A Guide to Root Canal Treatment

When it comes to emergency dental procedures, root canal treatment is up there with those that have the most fearsome reputation for being painful, complicated and awful to endure. Many people tend to view root canal treatment as the dentist’s last resort for saving a rotten tooth. By implication, therefore, it has become viewed as the treatment that even dentists avoid, until they have no other available option.

So what is the reality about root canal treatment? Is it as bad as everyone thinks? In this article, we will look at what root canal treatment involves, why you may need it and what you can expect from the procedure. Hopefully, we will dispel a few of the more colourful myths about the treatment along the way, too!

What is root canal treatment?

Root canal treatment is the everyday term for the dental procedure known as endodontics. Root canal treatment is a technique for removing the inner pulp from the tooth via the root canal. The pulp may need to be removed from a tooth because it has become infected. An infection in the pulp can spread to other areas of the mouth and face, or lead to a painful abscess in the tooth.

How does the pulp become infected?

Each of our teeth has three main parts. The first is the hard, outer enamel which is designed to protect the more sensitive areas of the tooth. The second part of the tooth is called the dentin. This is softer than the enamel, yet still provides a protective, supportive layer as it is formed of a strong bone-like substance. Finally, at the centre of the tooth is the pulp. The pulp is the confluence of nerve endings and blood vessels that bring the tooth its nutrients and keep it alive.

If the pulp becomes infected therefore, it constitutes a serious threat to the overall health of the tooth.

For the pulp to become infected, the decay needs to work its way through the enamel, through the dentin and into the pulp. Tooth decay forms because plaque builds up on our teeth. The bacteria in plaque react with sugars and carbohydrates in our diet to form acid, which proceeds to erode the enamel on our teeth and to attack our gums.

If we do not visit our dentist regularly and maintain a good standard of oral hygiene, cavities develop on our teeth which eventually rot through to the more sensitive pulp.

What does infection mean for the tooth?

Once the pulp becomes infected, the tooth is in real danger. In some cases, when the infection is identified and isolated early enough, it can be removed without damaging the pulp and without requiring root canal treatment. Once this has been done, the tooth cavity can be filled and the tooth should once again be protected against decay.

However, if the pulp is badly infected, then the pulp itself may need to be removed. This is required to protect the tooth from the infection re-occurring in the future. If the pulp needs to be removed completely, root canal treatment is required.

What are the symptoms?

Usually, the most obvious symptom is a deep, throbbing toothache that does not go away. Your infected tooth may also be highly sensitive to hot and cold. The reason that this toothache builds up in intensity is because, as the infection grows in the pulp of the tooth, the extra fluid puts greater pressure on the nerve endings within the tooth. This causes the tooth to throb painfully.

Infections in the pulp can develop into an abscess. An abscess is an area where the pus from the infection gathers. Once again, this can help to intensify the pain of the toothache and it increases the pressure in the tooth. As with any infection in any part of the body, it can also lead you to feel feverish and to have a higher temperature than normal.

What does root canal treatment involve?

The aim of effective root canal treatment is to remove the pulp from the tooth while still preserving the tooth.

Root canal treatment is usually performed under local anaesthetic and often, a number of visits to your dentist are required. The length of treatment required may be one of the reasons why dental patients view root canal treatment with such nervousness and dread.

Your dentist will need to drill into the tooth so that the infection is revealed. Then, your dentist will scrap away the pulp and the infection together, taking them out of the tooth via the root canal. Depending on how badly infected the tooth or teeth are, this procedure may need to be conducted via a number of different root canals to ensure that all of the infection is entirely removed.

What are the complications?

There are very rarely significant complications in root canal treatment. In fact, the majority of patients who come expecting the worst find that it does not feel much different than most other straight-forward dental work – like having a filling or a crown done. You will usually experience most discomfort after the treatment, when your teeth and mouth can be sore for a few days.

One of the major complications from root canal treatment involves the nature of the treatment. What happens when the pulp is removed from the tooth? The pulp essentially keeps the tooth alive, so removing it means cutting off the tooth from its blood supply and its essential nutrients.

As we mentioned above, your dentist’s objective in performing root canal treatment is to preserve your tooth. If the infection has reached such a stage that the pulp cannot be saved, then the next best option is to remove the pulp before the rest of the tooth is compromised.

Once your dentist has removed the infected pulp from the inside of the tooth, the next stage of the treatment is to replace the pulp with a neutral material called Gutta Percha. The result, therefore, is that the tooth is still rooted into the jawbone and, as the inside of the tooth has been refilled, the infection will not be able to return.

In root canal treatment, there is often one final task to be done. As the dentist initially has to drill into the tooth to reach the infected pulp, the drilling can affect the shape, structure and strength of the tooth. The tooth may also be badly decayed on the outside anyway. Therefore, your dentist will usually recommend a crown over the tooth to protect what is left and improve the biting surface.

Are there any alternatives to root canal treatment?

Unfortunately, the only real alternative to root canal treatment is to have the infected tooth extracted. This is because the infection has reached such an advanced stage that many options are already closed off to you. For example, once the pulp of the tooth is infected, simply filling the cavity is impossible.

The key to avoiding any kind of major dental work is to catch decay and cavities early before they can do any serious damage. Therefore, you should endeavour to visit your dentist regularly for check-ups, as they will be able to identify potential problems. After all, plenty of root canal treatments can often have been avoided with a filling in a cavity six or twelve months earlier.

Some patients may be tempted to ask their dentist for a tooth extraction, rather than going through the time and expense of root canal treatment. Most dentists will advise against it. By keeping the original tooth in place, you preserve your natural bite. This can help to avoid further complications in the longer term – so most dentists will recommend as few extractions as possible, unless they are absolutely essential.

Does root canal treatment work every time?

It is rare for root canal treatment to fail, however it does happen. This can be because the root system of a tooth may be particularly complex, so not all the decay is thoroughly cleared out. Alternatively, it could be because the tooth restoration – in most cases, the crown – is inadequate or not properly cemented into place, so that it allows bacteria to work its way back into the tooth.

Finally, it could be that plaque and bacteria build up on the treated tooth in the same way that they built up on the original, healthy tooth – because of a lack of care and a poor standard of oral hygiene.

How do I look after a tooth with no pulp?

A tooth without pulp is essentially a dead tooth. However, it does not necessarily need any additional or unusual care and attention. Your crown will help to protect the tooth, so you simply have to ensure that you do not allow plaque and bacteria to continue to build up around the tooth and gums.

The most important element of looking after your teeth is brushing them regularly with a flouride toothpaste. You should also use either dental floss or alternatively interdental brushes to remove the plaque and debris from in between your teeth. Ideally, you should brush and floss twice per day.

The plaque on your teeth reacts with sugars and carbohydrates. You will find a lot of these in sugary sweets and fizzy drinks. Therefore, if you want to limit the levels of tooth decay that can damage your teeth and lead to root canal treatment, you should try to change your diet away from these types of items.


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