Nowadays dentists recognize that our natural teeth are the best we can have. That’s why they do their best to ensure that you do not lose any. A successful root canal treatment lets you keep the tooth; otherwise you have no other choice than to get it extracted.
Root canal treatment
By keeping your natural teeth, you prevent the other teeth losing their alignment and causing jaw problems or gum disease. Finally, by saving them, you avoid having to replace them with a bridge or implant. Treatment is necessary when the tooth pulp (nerve) is sick. This occurs when the tooth has been traumatized or when the dental caries has progressed too far into the tooth.
The purpose of a root canal treatment is to suppress inflammation (or abscess) by cleaning the root canal system of the tooth and filling it with a biocompatible paste. Although the tooth can be considered dead (no response to warm or cold), the periodontal tissues around stay healthy so you can feel normally the pressure when you bite on it. A tooth that had root canal treatment will however tend to become darker (black). It becomes dry and brittle and can fracture. When a tooth, following a root canal treatment, becomes too fragile, it is preferable to protect it with a crown.
What is a root canal?
Teeth are composed of three hard layers: enamel, dentin and cementum. The space inside these layers is called the canal. The latter is filled with a tissue: the dental pulp. This is a soft tissue which contains nerves and blood vessels allowing the tooth to grow. Once the tooth has fully grown, it can survive without pulp. If the pulp is infected, it will be removed. The treatment is called root canal or endodontic treatment.
When do you need a root canal?
The dental pulp can be damaged by an enamel crack with deep caries or an accident. Bacteria can enter the tooth and thus infect the pulp, which can cause pain or inflammation. It happens that the pulp can become infected or die painlessly. Your dentist may notice changes in tooth color, appearance of the gums, bone or tooth root, thanks to the signs seen on radiographs. Sometimes, if the tooth is badly damaged, your dentist may conclude through its examination and x-rays that the pulp of the tooth may not survive. In all cases, root canal therapy can reduce, even prevent the symptoms to appear and save the tooth.
- A member of the dental team will place a rubber dam around the tooth to protect it during the treatment against bacteria that live in the saliva.
- Your dentist or endodontist may proceed with local anesthesia, if there is risk of feeling pain.
- Your dentist makes a small opening in the tooth to reach the canal system and the damaged pulp.
- He removes the pulp, cleans and shapes the canal with precision instruments.
- Then, he fills and seals the channel with a material similar to rubber (called gutta-percha). Using a shutter which presets the instrument temperature to melt the rubber and make a better seal.
- Finally, he closes the opening of the tooth with a temporary or permanent sealer.
Points to consider
Root canal treatment may take one or several visits, depending on the complexity and the anatomy of the canal and the magnitude of injury to the pulp.
Sometimes, if the infection has spread from the tooth to the bone – causing abscess – infection must be drained before the channel is closed.
Your tooth may remain painful 1 to 2 weeks, and sensitive up to 3 months after treatment. Rarely do you experience severe pain or inflammation. If this is the case, you should call your dentist or endodontist as soon as possible.
To look and function like a natural tooth, your tooth must then be restored with a filling or a crown. The type of restoration will depend on the strength of what remains of the treated tooth. A posterior tooth will probably receive a crown as much pressure is exerted on the teeth when you chew. If there is not enough tooth structure, your dentist may use a post to help hold the crown in place. A discolored tooth can be either bleached or covered with a crown or a veneer.
Second treatment and root surgery
Although the root canal treatment is successful in most cases, it happens that a second treatment is necessary. The filling material is removed and the new channel cleaned, prepared and plugged.
Endodontist or dentist may use a conventional surgery if a root canal cannot be done or has not been successful. Surgery is used to:
- Check the end of the channel to ensure there are no cracks (or fractures).
- Remove portions of the channel that have not been cleaned in a conventional treatment.
- Eliminate an infection that does not heal after regular treatment.
All dentists learn to do root canals during their studies. Nevertheless, in some complex cases of surgery or treatment, your dentist may refer you to an endodontist.
Most of the time, an endodontically treated tooth can be saved. But sometimes all attempts may fail and there is no other choice than to extract the tooth.