(Root Canal Therapy)
Root Canal (or ‘Endodontic’) therapy is a treatment used to repair and save a tooth where the nerve has become infected or injured, often due to tooth decay. ‘Endo’ is the Greek word for inside and ‘dont’ is the Greek word for tooth; precisely Endodontic therapy treats the inside of a tooth.
During a root canal procedure the nerve and pulp (living tissue inside the tooth), as well as any bacteria and decay, are removed and the inside of the tooth is cleaned and sealed. This allows us to save the tooth, whereas in the past the tooth may have needed to be extracted.
Contrary to what you may have heard, or ‘jokes’ you may have read, modern root canal treatment is very similar to having a routine filling and you can expect a comfortable experience during and after your procedure. For nervous or anxious patients we do offer a range of sedation options which you can read about here.
After root canal therapy has been completed, a crown (restoration) is recommended to protect, strengthen and further seal the tooth, as it will have become more brittle. For more information about crowns, please click here.
Advantages of saving the natural tooth with root canal treatment:
There are many advantages of saving the natural tooth instead of having it extracted, including:
- Maintain normal biting force and sensation. This will ensure efficient chewing function and prevent any negative impacts on diet.
- Prevents tooth shifting causing malocclusion (‘bad bite’) and also protects other surrounding teeth from excessive wear and strain.
- Prevents bone deterioration in the jaw.
- Maintain natural appearance and prevent ‘sagging’ of the face.
Where is the pulp in a tooth and what does it do?
‘Root Canal’ is the term used to describe the open space within the root of the tooth that extends up into the pulp chamber, which is the innermost portion of the tooth (see diagram below).
The pulp of a tooth is made up of soft tissue. It contains blood vessels to supply blood and nutrients to the tooth to keep it alive, and nerves to enable the tooth to sense pressure and temperature (hot and cold). It also contains small lymph vessels carrying white blood cells to the tooth to help fight bacteria.
What happens when the pulp becomes damaged?
When a tooth’s pulp becomes damaged (from decay or trauma), it breaks down and bacteria begin to multiply within the pump chamber; dominating and killing the white blood cells intended to eliminate them.
The bacteria and other decayed debris can then cause an infection within the root canal. Once the pulp becomes infected, it loses its ability to fight the spread of the infection.
The aim of a successful root canal treatment is to remove the bacteria and prevent it from getting back into the tooth.
If left untreated:
If the infection is left untreated it can spread into the surrounding bone. Abscesses (pus-filled pockets) may then form at the root(s) of the tooth ('apical foramen’), and there may be localised bone loss in the jaw around the ends of the infected root canal. Eventually the tooth will need to be extracted (removed).
What damages the pulp in the first place?
Reasons why a tooth’s pulp can become irritated, inflamed and infected include: deep decay within the tooth, a chip or crack in the tooth, or trauma to the face.
Can a tooth survive without the pulp?
The pulp is important during the tooth’s growth and development stages, however once the tooth has erupted through the gums and is fully mature the pulp is not vitally important to the tooth’s health or survival. The function of the nerve is only sensory – to provide the sensation of pressure and temperature (hot and cold).
The absence of the pulp and nerve will not affect the day to day functioning of the tooth, and the tooth will continue to be nourished by the tissues surrounding it.
What are the signs a root canal is needed?
It is important to take note that in some cases there will be no pain or other symptoms present. However, general symptoms include:
- Prolonged sensitivity or pain to hot and cold temperatures (after the temperature has been removed from the tooth).
- Severe toothache pain upon chewing or the application of pressure.
- Discolouration of the tooth (it will darken).
- Swelling and tenderness of the gums near the tooth.
- A recurring or persistent pimple on the gums.
The procedure is generally done over three appointments. Firstly the infected nerve and pulp is removed (‘extirpation’), then the canals are measured and cleaned of old debris (‘mechanical preparation’) and lastly the canals are sealed (‘obturation’).
Root canal therapy procedure- Summary:
Root canal therapy procedure- Animation:
A full explanation of the procedure is below:
During your appointments (mainly the second and third) the tooth will be isolated using a rubber dam (also called a ‘dental dam’). A rubber dam is a thin rectangular sheet made of latex rubber used to isolate one or more teeth from the rest of the mouth (if you are allergic to latex we have non-latex versions available). Isolating the tooth has a number of purposes:
- To prevent the bacteria in saliva from coming into contact with the tooth and therefore re-contaminating it.
