Root Canal (Endodontics)

When you think about the structure of your teeth you may think, as many people to, that they are incredibly tough and solid bone like parts of our body. Whilst you would be correct to a degree, in that the outer part is a solid shell coated in an incredibly tough layer of enamel to protect them further, that is not the case all the way through.

That's right, your teeth are actually soft on the inside, filled with soft tissue or pulp. There is in fact a whole area of dentistry that focuses on this area of the tooth. This is call endodontics. Of course when most people mention endodontics, they are really referring to a specific dental procedure, that being root canal treatment.

What is a 'root canal'?

When referring to a 'root canal', this is the part of the tooth on the inside, or the cavity naturally in the centre of the tooth. This area is not 'hollow' as such and contains what is call 'pulp'. The nerves that exist within your tooth are in this 'pulp chamber'.

You may be wondering, why does my tooth need or have nerve endings? This is a reasonable question, considering that the external part of the tooth is made of such a solid and hard substance. The nerves are in fact not really necessary to the tooth's function or health as such after they have come through the gums. Indeed, after your teeth have fully grown, the pulp itself starts to decrease in mass. The only real function that remains for the nerves that still exist is that of sensory, in other words to allow you to feel when something is hot or cold. Given that you probably 'feel' this first with your lips or tongue, the extent of its usefulness is somewhat limit.

We should note, that people often causally refer to a 'root canal treatment' as merely a 'root canal'. This abbreviation is of course reasonable, given that the treatment is all about the actual 'root canal' itself.

When and why do I need root canal treatment?

Whilst the pulp chamber of your tooth, or the root canal, is protected by a tough external layer, it is not impenetrable. Whilst physical trauma can lead to root canal treatment being required, a far more common reason is poor oral health and hygiene habits.

Tooth decay or cavities can break the outer layer causing an infection in the tooth itself. If you regularly attend our comprehensive routine dental examinations, you will have undoubtably had an x-ray at some stage. These x-rays help us detect these tiny cracks and decay early, allowing preventative treatments such as fillings, which the aim being to prevent further decay and root canal treatments.

Unfortunately, if your oral health and hygiene routines aren't in good shape and you possibly haven't seen us for an extended period of time, these dental cracks, or decay, can worsen, breaking through to the root canal. When this happens, bacteria can start to form and multiply within the tooth itself. As you cannot 'brush' the inside of your tooth to remove the bacteria, this can lead to an infection or even an abscess at the base or root of the tooth.

If the above has occurred and the pulp has become infected, it will almost always manifest itself in a very high level or discomfort and pain in that tooth. Unfortunately, the nerve endings we discussed above, once infected, will make their presence felt.

Other signs you may need root canal treatment include swelling of the gums nearby or a discolouration of the tooth. If any of these occur, it is important to come see us to discuss treatment options, such as getting a root canal treatment to try and save the tooth itself.

Won't the issue just go away?

You may be reading this think that like the common cold that the human body will fight of the bacteria and therefore it will simply go away over time. Unfortunately this is not the case.

If you delay treatment on a pulp infection, not only will you be having a bad day due to the continual pain, but when that does eventually subside and you are pain free again naturally, your dental health will be in even worse shape.

When the pain disappears from an infection in the pulp, it means that the tooth itself has died. The nerves are no longer able to send any signal back to you about the pain. This is a serious issue, as that pain is an indication there is an underlaying issue. Without it, the bacteria inside your tooth will continue to form and will slowly migrate into your gums and jaw. At this stage the treatments will become far more complex.

It's better out than in.

We get this a lot with patients dreading a root canal treatment because they have heard bad stories from their parents or even had a root canal from many, many years ago. In the past root canals were painful, however, with modern advances in dental treatment and technology and anaesthesia, it is virtually pain free. The fear is much worse for almost everyone than the treatment. Nevertheless, we always get patients saying can't you just pull out the tooth?

