Introduction

Root canal treatment is one of the most common dental procedures done at our centre. During the last 27 years of our practice we have performed more than ten thousands of root canal treatments and we are proud to say that our success rate has been 99%.In majority of cases, unless the tooth is grossly infected, we prefer to do single visit root canal treatment using rotary instruments, magnification loupes, apex locator.

Root canal treatment is an endodontic procedure where in infected pulpal tissue ( connective tissue including the nerve and fine blood vessels) are removed from the pulp space, which constitute pulp chamber in the center of crown and root canal space in the root of tooth. Root canal is biomechanically prepared and given a shape, disinfected and filled. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the pulp can be removed without destroying the tooth. That's because each tooth also is nourished by a blood supply in the gums.

 

Why Would You Need Root Canal Treatment ?

Root canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause of pulp infection. The decay erodes the enamel and dentin of the tooth until it reaches a root canal. This allows bacteria to infect the pulp. Antibiotics can't get to infections inside teeth. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing.

The second reason for a root canal is damage to the pulp that can't be fixed. Trauma or a fractured tooth can damage the pulp. Sometimes, common dental procedures, such as preparing a tooth for a crown, can hurt the pulp. Then the tooth might need a root canal.

When the pulp is inflamed but not infected, it may heal on its own. Your dentist may want see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can be painful and may lead to infection.

An infection in the pulp can spread to the surrounding bone and soft tissue causing swelling and abscess formation ,which can lead to further complications if left untreated.

If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. They also can be overstressed from chewing. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body.

 

Signs and Symptoms

  • If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.
  • Your tooth might need a root canal if:
  • It hurts when you bite down on it, touch it or push on it.
    It is sensitive to heat.
  • It is sensitive to cold for more than a couple of seconds.
  • There is swelling near the tooth.
  • It is discolored (whether it hurts or not).
  • It is broken.
  • Severe tooth pain, typically relieved by cold water and increases with the intake of hot liquids.
  • Pain worsens when you lie down and reduces when you sit up.
  • Constant tooth pain.
  • Tooth pain referred to head and ears as well.
    To determine whether your tooth needs root canal treatment, your dentist will often perform the following tests:
  • Hot and cold test.
  • X ray of tooth and surrounding bone.
  • Electric pulp test.

He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms.

An electric pulp tester should not be used if you have a cardiac pacemaker or any other electronic life-support device.

 

Length of Treatment

Root canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated root canal treatment often can be completed in one visit. Some teeth may be more difficult to treat because of where they are in the mouth. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved root canals that are difficult to find. If you have an infection, you will visit the dentist several times so that he or she can make sure that the infection is gone.

Once the root canal treatment is finished, you will need to see your general dentist to have a crown or filling placed on the tooth. You are likely to receive a crown if the tooth is discolored or if it is used for chewing. The purpose of the crown is to prevent the tooth from breaking in the future.

 

Procedure

Root Canal Treatment From Start to Finish

Root Canal 1 Root Canal 2


1. A Deep Infection

Root canal treatment is needed when an injury or a large cavity hurt the tooth's root. The root becomes infected or inflamed.

2. A Route to the Root

The dentist numbs the tooth. An opening is made through the crown of the tooth to the pulp chamber.
Root Canal 3 Root Canal 4


3. Removing the Infected/Inflamed Tissue

Special files are used to clean the infection and unhealthy pulp out of the canals. Then they shape the canals for the filling material. Irrigation is used to help clean the canals and remove debris.

4. Filling the Canals

The canals are filled with a permanent material. Typically this is done with a material known as gutta-percha. This helps to keep the canals free of infection or contamination.


5. Rebuilding the Tooth

A temporary filling material is placed on top of the gutta-percha to seal the opening. The filling remains until the tooth receives a permanent filling or a crown. A crown, sometimes called a cap, looks like a natural tooth. It is placed over the top of the tooth.

6. Extra Support

In some cases, a post is placed into the root next to the gutta-percha. This gives the crown more support.

7. The Crowning Touch

The crown is cemented into place.

Pain After Root Canal Treatment

Sometimes, in only about 1% of the cases, there will some pain after root canal or a ‘flare-up’ of the tooth causing pain and sometimes swelling. This usually happens within the first three days following treatment and is caused by dying bacteria inside the tooth that put off toxins as they expire. If this happens, you may need to be on an antibiotic. Call your dentist and let them advise you what to do.

These days, most dentists and Endodontists prescribe medications to get infection under control before a root canal is performed, although it is not necessary or advisable to wait until all the infection is gone before seeking treatment. While you cannot have root canal treatment if you’re severely swollen, an abscessed tooth needs to be treated as soon as possible.

Some dentists will begin treatment by draining the abscess first then scheduling the root canal treatment after the infection has subsided.

