Root Canal (Endodontic) Treatment

Root canal treatment is usually required when the pulp tissue within the root canal of the tooth has become inflamed and/or infected with bacteria. This is commonly a result of decay, repeated dental procedures and/or hairline cracks or chips on the tooth (which may not be readily detectable to the human eye).

The tooth in question may present with symptoms such as sensitivity to hot/cold, swelling and/or tenderness of the overlying gum. However, it is not unusual for there not to be any pain from the tooth in question.

The aim of root canal treatment is to keep the tooth healthy/return the tooth to health, therefore allowing it to be functional. The only other viable option for a tooth requiring root canal treatment is extraction; the resulting gap may either be left alone or replaced with either an implant or a bridge.

Untreated inflamed teeth which are not painful will eventually give rise to symptoms such as pain and swelling. The chances of success may also be reduced the longer an unhealthy tooth is left untreated.

Treatment is usually carried out under local anaesthetic administered into the gum adjacent to the tooth being treated. The tooth in question is then isolated with a rubber sheet, which has two roles: firstly, it prevents the tooth from being contaminated with saliva (which contains bacteria), and secondly, it improves patient comfort.

An opening is then prepared on the biting surface of the tooth to allow identification of the root canals of the tooth. The root canals are then enlarged gradually with small metallic files. This creates space for disinfectant solutions to be inserted into the enlarged root canals to wash out the inflamed/infected pulp tissue.

Once the root canals have been adequately disinfected, they are filled with a rubber-like biocompatible root filling; this prevents re-infection of the disinfected root canal. The opening is then sealed with a temporary filling.

A few weeks after root canal treatment, a new permanent crown is usually required to protect and restore the tooth to function. Sometimes, the existing crown can be retained, and the opening is simply filled with a white filling.

It is desirable to review the root-treated tooth approximately 1 year after treatment has been completed just to confirm that the treatment has been successful. This quick and simple check can be done at your routine check-up appointment with your dentist.

Due to the intricate nature of root canal treatment, it usually takes 1 to 2 appointments; each appointment is 60 to 90 minutes long. Sometimes, treatment may take 3 appointments. The time required depends on the number of root canals identified in the tooth and the complexity of the root canal anatomy (e.g. how curved the root is, how narrow the root canal is). These factors can only be confirmed once treatment is commenced.

No, the treatment is usually painless (just boring). However, it is not uncommon to have some pain and possibly swelling for up to a week after treatment has been completed. This pain is usually resolved with painkillers, which may be bought over the counter at your local chemist.

All dentists receive basic training on root canal treatment in dental school. General dentists perform most aspects of dental treatment but sometimes refer more complex cases to Specialists in root canal treatment (Endodontists).

Specialist Endodontists are dentists who have undergone further advanced specialist training in all aspects of root canal treatment. This full-time postgraduate training takes an additional 3 years to complete. In addition to being able to perform routine and complex root canal treatment procedures, Endodontists have skills in finding the cause of oral and facial pain.

The success rates for root canal treatment are usually in the region of 85%-95%. However, as with any medical procedure, success can never be guaranteed, no matter how straightforward the treatment is. This is because healing and, therefore, success is ultimately dependent on the response of the individual patients to the treatment carried out.

Occasionally, it may not be beneficial or possible to root treat a tooth. Examples of these cases that have a poor prognosis are root canals that are not accessible (e.g. blocked by previous attempts of root canal treatment), root fractures, and insufficient tooth left for a post-endodontic filling/crown.

Usually, once the tooth has been assessed and X-rayed, a decision can be made whether the tooth can be treated; however, there are some cases when a decision on the viability of root canal treatment can only be made once treatment has been started.

No. Antibiotics do not eliminate the infection from the tooth; they only give temporary relief. The only way to predictably eliminate the infection from the tooth is to carry out root canal treatment. In addition, repeated doses of antibiotics may result in their becoming less effective as you may gradually build up a resistance to them.

Three to five small X-rays are usually required during root canal treatment. As the treatment carried out is in the root, which is embedded in the bone, the only way to check each stage of the treatment is to take an X-ray. By checking each stage thoroughly before going on to the next stage of treatment, we are maximising the chances of a successful outcome.

The radiation exposure from the dental X-rays taken is minimal, and European and national guidelines are strictly adhered to when justifying and taking any radiographs.

Steven Williams
BDS. MFDS RCPS (Glasg) Mclin Dent (Endo) MRD RCS (Ed)