Root Canal Treatment

Root canal treatment is usually required when the inside part of a tooth is infected by bacteria entering the pulp chamber through a crack or cavity. Initially that infection is trapped inside the pulp, but it can eventually spread, damaging the tooth and the surrounding tissues it spreads to. If the infection is still not treated by this point, the tooth may be lost and the infection may even spread to the blood, which can be very dangerous. Root canal treatment can also be required following trauma to a tooth or irreversible inflammation of the nerve tissues following exposure to heat or bacteria (usually due to decay). 

The quickest, easiest and cheapest solution for this problem would be to remove the tooth. This remains a viable option and one which you will be offered. However, we are passionate about retaining viable teeth and we want you to be able to keep your natural teeth for as long as possible, which is why we will recommend root canal wherever it is appropriate. Where the prognosis is poor, we would advise you of this and would not encourage you to spend a significant amount of time and money on a tooth likely to be lost in the not-too-distant future.

This procedure is always undertaken under local anaesthetia (unless you are very brave). Whilst there are many horror stories about root canal treatment, other than being a long, fiddly procedure, it is generally very well tolerated. The procedure involves:

• Preparation of an “access cavity” – a hole down to the pulp chamber of the tooth
• Placement of rubber dam – a device placed over the tooth to isolate it and protect your airway. It prevents you swallowing or inhaling the fine instruments we use or ingesting any of the anti-bacterial solution. It also minimises contamination of the root canal by saliva. It is not the most fun to wear but it is to keep you safe.
• Cleaning and shaping of the root canal space to remove any remaining infection and bacteria
• Copious irrigation using anti-bacterial solutions to decontaminate the root canal
• Obturation (filling) of the canal with a mixture of sealant and a soft, rubber-like material called Gutta Percha. At this time, some of the root filling may be cut back and packed with amalgam filling to provide retention for the permanent restoration (also called a Nayyar core). The access cavity is then also filled and the tooth is now ready for the final, permanent restoration.

Root canal treatment is almost always carried out over more than one appointment unless there is absolutely no evidence of any infection. The cleaning, shaping and disinfection is carried out at the first visit and the root canal is filled at the second visit. Between visits, a strong, antibacterial dressing is placed within the canal(s) to ensure minimal bacteria remain at the time the root filling is placed. The gap between the first and second visit is usually at least two weeks, but preferably four weeks.

Every patient is different and treatment plans differ depending on the complexity of the infection. In all cases we will keep you continually informed and in control of your treatment path. 

In cases of retreatment or complex, molar root canal treatment, we routinely offer referral to an endodontist (specialist in root canal treatment), either Dr. Pratik Shah at Island House Dental Care (Woodbridge) or Charing Cross (Norwich). Treatment is carried out under great magnification and with exceptional skill using an operating microscope so that additional canals and even the most tortuous of canals can be successfully disinfected and filled, offering you piece of mind and the best possible prognosis.

This greatly depends on how much of the tooth has been lost and whether it is a front or back tooth. The gold standard restoration for a root canal treated back tooth would be a crown or cuspal-coverage inlay (a laboratory constructed restoration which occupies the cavity and covers the biting surface of the tooth but not the side walls). Root canal treated teeth are weaker than ordinary teeth and at risk of fracture. Where fracture occurs, it can frequently be unfavourable and result in the need for extraction, particularly where the fracture involves the root itself. Crowns and cuspal-coverage inlays better displace forces during biting than ordinary fillings and reduce, but do not completely remove, this risk. They also provide a better seal in preventing saliva and bacteria from leaking into the tooth, as this can potentially cause the root canal treatment to fail.  A crown is not usually so crucial for strength on a front tooth, but they are often required as root canal treated teeth can become very dark and discoloured relative to the adjacent natural teeth. Where this is not the case, a simple filling within the access cavity will often suffice.

If you are concerned about root canal treatment, please don’t be. The team at Leiston Dental Care is highly experienced and you can call us on 01728 561873 to arrange an appointment or please use website contact form.