Root Canal Treatment

"A well condensed, fully extended root filling is the key to the success of fillings, crowns, and bridges placed ontop."

Tags: dentist, london dentist, nhs, whitening, inman aligner, cosmetic dentist, checkup, dental, anish, anish dentist, london hygienist, dental hygiene, root canal.

June, 2013 by Mr Anish Patel
xrayendo
Left: Poor root treatment not extended to tips of roots. Right: Well extended root treatment.

Overview

Root canal treatment aims to clean the inside of the tooth and fill the resultant void with gutta percha, a rubberised material safely used for a number of years in dentistry. With treatment we can prevent further infection and breakdown of the tooth, and while success rates are high there are times when they drop. The more extensive the infection (abscessed tooth) the less likely treatment will be successful.

Decay left untreated or advanced gum diseases can progress to irreversibly damage the nerves of teeth and cause an infection which will not go away with antibiotics or a simple filling. Unfortunatey in this instance a little more has to be done to remove the decay in the roots of the tooth, and this is where modern endodontics comes in.

Whatever the cause you must seek advice to have the area drained and relieve the swelling. We will normally try and drain the swelling from inside the tooth or occasioanlly, if extensive, we will make a small incision into the affected area and drain the swelling directly. Once drained and the pressure is releived, the pain associated will often reside as well.

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What Caused This?

The most common causes of pulpal inflammation (pulpitis) and root infection (periapcial periodontitis) is extensive decay of the tooth. The decay once deep enough will eventually enter the pulp (nerves and blood vessels) of the tooth and it is here that bacteria cause a local inflammatory response breaking down the pulp. Without treatment and allowed to continue, pressure can build-up inside the tooth and it is this pressure exerted on the nerves of the tooth that causes the characteristic dental pain.

The swelling inside your mouth can be due to the infection spreading outside the tooth and into the bone and gums. If the infection has somewhere to exit (e.g gum boil) it has a point of release and it is likely you will not feel alot of discomfort apart from a foul taste in you mouth. If the infection is contained with pressure building up,you will often experience varying symptoms associated with a localised infection.

The less common cause of root infection is severe gum disease. Severe gum disease leads to bone loss around the tooth with bacteria entering along the sides of the tooth via the root tips instead of through the middle. Symptoms as above are often experienced.

The Procedure

Even though it may sound scary, I assure you that it involves many of the steps of a normal filling. You will be completely numb and will not feel a thing apart from small amounts of pressure. It is done at the practice many times a week and is a perfected routine procedure. Root canal treatment can be done over a longer 1 visit or two separate appointments.

1st Visit- 30-45 Minutes (Less time for front teeth and more for back)
1.  
We will place numbing gel where we plan to place the anaesthetic, so you are less likely to feel the small pinch. We then wait a minimum of 10 minutes for it to work.

2.  While we wait- We may be busy around you getting the rubber guard ready to place over your tooth. This protects you from swallowing any materials we use and makes for a clean, infection free environment for us to work in.

3.  Only when you feel ready do we proceed. I will check that you feel numb by asking you and sometimes checking that one side of your tongue and lower lip have lost sensation.

4.  We start to remove the decay from the top part of the tooth and the root canal. You will see us stop occasionally and wash the tooth out with disinfectant.

5.  Once cleaned we will switch to our small instruments to clean right down to the bottom of the tooth roots. If your having NHS root treatment we will use hand files, and a rotary drill for Private Root canal treatment.

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Left: Manual stainless-steel hand files. Right: Rotary root canal treatment motor.

6.  The next step is to take an x-ray of the tooth and check how long the roots are. You will see us measuring with a small ruler and placing mini instruments inside the tooth before we take the x-ray.

7.  The next step is to place antibiotic and anti-inflammatory paste inside the root and place a temporary filling on-top. We then wait at least a week for everything to settle down.

2nd Visit (30-45min (Less time for front teeth and more for back)
1.  
The same applies for this visit and we will place numbing gel followed by the anaesthetic. We will then wait until you are ready to proceed.

2.  The temporary filling will be removed along with the paste that we placed inside. We will clean the tooth again with same disinfectant used last visit.

3.  The root canals will be shaped and cleaned with small instruments (again depending on option taken NHS or Private).

4.  The roots are dried and filled with multiple rubber points (NHS) or one exactly matched point (Private) and sealed. This will prevent any infection from getting down the root canal.

5.  The tooth can then be filled with a simple filling (metal or white) or a crown if more than the just the center of the tooth has been drilled.

This may look overwhelming, however root canal treatment is a routine procedure and done many times a week. A lot of the steps above are done simultaneously without you knowing! As mentioned above we can sometimes compress these two sessions into one!

What To Expect After A Surgery

After root canal treatment, your lips and gums may remain numb for a few hours until the anesthetic wears off. Later you may have throbbing pain, which you can treat with pain medicines, such as ibuprofen, paracetamol, or a stronger prescription painkiller with supplemental antibiotics. The pain usually lasts only a day or two.

Risks Of Having And Not Having Treatment

The major risk of not having treatment is progression of the swelling and infection to areas that may restrict swallowing and breathing. Therefore, no matter how large or small, it is important you have a medical professional check it and treat urgently.

With any root canal procedure there are associated risks, albeit small and unlikely, it is something everyone should know. They include: prolonged numbness and altered sensation, fracture of the tooth or instruments, recurrent infections despite treatment, jaw ache (due to keeping mouth open for a long time), and extraction of tooth if root canal fails.

Alternatives

Once the swelling and infection is controlled (antibiotics or draining) you can have the tooth extracted if you wish. Removing the source of infection (the tooth) will have the same effect as root treatment. The obvious difference is the lack of tooth to chew with, aswell as the remaining teeth tilting and shifting and moving into the space left.

What To Think About

After a tooth has been root filled it becomes brittle and is more prone to breaking. A crown is advised to protect the tooth from this by surrounding all remaining cusps and holding the crown together. Crowns are also better at preventing re-infection from bacteria than a conventional filling.

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