Root canal treatment or endodontics is used to save the tooth when the dental pulp (blood vessels and nerve in the centre of the tooth) dies and the tooth becomes infected. The cause of infection is usually decay in the tooth, under a filling or if the tooth fracture. Without treatment, this can cause a dental abscess resulting in pain, swelling and infection of the jaw bone.
The only alternative to carrying out root canal treatment is to remove the tooth. Although some people would prefer an extraction, it is usually best to keep as many natural teeth as possible.
The aim of root canal surgery is to avoid removal of the tooth where possible. Before surgery, you may be given antibiotics to control any infection that has gone beyond the tooth, to the bone.
When the pulp of the tooth is dying or has died, the pulp chamber becomes infected. The body’s own natural defences cannot fight the infection because no circulation remains in the tooth. Root canal treatment is used to open up the pulp chamber, clean out the infected remains of the pulp and fill the chamber with an inert (non-active) material to prevent the infection returning.
Disease or infection of the tooth pulp occurs when tooth decay is not treated or when there has been a knock or blow to the tooth. A loose or broken filling may also cause infection in the tooth pulp.
The medical name for root canal surgery is endodontics. Root canal surgery is usually carried out under local anaesthetic (injection), although in some cases, where the tooth has clearly died and is not sensitive, this may not be necessary.
Root canal surgery is usually carried out under local anaesthetic, although in some cases, where the tooth has clearly died and is not sensitive, this may not be necessary. Local anaesthetics will not work in an infected area, and your dentist will usually give you antibiotics to settle the infection first and start treatment about a week later.
Your dentist will first open the tooth through the crown (the flat top part) of the tooth, so that the pulp chamber can be accessed. Any remaining tooth pulp is then removed.
Once the pulp has been removed, the remaining root canal will be cleaned and enlarged so that it can easily be filled. The root canals are normally an oval shape and may be very fine and difficult to fill.
Your dentist will use a series of small files to enlarge the canals and make them a regular shape so that the root filling can be placed. The treatment may take several hours to complete, and may be carried out in one, or several visits.
Generally, the front, incisor and canine teeth have one canal, premolars have two canals, and the back molar teeth have three. The more roots a tooth has the longer the treatment will take to complete.
If the treatment is carried out over several visits your dentist may put a small amount of medication in the cleaned canal in between visits to help clear up any remaining germs and bacteria. The tooth will then be sealed with a temporary filling. You may also be given antibiotics to manage and prevent further infection.
Once the root canal has been cleaned out and shaped, the root filling will be sealed tightly into the root canal. The tooth may then be restored with a filling.
Root-filled teeth are more brittle than live ones and in some cases your dentist may suggest placing a crown on the tooth to protect what remains of the tooth structure. In some cases a root-filled tooth may darken, particularly if it has died as a result of a blow and there are several ways for your dentist to treat this.
Root canal treatment is usually very successful. However, if the infection comes back, the treatment can be repeated.
You should try to avoid chewing or biting down, especially on hard foods, until the treatment has been completed. This could be at the end of several visits.
After the final treatment your restored tooth should be pain-free, although it may feel sensitive for a few days. Over-the-counter (OTC) painkillers such as paracetamol or ibuprofen can be taken to relieve any discomfort. Ibuprofen may not be suitable for people with asthma, or those with stomach, kidney or liver problems. If you are unsure, speak to your pharmacist or GP. Children under 16 years of age should not be given aspirin. If any pain or swelling remains after a few days you should return to your dentist.
A restored tooth or crown should last for many years without further treatment, as long as you maintain good oral hygiene and visit your dentist as soon as possible if any pain or complications arise. Many crowns last an entire lifetime.