Most of the time, however, there is little or no pain after root canal, if done when first indicated. If there was a lot of infection in the tooth before the root canal, there will be healing time required after the procedure and you may experience some pain. This pain can be moderate to severe and last several days, getting a little better each day.

If your tooth hurts when you chew on it, it is still healing and you need to chew on the other side of your mouth until the pain is gone. Some teeth swell in the socket and feel ‘higher’ than the other teeth, disrupting the healing process. If this happens, call your dentist or Endodontist and get an appointment. They can adjust your bite to prevent this tooth from hitting so hard when you bite.

Some people are surprised when they experience any pain after root canal thinking the nerves are gone. The nerve inside your tooth is gone, but there are still nerves surrounding the outside of your tooth where in enters the gum.

These nerves can be irritated by the procedure or the abscess that caused all your problems to begin with, and can take time to heal.

Teeth that have a fracture can still have sensitivity after a root canal, and should be crowned as soon as your dentist can give you an appointment.

Avoid chewing on the tooth until your dentist has crowned it. Even after crowning, some teeth that have fracture will be sensitive on occasion, much like a healed broken bone is sometimes sensitive. This is normal and nothing to worry about unless the pain or sensitivity gets severe.

A root canal removes the nerve inside your tooth. If you experience sensitivity to hot or cold liquids after your root canal, you may have another tooth involved, as the nerve inside the tooth controls temperature sensations.

Extreme pain (which cannot be controlled by a pain killing medication) after root canal is rare and should be reported to your dentist.

 

Possible Complications

Sometimes, when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.

Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.

A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. If saliva can get into the hole, it will have to be filled. Sometimes, the tooth has to be removed. If the hole is far enough under the gum that saliva can't reach it, the hole may close on its own.

Finding root canals can be difficult. If all of the canals aren't found and cleaned out, the tooth can stay infected. This also can happen if a canal isn't measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist's tools can't reach.

The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small cut is made in the gum so the dentist can get at the root of the tooth. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

If your tooth hurts when you chew on it, it is still healing and you need to chew on the other side of your mouth until the pain is gone.

Some teeth swell in the socket and feel ‘higher’ than the other teeth, disrupting the healing process. If this happens, call your dentist or Endodontist and get an appointment. They can adjust your bite to prevent this tooth from hitting so hard when you bite.

Sometimes, in spite of best efforts, the body does not heal the infection that was inside the bone around the tooth. It is a biologic procedure and is not guaranteed because everyone has differing immune systems and healing capacities. If your tooth does not heal, a re-treatment of the root canal can be performed, where the root canal is tried again.

If a pocket of infection is left in the bone that does not heal, an apicoectomy might be indicated. This is where a surgical procedure is performed and a small incision is made in the gum above the tooth and the infection is removed, the area sterilized and cleaned. The need for an apicoectomy is rare, but the success rate is high.

A root canal removes the nerve inside your tooth. This nerve controls sensitivity to hot or cold. If you experience pain with hot or cold after your root canal, it is impossible for it to involve the root canal tooth, unless a canal was missed. Unfortunately, it may be another tooth that may need root canal.

 

Are Root Canal Treatment Safe ?

There are people that insist that root canals are not a safe procedure and that no one should ever have one. These people refer to a study done in the early 1900's of Dr. Weston Price. This study concluded that infected material and bacteria are left in the tooth and continue to infect the body after the root canal is finished, therefore infection remains in the tooth and surrounding jaw bone.

The dental community has been accused of everything from total ignorance of this situation, to deliberately covering up these conclusions.

The American Association of Endodontists (AAE) website, http://www.aae.org/patients/mythsrootcanal/ has this to say on the subject:

"Root canal treatment is a safe and effective procedure.

Research studies performed in the 1930s and 1940s and those conducted in later years showed no relationship between the presence of endodontically treated teeth and the presence of illness. Instead, researchers found that people with root canal fillings were no more likely to be ill than people without them.

Over the past several years, however, a very small number of dentists and physicians have been claiming that teeth that have received root canal (endodontic) treatment contribute to the occurrence of illness and disease in the body. This claim is based on the outdated research performed by Dr. Weston Price from 1910-1930. His research stated that bacteria trapped in the teeth during root canal treatment can cause almost any type of disease, including arthritis, heart disease, kidney disease, and others.

The presence of bacteria in teeth and mouth has been an accepted fact for many years. But presence of bacteria does not constitute "infection" and is not necessarily a threat to a person's health. Bacteria are present in the mouth and teeth at all times, even in teeth that have never had a cavity or other trauma.

More recent attempts to copy the research of Dr. Price (and to check its accuracy) have been unsuccessful. Researchers now believe that the earlier findings may have been caused by poor sanitation and imprecise research techniques that were common in the early 1900s.

These more recent studies support the truth we report today—that teeth that receive proper endodontic treatment do not cause illness."

