Root canal treatment, also known as endodontic treatment, is the process of removing infected, injured or dead pulp from your tooth. The space inside the hard layers of each tooth is called the root canal system. This system is filled with soft dental pulp made up of nerves and blood vessels that help your tooth grow and develop. When bacteria (germs) enter your tooth through deep cavities, cracks or flawed fillings, your tooth can become abscessed. An abscessed tooth is a tooth with an infection in the pulp. If pulp becomes infected, it needs to be removed. An abscessed tooth may cause pain and/or swelling. Your dentist may notice the infection from a dental x-ray or from other changes with the tooth. If left untreated, an abscessed tooth can cause serious oral health problems.
Your dentist may do root canal treatment or refer you to an endodontist. An endodontist is a dentist who has completed a university post-graduate specialty program in endodontics. Endodontics is a specialty of dentistry concerned with the treatment of the dental pulp or nerve of the tooth. If your child’s primary (baby) tooth is damaged, your dentist may refer you to a pediatric dentist for this procedure. A pediatric dentist has at least 2 years of extra university training in treating children.
The dentist removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Afterwards, you will return to your dentist, who will place a crown or other restoration on the tooth to protect and restore it to full function. After restoration, the tooth continues to function like any other tooth.
Many endodontic procedures are performed to relieve the pain of toothaches caused by pulp inflammation or infection. With modern techniques and anaesthetics, most patients report that they are comfortable during the procedure. For the first few days after treatment, your tooth may feel sensitive, especially if there was pain or infection before the procedure. This discomfort can be relieved with over-the-counter or prescription medications. Follow your dentist’s instructions carefully. Your tooth may continue to feel slightly different from your other teeth for some time after your endodontic treatment is completed. However, if you have severe pain or pressure, or pain that lasts more than a few days, call your dentist.
Endodontic treatment can often be performed in one or two visits and involves the following steps: The dentist examines and x-rays the tooth, then administers local anaesthetic. After the tooth is numb, the dentist places a small protective sheet called a “dental dam” over the area to isolate the tooth and keep it clean and free of saliva during the procedure. The dentist makes an opening in the crown of the tooth. Very small instruments are used to clean the pulp from the pulp chamber and root canals and to shape the space for filling. After the space is cleaned and shaped, the dentist fills the root canals with a biocompatible material, usually a rubber-like material called “gutta-percha”. The gutta-percha is placed with an adhesive cement to ensure complete sealing of the root canals. In most cases, a temporary filling is placed to close the opening. The temporary filling will be removed by your dentist before the tooth is restored. After the final visit with your dentist, you must return to have a crown or other restoration placed on the tooth to protect and restore it to full function. If the tooth lacks sufficient structure to hold the restoration in place, your dentist may place a post inside the tooth. Ask your dentist t for more details about the specific restoration planned for your tooth.
The dentist gives you a local anesthetic (freezing). To protect your tooth from bacteria in your saliva during the treatment, the dentist places a rubber dam around the tooth being treated. The dentist makes an opening in the tooth to reach the root canal system and the damaged pulp. Using very fine dental instruments, the dentist removes the pulp by cleaning and enlarging the root canal system. After the canal has been cleaned, the dentist fills and seals the canal. The opening of the tooth is then sealed with either a temporary or permanent filling.
The cost varies depending on how severe the problem is and which tooth is affected. Molars are more difficult to treat and usually cost more. Most dental insurance policies provide coverage for endodontic treatment. Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with a bridge or implant to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.
You should not chew or bite on the treated tooth until you have had it restored by your dentist. The unrestored tooth is susceptible to fracture, so you should see your dentist for a full restoration as soon as possible. Otherwise, you need only practice good oral hygiene, including brushing, flossing, and regular checkups and cleanings. Most endodontically treated teeth last as long as other natural teeth. In a few cases, a tooth that has undergone endodontic treatment fails to heal or the pain continues. Occasionally, the tooth may become painful or diseased months or even years after successful treatment. Often when this happens, another endodontic procedure can save the tooth.
Most teeth can be treated. Occasionally, a tooth can’t be saved because the root canals are not accessible, the root is severely fractured, the tooth doesn’t have adequate bone support, or the tooth cannot be restored. However, advances in endodontics are making it possible to save teeth that even a few years ago would have been lost. And, when endodontic treatment is not effective, endodontic surgery may be able to save the tooth.
After a root canal treatment, your tooth has to be restored (fixed) to look, feel and work as much like a natural tooth as possible. If an endodontist performed your root canal treatment, he or she will fill the opening of the tooth with a temporary filling and send you back to your dentist for tooth restoration. Your dentist may use a permanent filling or a crown to restore your tooth. The choice of restoration will depend on the strength of the part of the tooth that’s left. A back tooth will likely need a crown because chewing puts a great deal of force on back teeth. If there is not enough of the tooth left, posts may be used to help support the crown.
Root canal treatment may be done in 1 or 2 appointments. After root canal treatment, your tooth may be tender for the first week or two. Bad pain or swelling are NOT common. If this happens, call your dentist or endodontist. You can still get a cavity or gum disease after a root canal treatment. Root canal treatment does not protect your tooth from other types of damage. With proper care and regular dental visits, the tooth could last as long as your other teeth. Most of the time, a tooth that has had a root canal treatment can be saved. However, there are cases where everything possible has been done to save a tooth and still the tooth must be extracted (pulled).
Most root canal treatments are successful. But in some rare cases, a second root canal treatment is needed. Sometimes this is caused by new trauma, deep decay, or a loose, cracked or broken filling which can cause a new infection in your tooth. In some other cases, your dentist or endodontist may discover very narrow or curved canals that could not be treated during the initial visit. This is called retreatment. When retreating a tooth, the root canal filling material is taken out, and the canal is recleaned, reshaped and refilled.
Sometimes root canal surgery is needed when a regular root canal treatment cannot be done or when it has not worked. Surgery is done to: Check the end of the root for fractures (cracks). Remove parts of the root that could not be cleaned during regular root canal treatment. Clear up an infection that did not heal after regular treatment.