Root Canal Treatments

Every tooth has a hollow chamber in the middle which has branches that go down through the middle of the root and open out at the end of the root. At the end of the root if where the nerve and blood vessels enter the tooth travelling up through the root into the chamber and back out again. The nerve may get damaged due to the presence of bacteria entering the chamber through deep dental decay or fractures in the tooth. Trauma can also damage the nerve beyond repair either through a sharp shock like a blow or slowly over time through grinding overloading the tooth. Teeth may occasionally be worn down so much that the nerve is exposed again allowing bacteria to enter the enclosed nerve. Once the bacteria enter the nerve chamber they cause swelling in the middle of the tooth which cuts off the blood supply leading to the death of the tooth. At most of these stages, the tooth will be causing varying degrees of pain. The classic symptoms of a nerve that is beyond repair, that is irreversibly damaged are- a)a pain waking you from your sleep, b) pain coming on spontaneously not necessarily after food and c) painkillers stop working.  Earlier on before the tooth has fully died off it may be possible to put a dressing in the tooth and soothe the irritated nerve. However, once the nerve is beyond repair then there are only two choices to resolve the pain

• An extraction—remove the tooth entirely
• A root canal treatment

Both of these procedures are designed essentially to remove the infected nerve material which is causing the pain stimulus. During a root canal treatment, the chamber in the middle of the tooth and the branches extending into the roots are cleaned out down to the end of the root to remove infected material. The area is disinfected with various medicaments and in the end of the day filled with a rubbery material known as gutta-percha and the tooth restored to form and function. Root canal treated teeth often need crowns as a lack of tooth structure from significant decay or fracture is usually the cause of the need for a root canal treatment in the first place. In this instance, the crown is being used to copper fasten the tooth structurally. There are few things more frustrating than having a root canal treatment done and six months later breaking the tooth on a piece of bread and having to have the tooth extracted anyway.

Some root canal treatments are more straight forward than others. For example, the root canal system on a younger person will be much larger and patent than on an older person as the root canal chamber tends to shrink with time. A front tooth will be easier to access and also tend to have only one root as opposed to four on an upper back molar. Some people simply find it difficult to open wide enough to access a back tooth. Most root canal treatments will require two visits about a week apart. Appointment time length would vary from one hour to two hours. Two hours is a long dental appointment but usually is not any trouble for most people. Very rarely a tooth that is very infected may take even a third visit with repeated dressings required to reduce the bacteria count sufficiently.

The price of a root canal is generally determined by the number of roots the tooth has. This has a direct effect on the complexity of the procedure and therefore its technical difficulty. Root canal treatment on a single-rooted tooth costs 400euro, a double rooted tooth 450 euro and a molar three to four rooted tooth 650 euro. The incisors usually have one root as do the canines,- the first three teeth from the front. Tooth number four usually has two roots whilst number five may have one or two. These are the premolar, ‘middle’ teeth. Tooth numbers six back are the molars and these usually have three roots or more.

Root canal treatment should not hurt. Local anaesthetic cream followed by local anaesthetic injections will be given with the purpose of numbing your tooth and facilitating pain-free treatment. Teeth requiring root canal treatment are quite often very inflamed and may require some extra anaesthetic and also longer time for the anaesthetic to take effect. Root canal treatment cannot be successfully done on a tooth that’s not good and numb!

The final stage of a root canal treatment is when the roots are filled and the top of the tooth restored. This involves a semi-soft material being pushed down into the roots to fill all the nooks and crannies. Filling the roots can push debris and antiseptic out through the end of the tooth and quite often root treated teeth are tender for a number of days. In fact, 1/3 of these teeth give a little pain in the first 72 hours. At the end of the first week, this falls to 10%. This post-operative pain should gradually fade away to nothing. As root treated teeth often have an area of infected or absent bone around them it can take quite a while for the tooth to feel exactly the same as all the other teeth- bone healing is slow and can take months. Either debris or the root filling material itself can be pushed through the end of the root and this can make the tooth tender to bite on for a while until the body degrades any excess and removes it. If there is no sensation that the tooth may be high in the bite then this is the most likely cause and will in general settle without help. A high filling will need to be trimmed down as every time you bite the tooth is being pushed down more than it ought into healing bone.

Root canal treatment when done well has got a success rate of 85-90%. Another way of looking at this is that even under perfect conditions in the best hands one in ten will fail and need to be redone or extracted. Factors which affect the success rate are the amount of healthy tooth remaining, whether or not a crown is placed, whether the tooth has healthy neighbours supporting it and whether the tooth is being used to hold in a denture or bridge(false teeth).

A root canal can be redone. Usually, it will be assessed in the mouth and by x-ray to see if there are obvious faults we feel we could improve on. If the root canal looks reasonable but is still failing usually a referral to a specialist is called for. A root canal specialist is known as an endodontist. It is worth bearing in mind that in general root canal treatment has a success rate of 85-90% however a redone root canal has a success rate of 70%.

The main factor post root canal is likely to be how numb your mouth is rather than having a soft filling. Modern white fillings can be eaten on immediately unless told differently. Care must be taken not to bite a numb lip, cheek or tongue and not to burn them with something too hot. It makes sense to have cool or lukewarm drinks and mostly soft food while the anaesthetic is still affecting your mouth. Otherwise, it is probably a good thing to eat as root canal treatment is a long appointment and your body may need some fuel.

There is no reason not to drive after a root canal under local anaesthetic. If there has been a degree of sedation or general anaesthetic someone else ought to drive you. It is a sensible precaution if possible not to plan a long journey but only because you may be a bit tender and that may be distracting when the anaesthetic wears off.

There are a couple of reasons for a root treated tooth to discolour. Firstly the blood products from the degrading blood vessels in the root including iron leach out into the tooth giving often a greyish brown darker hue. In fact, early in the process, this can appear pinkish. Another factor is that over time the dentine becomes drier and its structure changes somewhat making the tooth more yellow. If the tooth is to have a crown or veneer then this change in colour is likely to be masked by lifelike aesthetic porcelain. In a front tooth that doesn’t require a crown, a process called internal bleaching can be used. This is where a whitening material is sealed into the chamber where the nerve used to be, often over a weekend. This is a successful and safe procedure.