Root Canal Treatment is a means of saving a tooth that has been damaged by deep decay, breakage, or infection. The purpose of treatment is to restore the tooth to good health so that it can function properly inside your mouth. An endodontist is a specialist in root canal treatment.
Deep inside every tooth is a pulp chamber and root canals that contain living tissue called the pulp. The pulp is often mistakenly referred to as the ‘nerve’, but in fact it contains a fine network of tissue fibres, nerves, and blood vessels. If a large cavity in a tooth reaches the pulp chamber, or if a tooth breaks, bacteria can reach the pulp. These bacteria damage the pulp and eventually destroy it. The root canals become infected and inevitably an abscess forms beneath the root of the tooth, in the jaw bone. Pain (occasionally severe) may occur at any time during this process, although it does not always, and the infection can spread.
The purpose of the treatment is to remove the bacteria or dying nerves from inside the tooth and to disinfect the root canals. This is achieved by making a small hole through the tooth into the pulp chamber, locating and measuring the root canals, then cleaning and widening them using fine instruments called files. Once clean, the canals are filled to seal them off from re-infection. In most cases abscesses will start to heal at this point. Changes on the x-ray are not usually seen however for up to six to eight months following treatment.
No. Local anaesthesia is used throughout the procedure, and every possible step is taken to ensure that you are comfortable while the work is carried out. On very rare occasions some teeth are particularly sensitive, however, a number of techniques are available to enable even these teeth to be tackled. Following treatment you will be informed of the possibility of discomfort from the area. This is usually minor, and does not last long. Occasionally (5% incidence) the tooth can flare and give rise to significant pain. Should this occur the acute symptoms are usually treated with antibiotics and anti-inflammatories (painkillers). A flare up is an unfortunate and rare occurrence and is related to factors such as host response and bacterial virulence. It does not mean that the tooth has a lesser chance of successfully being treated.
The only way to ascertain what is happening inside and underneath teeth is through the use of x-rays. X-ray pictures inside the mouth produce only very small doses of radiation and pose virtually no danger. However, to further reduce risk, the surgery is equipped with the very latest computerized x-ray system and a high frequency x-ray tube. This reduces the already small radiation dose by a further 75%- 80%. and means that for the same dose of one regular mouth x-ray, four computerized x-rays can be taken. For most endodontics 2 or 3 x-rays are all that is required.
This can vary according to the complexity of the root canals, the presence of infection, or if re-treatment is being carried out. Sometimes treatment can be carried out in one session lasting between one to two and a half-hours. If the canals are infected or are being retreated it is usually necessary to place an antibacterial dressing in the tooth, which is sealed in for a period of a few weeks and bring you back for a further appointment.
Root canal treatment does enjoy a high level of success. However, it should be remembered that it is impossible to guarantee the success of any medical procedure. Even with the very best treatment healing may not occur due to circumstances beyond the control of the physician. For teeth without abscess formation (dying only), root canal treatment enjoys a very high rate of success (90%-95% survival at 10-15 years). Once a tooth has become infected the success rate can diminish with the increasing size of the abscess. Success in these cases could be quoted at 70%-85% survival at 10-15 years.
Should treatment fail, which can be established either through a return of the pain symptoms or an x-ray showing no healing, further steps might need to be taken to eradicate the infection. These include redoing the root treatment again, surgical techniques or possibly the extraction of the tooth. Please see below what the cost implications would be for this.
It is undoubtedly true that the complexity of the root canal system will allow bacteria to evade our efforts at disinfection, and that some bacteria will survive if they have penetrated deep into the tooth. It is also true to say that the effect of these types of bacteria and the chronic inflammatory response that the body produces to protect itself from them, can potentially cause systemic diseases in susceptible individuals.
As with any medical intervention, it is important though to weigh up the evidence of the risks against the benefits. There is currently no modern scientific evidence to link residual bacteria left in root treated teeth with any systemic disease. For this process to be feasible it is likely that the patient will be disease susceptible and this would be a great rarity. As a living organism we co-exist with bacteria in our bodies continuously. This risk will therefore be very small, and impossible to quantify.
Without root canal treatment the only way to completely eradicate the source of infection would be to extract the tooth. This could lead to both cosmetic and functional disadvantages, possibly altering the quality of life. Replacement (false) teeth can be provided, but all of these, whether fixed or removable, are invariably compromises that damage the adjacent teeth or gums, leading to further tooth loss over time.
An implant will be an effective replacement that has a good success rate and does not tend to damage adjacent structures. These are placed surgically, as long as there is bone of sufficient quality and quantity to support it. Implant treatment is generally quite expensive.
I believe that consideration of the above factors would tend to support the notion of trying to save a tooth rather than extract it, but this is a personal view.
Root treated teeth are susceptible to breakage for two reasons. Firstly the tooth itself is weakened by the large cavity or breakage that originally caused the problem. Secondly the nerves inside the tooth provide it with a pressure sensitive control mechanism and the tooth is protected from high breaking forces. With no nerve the fine control is lost and higher forces can lead to breakage.
A crown (cap) is often necessary, particularly for back teeth that do the heavy chewing. The tooth can be used normally following treatment, however, until strengthened you should take care not to bite too heavily on it.
I will often await signs of healing on an x-ray before recommending final protection with a crown. This is established at a 6 month or year recall appointment with us, and it is important that you attend this so the status of the tooth can be established. During this time the tooth is protected with a provisional sealed filling usually provided by myself.
If a crown is recommended it is essential that you return to your dentist so that the tooth can be properly protected. A badly fractured root treated tooth often cannot be saved.
Your own particular requirements can and will be discussed before any treatment is undertaken. Often, reassurance and a gentle manner explaining what will happen works well for many anxious patients.
The dental chair is equipped with an audio-visual unit, which you can control and a number of films, documentaries and programmes are available to aid relaxation and distraction.
If you are considerably anxious sedation facilities are available. Sedation produces a state of relaxation and reduction of anxiety through administering anxiolytic drugs. This will vary according to the level of patient anxiety, from simple Valium taken the night and morning before the appointment, a larger dose of Temazopam half an hour before the appointment, or for really phobic patients an intravenous mixture of hypnotics and anxiolytics administered by a consultant anaesthetist. As your safety is of paramount concern the presence of an anaesthetist to administer this more powerful sedation is mandatory. The drugs induce a retrograde amnesia so the patient has only a very vague memory of what happened.
Any form of sedative agent leaves the patient slightly groggy for a few hours following the appointment. We therefore insist that the patient is accompanied home by a responsible adult and instructed not to drive, operate heavy machinery or sign important documents for up to 5-6 hours.
Specialist endodontic treatment is not cheap as the procedures are time consuming, requiring expensive specialised equipment and highly trained staff. A price list is available on this web site but it should only be used as a guide to likely costs. Before any treatment is started the costs are discussed and once a price has been quoted we endeavour to keep to this, so you do not need to worry about a growing list of extra charges.
Initial consultation and all x-rays.
The tooth sealed using a permanent filling material suitable for a crown core. NOT permanent cast post and cores.
Any necessary emergency appointment with the practice during or immediately following treatment.
Insurance form completion & report to referring dentist.
A review appointment 6 months to 1 year following treatment.
Please note Item 3. Some endodontic specialists will send you back to your own dentist for the final/provisional filling. I prefer to do this myself so that I can ensure an immediate good seal preventing microleakage and re-contamination. Furthermore, the dentist who does place the final restoration may damage prepared areas as they will not have had the benefit of working inside the tooth, fully appreciating its internal dimensions.