- It keeps the tooth surface dry and ensures a clear view for the dentist.
- Prevents water and solutions (such as bleach) used in the procedure from entering your mouth and throat.
- Protects your throat from particles of tooth debris, and prevents instruments (such as tiny files) from accidentally entering the mouth or being inhaled.
- Helps prevent your gag reflex being triggered.
- Protects lips and cheeks by keeping them shielded.
Be assured you can still breathe and swallow normally with a rubber dam in place.
To place the rubber dam, a hold puncher is firstly used to make a hole in the sheet so it can fit around the tooth. The sheet is then put onto a metal frame to assist in placing it, and is then stretched over the tooth (so the tooth sticks out through the punched hole). A small metal clamp is then placed around the tooth to prevent the dam from slipping and to create a water tight barrier.
Pulp extirpation is the removal of the nerve of the tooth. An opening is made in the tooth to create access to the root canals. An x-ray will be taken to confirm the root canal has been located. Then the pulp, nerve and infected tissue is removed using a small instrument called a broach. Anti-bacterial and anti-inflammatory medication is them placed inside the tooth for both pain relief and to start sterilising the tooth. A temporary filling is placed to seal the hole – keeping the medication in and any further bacteria out.
Also called ‘instrumentation’, it involves measuring the root canal lengths and cleaning them out (debriding). Firstly, the temporary filling is removed and the tooth is re-accessed through the opening.
Measuring the root canals:
There are two ways the dentist can measure the root canals: using x-rays and an instrument called an apex locator. At VC Dental we use a combination of both to provide an accurate picture.
The root canal lengths will be calculated to what is known as the ‘working distance’ (distance from the ‘apex’ – ends of the root). This needs to be calculated for all the canals in the tooth as their lengths will vary. Canal length measurement is important because if the measurement is too short, bacteria and infection can remain in the tip (end) of the canal; and if it is too long it can cause irritation to the tissue surrounding the tooth.
Cleaning the root canals:
Now the canal lengths have been established, they need to be cleaned and shaped to those measurements. This is the most crucial stage in root canal treatment. Cleaning the root canal is necessary to remove as much bacteria, and remnants of nerve and decayed tissue, from the roots as possible.
The process requires ‘chemo-mechanical preparation’, meaning it requires chemical action in the form of dental bleach (sodium hypochlorite) and mechanical action in the form of filing.
Files are used to enlarge, shape and smooth the canals (so they can receive fillings and sealers in the next appointment). At VC Dental we use a combination of hand (manual) and rotary (electric) files to ensure the best result.
Because the root canal structure is made up of a system of interconnecting smaller canals (rather than just one or two main canals), using hand and rotary files alone would not be sufficient. The chemical action of the bleach is essential to disinfect areas that the files alone cannot reach. Frequent flushing of the canals with bleach is crucial to success.
The canals will then be dressed with an anti-bacterial solution of calcium hydroxide. This paste has a very high pH to kill off any remaining bacteria in the canal before the final appointment to seal the canals. The temporary filling will then be replaced.
Obturation (sealing the canals):
Obturation means sealing the root canal completely with airtight sealing agents. Sealing the canals before placement of the final restoration is important to prevent them from becoming re-infected with bacteria.
The temporary filling is removed and the tooth is re-accessed through the opening. Firstly, a rubber-like root filling material called ‘gutta-percha’ is used to fill the canals. It is a thermoplastic material (‘thermo’ meaning heat and ‘plastic’ meaning shape) that is heated and then compressed into and against the root canal walls to seal them.
The gutta-percha is used in combination with an adhesive cement called a root canal sealer. The sealer is utilised as a lubricant and binding agent to eliminate any spaces within the canal where the gutta-percha may not be able to penetrate.
The temporary filling will be replaced until the final restoration is cemented.
The temporary filling is removed and the opening is sealed with a permanent composite filling. A crown is then recommended to restore strength and functionality to the tooth.
For more information about crowns, please click here.
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