 

Top 10 Myths About Root Canal

People seem to cringe when they hear the words root canal. But reading the truth about these 10 root canal myths can help you get a better sense of what having a root canal really is all about.

1. Root Canals Hurt

According to the American Association of Endodontists, the perception of root canals being painful began decades ago when root canal treatments were painful. Today, with modern technology and better anesthetics, root canal treatments are no more painful than having a filling. Knowing what to expect while having a root canal can help ease a lot of anxiety.

2. Root Canals Require a lot of Visits to the Dentist

With today’s cutting edge technology, most root canals can be performed in one or two office visits.

3. Crowns Cause Teeth to Need Root Canals

Many people believe that having a crown on a tooth means that the tooth will eventually need a root canal. Crowns do not cause the need for root canal therapy. If a crowned tooth does require a root canal, it could be that the tooth has abscessed or that decay has gotten underneath the crown and reached the pulp of the tooth.

4. Root Canals Cause Illness

There is no evidence to support that root canals cause illness. However, there is evidence to support the fact that people who have had root canals are no more at risk for developing illness than people who have never had root canals.

5. Root Canals Involve Removing the Roots of the Tooth

When the dentist or endodontist performs a root canal treatment, he or she remove the pulp from inside of the tooth. The roots of the tooth are not removed.

6. Pregnant Women Can't Have Root Canals

Pregnant women can and do have root canals. Having a root canal does require a small x-ray, but the radiation exposure is very minimal and the x-ray is aimed at the mouth, not the abdomen area. If you are pregnant and your dentist needs to give you an x-ray, he will use a lead apron to cover your belly. The anesthetics that dentists use are also safe for pregnant women.

Be sure to let your dentist know beforehand if you are pregnant.

7. Even With A Root Canal, The Tooth Will Come Out Eventually

If you have your tooth properly restored, maintain good oral hygiene and visit your dentist for regular checkups, your natural tooth could last for the rest of your life.

8. If the Tooth Doesn't Hurt, There is no Need for a Root Canal

While a throbbing toothache usually results in the need for root canal treatment, many times a tooth can require root canal treatment when there is no pain present. Dentists and endodontists are specially trained to test a tooth to see if the pulp has been infected or damaged. If this is the case, a root canal would be necessary to save the tooth.

9. Pulling the Tooth is Better than Getting a Root Canal

Keeping your natural teeth for as long as possible is very important for proper eating and chewing functions. There are several options available for missing teeth, such as dentures, partial dentures, dental implants and fixed dental bridges, however, these alternatives can be much more expensive than saving your tooth with a root canal treatment.

10. After Having a Root Canal, My Tooth is Completely Restored

After having a root canal, it is extremely important to make a follow-up appointment with your dentist to have the tooth permanently restored. After the pulp of the tooth has been removed, the tooth can become very dry and brittle. Having a permanent restoration will help protect your tooth from fracturing.

 

Root Canal Alternatives

Getting the tooth removed is the only alternative for a tooth that requires root canal therapy. But most times, having the tooth removed is not the best solution.

If you choose to have it removed, adjacent teeth to the missing tooth can shift over time and misalign your bite, possibly developing jaw problems. You won’t be able to chew as well which could result in stomach and digestive problems.

Missing front or premolar teeth can be seen when you open your mouth or smile making you unattractive. There are reports of people that could not get a job because of missing teeth that show when they smile.

So what are the root canal alternatives? You have two choices: (1) get the tooth pulled and have a “ dental bridge” installed or (2) have a "dental implant” installed.

A crown, sometimes called a ‘cap’, is a strong, protective covering for your tooth made to look just like your real tooth. After a root canal, the tooth no longer has a blood supply. Over time it becomes brittle and most dentists recommend a crown afterward to prevent fracturing and loss of the tooth, especially your back or molar teeth which take the most pressure from chewing.

If you choose to have the tooth removed, a dental bridge may be required to complete your bite or to restore your smile. A dental bridge is built by grinding down the two teeth on either side of the space left by the pulled tooth, having crowns made for those two teeth with a fake crown attached in the middle to fill the void left by the pulled tooth. This dental bridge, when installed, fills the area and makes it look like you still have your tooth.

Cleaning of the dental bridge is harder than a natural tooth, since you now have two teeth attached to one another by the fake one in the middle.

A dental bridge is expensive and is charged by how many crowns it contains.

Another root canal alternative is to have the tooth removed and be replaced by a dental implant. A dental implant consist of a dental screw that is placed into the bone at the site of the missing tooth. A fake tooth (a crown) is attached to the screw after the area has healed completely.

This process for a dental implant takes approximately 6 months of healing time to complete. It is also expensive, costing Rs. 30000-40000 depending upon the implant system used. The advantages of a dental implant are that they do not require any grinding down of other teeth (like a bridge does), can be cleaned more easily than a bridge, and is the most like your real tooth.

