retreatments (re-doing a root filling for a second time) have a slightly lower success rate, 80% is a reasonable expectation.

Why do you place a temporary filling and not a permanent filling?

The primary reason a permanent filling is not placed is that the majority of these root filled teeth will require more complex treatment other than a filling. It is recommended that nearly all back teeth which have been root filled are crowned subsequently to prevent these teeth from fracturing.

The placement of a crown is a complex procedure in its own right. It involves the removal of all the existing fillings in the tooth and the placement of a core. This core will be the foundation on which the crown will sit. Sometimes I am requested to place the core. There will be an additional cost for this procedure.

Will the tooth discolour or go black?

It is probably reasonable to expect a slight alteration in colour of the tooth following root canal treatment, particularly where a front tooth is involved. The reason why this discoloration occurs is varied.

The materials used in the root filling are often dark in colour. By leaving these materials in the crown (top half) of the tooth it is easy to see that they will darken the tooth to a certain extent. So if these darker materials are kept within the root of the tooth, their impact on the tooth colour will be reduced. Secondly, if the discoloration proves to be a problem there are procedures which can be undertaken to improve the colour and appearance and may be required anyway.

Is the treatment painful?

No, like all procedures in dentistry, local anaesthetic is used to effectively ‘numb’ the tooth. After the treatment has been completed, the tooth may feel a little tender or uncomfortable to bite on for a few days. See Post Treatment Advice.

How long does the treatment take?

This will largely vary according to the complexity of the root canal system and any problems that are encountered.

  • A front tooth will take in the region of an hour to an hour and a half

  • A premolar tooth will take from an hour and a half to two hours

  • A molar tooth will take in the region of two to two and a half hours

  • A single visit treatment strategy will be used where possible.

What if I don’t have the treatment?

Unfortunately the only predictable alternative treatment is extraction of the tooth. Once the pulp is diseased, the damage cannot be reversed and it will not heal spontaneously.

Are there any complications I should be aware of?

As with all treatments whether it be dental or medical there can be some complications. These include * Acute flare up – See Post Treatment Advice.

Perforation – an instrument can break through the root walls.

Instrument separation or failure- the instruments used in root canal treatment are very fine and fragile. Occasionally these instruments may fracture and create an obstruction within the canal system. This may complicate the treatment.

It is however important to remember that there is a very high success rate and that these complications can be dealt with, in most cases without comprising the success of the treatment.

Is there any aftercare treatment?

A root filled tooth needs the same day to day care as every other tooth. It can still decay. It is important that the tooth is fully restored and you continue to clean the area as normal. It is also advised to attend for regular check ups with your dentist to ensure good oral hygiene.

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