Root canal, or endodontic treatment is a dental procedure in which the damaged or diseased nerve or pulp inside a tooth is removed and replaced with a permanent filling material.
Infected or damaged nerve tissue will often cause a number of symptoms in the tooth, primarily toothache or acute sensitivity. It can also cause pain on biting, or an abscess resulting in swelling of the facial tissues or a blister on the gum beside the tooth. In order to resolve these symptoms, the problem nerve must be removed and the infection must be controlled.
To gain access to the nerve space of the tooth, a small opening is made in the biting surface (even if it is covered by a crown or a bridge) and, with the aid of a microscope, a series of very fine files are used to locate, debride and clean the root canals in preparation for their sealing with a rubber based material called gutta percha. Treatment is carried out using local anaesthetic to suit the patients' need. A rubber sheet, called rubber dam, is used to isolate the tooth to be treated. It is stretched over a small frame, which sits comfortably on the mouth/chin area. This not only prevents saliva from contaminating the inside of the tooth but also allows the patient to be free from having debris and irrigating solutions in the mouth.
Although, in very simple cases root canal treatment can be carried out in a single visit, two appointments are usually required for most people. The first visit is usually the longer, about 60-70 minutes of actual treatment, during which time the root canals are located, prepared and left dressed with an anti-bacterial paste until the second visit. This is usually a shorter appointment, when the permanent root filling material is placed and the tooth is sealed with a temporary top dressing, ready for your dentist to place either a new filling or a crown over the biting surface of the tooth.
The success rate for first time endodontic treatment has been quoted as being in the region of 90%. If prior root canal treatment has failed, remedial treatment to rectify a recurrent infection can be carried out. In these cases, the success rate is obviously reduced to approximately 80%.
However, sometimes treatment does fail, in which case other avenues have to be explored. Occasionally, after treatment has commenced, it becomes apparent that the tooth cannot be salvaged. It may be that the tooth is too severely decayed for the dentist to be able to satisfactorily place a filling or crown, or it may be that the tooth is badly cracked and impossible to repair. If the root canals have "sealed themselves off" and cannot be located, this can also limit the prognosis for a tooth.
Sometimes, procedural errors occur. Due to the fine nature of both the root canals and the files used, these files can fracture and remain in a canal. However, this does not necessarily have any consequence to the success of the root filling. All files are single use and are sterilised before use. Patients are always informed if a file becomes fractured in their tooth.
Very rarely, if access to the nerve is to be gained through a ceramic crown or a bridge, the porcelain facing can chip off when drilling. This would not necessarily render the crown/bridge non-functional but it may need to be replaced for aesthetic reasons.
Once the nerve of a tooth is infected or damaged, root canal treatment becomes the only means of retaining a tooth. Antibiotics are a short-term solution and will treat the effects of the problem but not the cause. These drugs may mask the symptoms temporarily but the problems will return. However, if the tooth is symptom free, it can be left untreated if preferred, at the risk of future pain and possibly loss of the tooth. The other alternative to root canal treatment is extraction of the tooth in question. This is perfectly feasible, and may be preferable in some cases. The tooth can then be replaced by means of either a denture, bridge or dental implant. Or, the tooth may not be replaced at all. It is advisable that any of these alternatives be discussed with your dentist.
Immediately after treatment, the tooth may feel sore and tender to bite on, as if it is bruised. It is usually recommended that Ibuprofen be used to relieve this, provided you are able to use it. This may continue for a few days, or in some cases, a couple of weeks.
Because of this, it is important to maintain regular dental check-ups, as it will no longer be possible for you these early signs of dental decay.
However, if properly cared for, along with the other teeth, a root filled tooth should continue to function happily for many years.