Whilst the saying of its better out than in is valid in some real life scenarios, this is not one of them. Removing a tooth is always a last resort. By removing a tooth, we affect the underlaying bone as well and risk infections and other complications. If a new tooth is not implanted quickly the bone may even shrink. Additionally, any artificial tooth will never be 'as good' as a real one. Therefore, if you ask us to pull it out, we will usually tell you, it's better in than out.

What is the process for a root canal treatment?

A root canal treatment involves the process of removing the infected pulp and nerves from inside the tooth, cleaning it out and sealing it off. In a lot of cases this can be done in one visit, however, it may require multiple, particularly if there is already an abscess under the tooth and medication, such as antibiotics, is required to reduce the infection first.

The actual procedure itself will always start with an x-ray. This x-ray, will be focused on the tooth on which the root canal treatment will be done. Generally this is referred to as a periapical x-ray, however, the exact type of x-ray taken will be determined by the dentist treating you. The key requirement is that we are able to see the entire tooth, from crown to the roots.

The purpose of the x-ray is primarily two fold. Firstly, the x-ray allows our team to see if there is any infection in the surrounding bone itself which our team needs to be aware of for the treatment. This may be the stage at which a decision is made to postpone the treatment to allow antibiotics to first combat this infection.

The second reason for the x-ray, is to determine the exact shape and layout of the root canal in the tooth. This will guide our team during the rest of the treatment process.

Once the x-ray has been taken and has been evaluated, the next step is a local anaesthesia. This will numb the area surround the tooth. Whilst this will not in effect do anything if the tooth is already dead, to avoid any discomfort during the procedure our team will almost always administer this.

Now that the area is numbed, we must ensure that your saliva does not affect the area being treated. The tooth and area surround must be kept dry for the treatment period. To do this, our dentists will place a small rubber sheet, or rubber dam, around the tooth.

With the area numbed and kept dry, work can being to access the root canal of the tooth. As you may have guessed, this will require drilling a small hole into the tooth. This process, whilst it may sound unpleasant, will be pain free due to the anaesthesia we have applied. The drill bits we use are very specialised for the task and prior a clean, small access hole into the pulp chamber.

With access to the root canal now open, the cleaning out process can being. A series of small root canal files are used during this process. Each of these files increases in diameter slowly and is slowly worked down into the tooth, scraping and scrubbing out the inside of the tooth. During this process we may use water or even a sodium hypochlorite to wash away an debris.

Once the tooth has been cleaned out, we need to ensure that nothing can get back into the root canal. This is achieved by filling up the now empty space with a sealant. This sealant is generally a soft paste like substance and possibly some rubber like compound or gutta percha. The top of the small access hole, is then covered with a filling. This is a slightly stronger compound and will ensure that nothing can get inside the tooth. In some cases a dental crown will be used instead of a filling, depending on how decayed the tooth is.

We should note, that this last part of the process, the filling of the tooth inside, does not always occur on the same day. In some instances our dentists may determine that a medication should first be applied to the inside of the tooth to clear up any infection. If this is required, a temporary filling is placed over the hole to prevent any debris or saliva getting inside the tooth. After approximately a week, this will be removed and the root canal filled and permanent filling placed on the tooth. Whilst the temporary filling is in place, we recommend minimising the amount of chewing you do on that tooth, as remember it is hollow and therefore more fragile.

What happens after the root canal treatment?

For those who wear afraid of the process coming in, there is almost always a sigh of relief that it is over and then a comment or two about how the whole thing really wasn't that bad and how they didn't really feel anything.

In terms of eating and drinking, you should be able to go about your day normally post the treatment. Our team will advise if there is anything special you need to do, however, usually at most this will be to take some medication for a few days. If there is any discomfort, some ibuprofen or similar will usually counter this easily.

Is the tooth safe now?

In most cases, the treatment will result in the tooth being 'fixed' and lasting you a lifetime. Naturally, maintaining good oral health and hygiene will be critical, including coming in and seeing us for your twice yearly check-ups. If any changes occur or new cavities we can quickly and easily help you rectify these and help you keep your teeth for life.

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