Introduction
One in three adults in the UK have had a root canal treatment, making it a relatively common procedure. It’s often caused by deep decay in a tooth, but cracks and leaking fillings are also common reasons why you may need endodontic treatment.
In simple terms, the process involves clearing out any diseased tissue and disinfecting the root or ‘pulp’ of your tooth, then filling and sealing it. If you’d like to read more about exactly what the procedure includes, read our blog about it HERE.
Whether your dentist has referred you for a root canal treatment or you’re privately exploring options for endodontic treatment, you probably have a few top-of-mind questions.
In this blog we’ll do our best to answer the most frequently asked questions we get about the invaluable and often misunderstood procedure.
What is root canal treatment?
Root canal treatment saves a damaged tooth by removing infected pulp, disinfecting the area, and sealing it. This procedure is essential for preserving your natural tooth and maintaining oral health.
Watch Dr. David Selouk explain what Root Canal Treatment is
Who might a tooth need 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 in the jaw bone beneath the root of the tooth.
Pain (occasionally severe) may occur at any time during this process, although it does not always do so, and the infection can spread.
What is the pulp for?
The dental pulp is a specialised tissue within the center of a tooth and is a crucial part of a tooth’s structure, serving several important functions:
Nourishment: The dental pulp contains blood vessels that provide essential nutrients to the tooth, keeping it alive and healthy.
Sensory Function: It houses nerves that allow the tooth to sense temperature, pressure, and pain. This sensory input helps protect the tooth from damage by triggering responses to potentially harmful stimuli.
Formation: During tooth development, the dental pulp plays a vital role in the formation of dentine, the hard tissue that forms the bulk of the tooth beneath the enamel.
Defense and Repair: The pulp can produce dentine in response to damage, such as cavities or trauma, helping to protect the inner parts of the tooth.
Overall, the dental pulp is essential for the vitality, sensation, development, and defense of the tooth. An important part of the role of an endodontist is to try and maintain the health of the pulp wherever possible.
How will I know if I need root canal treatment?
There are various signs and symptoms, mainly pain, and your dentist canl investigate their cause.
Other than persistent tooth pain, other signs include sensitivity to hot, cold or biting, tooth discolouration, swelling and tenderness in the gums, or a recurring pimple on the gums.
These symptoms indicate that the pulp inside your tooth may be infected or damaged. It’s important to consult your dentist if you notice any of these signs, as early intervention can save your tooth and prevent further complications.
How is root canal treatment done?
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, or more advanced techniques like laser-assisted endodontics.
Once clean, the canals are filled to seal them off from reinfection. In most cases, abscesses will start to heal at this point. Changes on the x-ray are not usually seen for up to six to eight months after treatment.
Is it painful?
Root canal is no more painful than a regular filling performed with care. Local anaesthesia is used throughout the procedure and every possible step is taken to ensure you are comfortable while the work is carried out.
On rare occasions, some teeth are particularly sensitive, but various techniques are available to ease any discomfort.
Following treatment, you may experience mild pain. This is usually negligible and lasts only a few days.
Occasionally (10%-15% incidence), the tooth can flare up, giving 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 the tooth has a lower chance of being successfully treated.
Watch Dr. Richard Kahan Explain How Root Canals Relieve Pain
Are many x-rays taken?
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.
To further reduce risk, the academy uses the latest computerised 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 radiation exposure of one regular mouth x-ray, four computerised x-rays can be taken.
Most of the time, only two or three x-rays are required.
We use CBCT scanning which offers a 3D view of the tooth and surrounding bone, providing unparalleled clarity in diagnosis and treatment planning. We also use an intraoral scanner to take a digital impression of your teeth. With specialised design software, we construct a 3D-printed guide using our in-house printer.
How long does treatment take?
This can vary according to the complexity of the root canals, the presence of infection, or if retreatment is being carried out.
Sometimes treatment can be carried out in one session lasting between an hour and 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. This is sealed in for a few weeks to a few months before a further appointment to check that there is healing and treatment can be completed.
Is success guaranteed?
Root canal treatment enjoys a high level of success. However, it is impossible to guarantee the success of any medical procedure. Even with the 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 an exceptionally high rate of success (90%-95% tooth 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 is 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 be needed to eradicate the infection. These include redoing the root treatment, surgical techniques or possibly the extraction of the tooth.
What happens after treatment?
Root-treated teeth are susceptible to breakage for two reasons. First, the tooth is weakened by the large cavity or breakage that originally caused the problem. Second, 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 after treatment. However, until it is strengthened you should take care not to bite too heavily on it.
The need for a crown is established at a six-month or 12-month 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.
If a crown is recommended, it is essential that you return to your dentist so the tooth can be properly protected. A badly fractured root-treated tooth often cannot be saved.
I’m nervous about dental treatment. Is there anything that helps with nerves?
Reassurance, a gentle manner and a careful explanation of what will happen works well for many anxious patients. It’s also helpful to note that you are in good hands – our specialist team has decades of expertise, having performed these procedures hundreds of times.
That said, we understand that patients have negative associations with dental procedures, and these can make them nervous about coming in for a procedure. We make sure to discuss your particular requirements before any treatment is undertaken.
Watch Dr. Richard Kahan explain the critical role of patient communication in endodontic care.
The dental chair is equipped with an audio-visual unit which you can control, 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.
These vary according to the level of patient anxiety, from simple Valium taken the night and morning before the appointment, a larger dose of Temazepam 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 retrograde amnesia, so the patient has only a vague memory of what happened.
Any form of sedative agent leaves the patient slightly groggy for a few hours. We therefore insist that the patient is accompanied home by a responsible adult, and we instruct them not to drive, operate heavy machinery or sign important documents for up to six hours.
I’ve read that root canals sometimes fail. What happens then?
While root canal treatments have a high success rate, they sometimes fail due to various factors like complex canal structures or reinfection.
If this happens, you might need a retreatment in which the previous filling material is removed, the canals are cleaned and reshaped, and then they are refilled and sealed.
In some cases, if retreatment isn’t successful, an apicoectomy (surgical removal of the tip of the root) or extraction followed by a dental implant might be necessary.
What are the costs of root canal treatment?
Specialist endodontic treatment is an investment. The procedures are time-consuming and require advanced equipment and highly trained medical specialists.
A price list is available on this website but it should be used only as a guide. Before any treatment is started, the costs are discussed, and once a price has been quote, we endeavour to keep to it so you do not need to worry about a growing list of extra charges.
We also have various low-cost treatment options available when our fellowship course is under way.
What is included in your quoted costs for root canal treatment?
- Endodontic treatment/retreatment.
- In simple terms, we will seal the clean canal, but we will not apply a permanent crown. For this, you will be referred back to your general dentist
- Any necessary emergency appointment with the practice during or immediately after treatment.
- Insurance form completion and a report to the referring dentist.
- A review appointment six months to a year after treatment.
Conclusion
As we strive for our patients to feel as comfortable and well-informed as possible, we practise transparency and communication at all stages of the process.
Decades of expertise have paved the road to exceptional patient care, which extends beyond technical know-how into the more emotional and psychological aspects of dental care.
Our patients want to know what to expect, and they want to feel they are in safe hands. This is why we do our best to give them all the information they need in language that is easy to understand .
We hope all your questions were addressed in this blog. If not, please contact us and we will gladly help.
