Root Canal Treatment

Root canal treatment is undertaken if the nerve and blood supply has died and you would like to save the tooth, rather than extract it. Sometimes teeth can die quietly and with no pain; a chance finding on an x-ray may show an abscess even though the tooth has been symptom-free. Other times, the tooth is very painful to eat, touch, bite on, and pain relief does not appear to work. Disturbed sleep is another typical symptom of an abscess developing. Sometimes it is very difficult to pinpoint which tooth is causing the problem as there may be referred pain along the jaw line or to the ear.

Symptoms of a tooth requiring root canal treatment

• Pain that won’t go away – can be a dull ache, or severe pain
• Cannot chew teeth together without pain
• Swelling or a lump on side of gum – this could be a ball of pus
• Pain relief that doesn’t work anymore
• A tooth darkening
• Disturbed sleep

Why do teeth die?

Teeth die due to a large hole or cavity in the tooth being very close to the nerve, causing inflammation, pain and death. They can also die if you have an accident and knock your tooth. This can damage the nerve and blood supply, which can be reversible or irreversible. Sometimes teeth die when they have been had large fillings or crowns placed, as these procedures have removed a significant portion of the tooth structure. When we take an x-ray of the problem tooth, it can show an abscess or area of infection like a ball of pus at the root tip. These tooth require treatment – a root filling or an extraction.

Root canal treatment – the procedure

Local anaesthetic is placed to numb the tooth and surrounding structures. A rubber dam or umbrella is placed over the tooth to isolate it from the rest of the mouth. This means no bacteria from your mouth is introduced into the tooth, which would compromise the treatment. A hole is made in the centre of the tooth to access the root canal system. A series of hand files and rotary files are used to clean out the dead bacteria and nerve supply, using a mild bleach (hypochlorite) to dissolve the organic matrix. Once the tooth is fully prepared to the end of its root with its sequence of files, the tooth is temporised with a steroid-based medication or calcium hydroxide and sealed. The tooth is left for a number of weeks before stage 2 treatment. Ibuprofen and paracetamol are recommended following stage 1 treatment as the area may be sore for a few days, which is normal and part of the healing process.

In Stage 2 treatment, like the first stage, local anaesthetic and a rubber dam is placed prior to removing the temporary filling. The tooth is flushed out with hypochlorite again, and a size-matched rubber point called Gutta Percha is fitted into the canal with a sealant. The hole in the tooth is then sealed with a white composite filling.Sometimes if the tooth has been compromised or is in heavy function, it may be recommended to have a crown placed. Sometimes we can delay this procedure for six months to a year following root canal treatment, to ensure the tooth has healed and is symptom-free. Most back teeth are recommended to have a crown placed. Some teeth go dark following root canal treatment, and can be internally bleached to try and restore their natural colour, or have a crown placed.

RISKS OF ROOT CANAL TREATMENT

The molar root canal system can have 48 different variations of anatomy. This is the main reason I refer all my molar treatments to Venkat at The Root Canal Clinic as this is his special interest in restoring. Lower front teeth have very complex anatomy also, and I refer these too.

Anterior, canine or premolar root canal treatment is more straightforward. However risks to any root treated tooth can range from

• blocked or calcified canals which may prevent the file from bypassing this
• a metal instrument breaking within the tooth
• the filling material over-extending past the root tip
• perforation of the crown or root
• tooth fracture
• pain
• infection
• darkening of the tooth

Every care is taken to avoid these risks happening, but inevitably some may happen and require referral to Venkat operating out of ProMed House off Cameron Road.