When is Root Canal treatment required?
Sometimes the nerve of a tooth can become infected or inflamed – it may be very sensitive to temperature, there may be swelling in the area or the tooth may be very painful to bite on. When this happens a dentist can offer two solutions – either extract the diseased tooth or provide root canal treatment.
Root canal treatment, or endodontic treatment as dentists call it, involves cutting an access cavity into the tooth, so that the dentist can clean out the hollow space within the centre of the tooth – the pulp chamber. The dentist then finds the root canal(s) – fine canals which run down from the central pulp chamber to the ends of the roots. There can be just one or many root canals depending on the position of the tooth, and they must all be found and treated for the root canal treatment to be successful.
Once inside the tooth the dentist will clean out the dead and dying material and then clean and shape the root canals. In order to complete this part of root treatment correctly it is essential for a dentist to take x-rays of the tooth or use an electronic device, which determines how long the root canals are. Once all the measurements are taken and the root canals prepared, then the dentist places the root filling which runs up to, but not beyond the end of each root canal. This root filling will fill the canal completely and produce a tight seal at the end of the canal. The dentist will then take a final x-ray to check that the root filling is correctly positioned.
The length of the procedure varies. Straightforward cases may be completed in ½ to 1 hour. More demanding teeth may take considerably longer – sometimes over two hours. Such cases (and very infected teeth) will frequently necessitate more than one visit before the procedure is completed.
The symptoms associated with root canal treatment will depend on the complexity of the case, but with adequate local anaesthetic the procedure itself should be painless. It is normal to have some slight discomfort for 2 or 3 days after treatment. The pain however, can usually be controlled with over-the-counter analgesics.
A root treated tooth should feel the same as a healthy tooth, but it will be more brittle than the same live tooth and it is important to have a strengthening restoration placed soon after root treatment, otherwise the teeth can fracture or split and be lost.
Unfortunately sometimes root filling material is not positioned at the correct length – either too short or too long, and the infection can return. Alternatively sometimes the root canal cleaning instruments can perforate through the side of the root causing infection around the tooth. In all cases where root treatment has failed immediate attention should be provided by a dentist, and treatment thereafter may involve referral to a specialist in root canal treatment, known as an endodontist.