A root canal and crown for a tooth can be the most economical way to go. If a root canal costs 3000-5000 and was crowned afterward for another Rs.5000-12000, your total would be Rs. 8000-17000, and you would be able to clean around the tooth just like a normal tooth creating much less chance of developing decay in the tooth. (Yes, teeth can still develop decay after having a root canal and crown so cleaning them is still important).

over all, a root canal costs less than a dental bridge or dental implant. You should research the alternatives to make an imformed decision.

 

The Second Time Around : Possible Re-treatment or Surgery

A root canal can fail for several reasons. A tooth can become infected again if your dentist did not completely clean out all of the root canals. Bacteria can get inside a tooth if a filling or crown starts to break down or leak.

A repeat root canal treatment tends to be more involved and take more time than the first one. Your dentist must remove the crown, post and core, and filling material before he or she can do the second root canal. Some people who need another treatment may have infections that are difficult to destroy. Because they take more time and can be complicated, second root canals also usually cost more.

Sometimes a second root canal can be hard to do. For example, it may be too risky to remove a post and core. The post that is in the tooth may be cemented or set in very tightly. If that is the case, the tooth may be injured in the process. So your dentist may decide to do endodontic surgery instead.

This surgery allows the dentist to get inside a tooth's root from the bottom of the tooth, rather than the top. Your dentist will not touch the crown of the tooth. The retreatment of the root canal will occur through the root.

Endodontic surgery is done in the dentist's office. First, you will receive a shot to numb the area. Then your dentist will make a small cut in the gum near the tooth. He or she will clean out the infected tissue around the tip (apex) of the root. Then, your endodontist will shave off the tip of the root. This procedure is called an apicoectomy. The endodontist will clean the inside of the canal from the root end, and then put a filling in the end of the root. The cut is then stitched. Endodontic surgery is successful about 95% of the time. If the surgery does not get rid of the infection, the tooth will have to be extracted.

 

Restoring a Tooth After Root Canal Treatment

After your tooth's root canal treatment has been completed your dentist will need to discuss with you what additional dental work will be required so to make the tooth fully functional again.

Different types of restorations that a root canal treated tooth might require varies from simply placing a composite filling in access cavity to core build up and crowning to more complex ones requiring post and core build up and crowning. The type of restoration which your dentist will suggest you depend on the location of tooth in the mouth and the extent of damage to the tooth. Many times a tooth that has required root canal treatment is one that has a big filling or else has large portions missing due to decay or breakage. These teeth, in this state, are not as sturdy as they once were and for this reason it is commonplace that a dentist will recommend that a tooth that has had root canal treatment should be restored with either a dental crown or else a dental crown in combination with a dental post.

The dental restoration that is chosen for rebuilding a tooth that has had root canal treatment provides another function also. It provides a seal protecting the interior of the tooth. This barrier helps to prevent seepage of bacteria and contaminates from the oral cavity into the interior aspects of the tooth (a phenomenon termed "coronal leakage"). Your dentist will need to advise you as to what they think is best for your situation but, in general, the sooner arrangements can be made to have the permanent dental restoration placed (thus creating the best possible seal) the better.

Placing a post in a tooth that has had root canal treatment.


A "post" is a rod like structure made up of either metal, or carbon, quartz ,glass fiber or even ceramic. Purpose of putting the post in tooth is to provide a surface around which a core can be built up. Post does not strengthen the remaining tooth structure in any way. There are two ways to put a post and core in a tooth. The post can be pre-fabricated and used with a core material that is built up around it. Or, the post and core can be custom-made in one piece to fit your tooth. This second type often is used in front teeth. It takes two dental visits. During the first visit, your dentist prepares the tooth and takes an impression so the post and core can be made. During the second visit, your dentist cements the post and core to the tooth.

How does a dentist place a post in a tooth?


When placing a post a dentist will first use a drill and remove some of the gutta percha filling material that was placed during the tooth's root canal treatment. They will then cement the post and subsequently place a core of filling material around the post's upper portion, so to increase the overall amount of structure that will extend up into the crown.

Placing a dental crown on a tooth that has had root canal treatment.


Crowns are dental restorations that cup over the portion of a tooth that lies above the gum line. People sometimes refer to dental crowns as "caps." Dental crowns can either be gold or else have a porcelain surface so they look white like a tooth's neighboring teeth.

A dentist will use a dental crown as a means of improving the appearance of a tooth, restoring a broken tooth to its original shape, and/or strengthening a tooth. Additionally, and very importantly, dental crowns create an excellent seal over a tooth. By this we mean that a crown cemented in place provides a barrier that is helpful in preventing bacteria and contaminates from seeping back into those inner aspects of a tooth where the root canal treatment has been performed. After a tooth has had its root canal treatment completed, any or all of these qualities which a crown can provide may be needed.

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