Root Canal Treatment & Root Fillings
Tooth root fillings and Root Canal work, which dentists technically call Endodontics, can often help save a tooth that has broken, decayed or otherwise had a bigger problem that's involved the nerve of the tooth (the pulp) such that an ordinary filling won't fix it. Sometimes Root Canal Treatment has a reputation of being painful, but the truth is the affected tooth is often deeply decayed or cracked or damaged in some way, so is often already in pain OR is about to be, so afterwards the root-filled tooth can be tender for a couple of days, like a scratch can be, but soon heals up once all the old infected nerve space is cleaned out and disinfected and sealed with a root filling.
Root Canal work may also need to be combined with other Dentistry, such as Crowns, Bridges, Fillings or other dental treatments and cosmetic Dentistry. Indeed sometimes when teeth have been Crowned or Bridged, because the tooth underneath has been compromised in some way, these teeth may need a Root Canal treatment later if the delicate nerve dies or just gives up. However this RCT can often be done through the biting surface or behind the Crown/Bridge, allowing you in most cases to not disturb the Cosmetic or Functional aspect of such Dentistry.
However sometimes certain teeth have continual infections or past cracks and fractures that complicate Root treatments and only show up using a special dye to identify these, so a decision may be made to Extract such a troublesome tooth and consider a replacement, such as a denture or fixed-bridge or dental tooth implant, which you can read more about in our Dentistry Treatment Information menu above.
Please read below for some more details and information about Dental tooth Root Canal treatments.
Do you need a root canal treatment (RCT)?
When the nerve of a tooth becomes inflamed or infected, root canal treatment(RCT) can save the tooth, by removing the offending nerve and cleaning the canals, yet leaving most of the good tooth behind.
How do you know if you have an inflamed/infected tooth nerve?
Some signs are heat and cold sensitivity, swelling and pain, or a bad taste in your mouth. Or, you may experience no symptoms at all, and not realise that you have a dental problem until your Dentist discovers this before you get any painful symptoms.
Where and what is the root canal in a tooth?
To understand this, we need to look at the anatomy of the tooth. The white outside portion of a tooth is called the enamel. Inside the enamel is another hard layer, the yellower dentine. There's a small chamber at the centre of the dentine called the pulp chamber. Inside the pulp chamber is the tooth pulp, a soft tissue made up of fine nerves, arteries, and veins. The pulp extends from the pulp chamber all the way down to the end of the root, through a narrow space called the root canal. This looks like a thin, hollow tube down the centre of a root and appears dark on an Xray. However as the diagram below shows, canals in teeth can be a lot more complexly shaped than a straight hollow tube, which is why treatment takes longer and can be complicated.
In general, teeth in the front of the mouth have only one or two root canals, while teeth in the back can have two, three, four or more root canals.
How does a nerve get inflamed/infected in the root canal?
Deep cavities or cracks can allow germs to get into the pulp chamber. These germs cause infection, and the pulp fights (painful inflamation) then dies (no pain). The dead pulp makes pus from the infection eventually builds up at the root tip and makes a hole in the bone. This is called a tooth abscess and can swell locally or find an escape route to the surface of the gum, leaking out through a gum-boil that looks like a spot on the gum.
A blow to a tooth may also cause the pulp to die and then become infected later. An infected tooth will never heal on its own, and as it gets worse, it will continue to be a source of infection that weakens your body's immune system. This can affect your entire body and even make you feel run down. This damage to the bone and the swelling inside the bone can also be excruciatingly painful, and possibly life-threatening if not treated. Years ago, an infected tooth would have to be extracted, but today, we can save the majority of teeth ( 6 out of 7) with root canal treatment, but it will often take longer than just the one visit an Extraction would need, if you want to try to save the tooth.
Thus we reach the root canal where the dead nerve is and clean it all out of the infection, then seal it up so infection cannot easily come back again, which we call a Root Canal treatment (RCT), with the sealer/filler in the root canal called a "Root Filling", which is described in more detail below:
The example below shows before and after X-ray views of a 3 rooted molar tooth that needed root canal treatment.
It's not easy getting to the ends of the roots of all the canals present - it is Dentistry's equivalent to keyhole Surgery !!!
This X-ray shows decay between Molar teeth and dark abcess ends on roots.
This X-ray shows 3 roots and their canals filled (white) and a large filling where decay was in the Crown.
What is involved with Root Canal Treatment ?
RCT is done whilst you are numbed up with local anaesthesia(like for a filling), then the root-canals are cleaned and dressed with antiseptic. Depending on the tooth, this can be done in one visit, but often it takes two or more visits. The difficulty is caused by having to work down very narrow canals, to the ends of the roots. It is very demanding work and is comparable to Surgeons doing micro-surgery. Often patients are unaware of this complexity due to the skills of their Dentist during treatment, which usually involves using X-rays to help measure the root canals involved.
Some after-pain is common, but if pain or swelling worsens after treatment, you need to contact your Dentist urgently. RCT has, on average a 6 out of 7 success rate (85%ish), so some teeth may be lost despite everyone's best efforts.
Thus you have to accept that even a RCT will not save every tooth, with some 1 in 7 still requiring an Extraction later, on average.
Also Teeth that have has an RCT (especially back ones) have been hollowed-out and weakened and so it is recommended that they are Crowned to give the best longer-term chances of not cracking and then having to be extracted because of that. However Teeth that have RCTs and are restored strongly with a Crown afterwards, have a 6 out of 7 chance of continuing to contribute to your Smiling and Chewing, but it's not 100% - are you willing to accept those extra risks, costs and time involved doing an RCT, which could take 2 to 4 visits, depending upon the tooth and it's original problems!
Always ask your Dentist or Specialist for specific advice for Option that suit you best.
Remember that the Price is only one consideration for your Dental Care and needs -
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*Dr.Kilcoyne is a UK registered Specialist in Prosthodontics (GDC No.58373) which includes The Functional and Cosmetic Dentistry aspects of Crowns, Dental Implants, Bridges, Veneers, Fillings, Dentures, Bonding etc. Please go to our MAKE an APPOINTMENT page if you'd like to access his Expertise.
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