The structure of a tooth broadly consists of two parts, the crown, and the root. The crown is that part of the tooth which we can see in our mouth and the root is that part of the tooth which we cannot see and is deep inside the jawbone, holding the tooth firmly in place.
Structurally the upper layer of the tooth is called the enamel, the second layer the dentin and the third layer is the soft tissue in the core which consists of nerves, blood vessels, and connective tissue, and is called the pulp.
When the pulp is diseased and cannot repair itself, it dies. The cause of the pulp disease could be a deep tooth decay, repeated dental procedures on the same tooth, traumatic damage to the tooth, a gum disease necessitating root canal treatment (RCT), or Endodontic treatment. “Endo” in Greek meaning inside and “Odont” meaning tooth.
Why do I need a root canal treatment (RCT)?
In the past, teeth with diseased or injured or infected pulp were removed, but with endodontic treatment (RCT) it is possible to treat a tooth with pulpal inflammation and infection thus saving the tooth from removal. When a tooth’s pulp tissue is damaged, it develops inflammation and bacteria begin to multiply within the pulp chamber. If this pulp inflammation and infection are left untreated it can cause pain and subsequently an abscess (a pus-filled pocket at the end of the roots of the tooth).
The signs to look for include pain, prolonged sensitivity to heat and cold, tenderness to touch and chewing, tenderness of lymph nodes and well as the nearby bone and gum tissue, swelling of gums surrounding the tooth which may spread to the face, neck or head. Pus drainage from gums, or roof of mouth. Or even pus drainage from skin on the face or neck.
In order to make a proper assessment and accurate diagnosis, a thorough history and examination is necessary, together with a radio-graphic picture i.e. an x-ray of the tooth or the area.
What is done in an RCT?
The aim of an endodontic treatment is to remove the inflamed pulp and make sure there is no infected tissue left in the root canals and to carefully clean and shape the inside of the root canals with special instruments. Only after making sure that the canals are free of infection are they filled with a special material to seal the space and a filling is placed which is mostly followed by a crown and the tooth continues to function like any other normal tooth. An RCT treated tooth can last a lifetime if you continue to care for it, however, regular follow-ups are necessary.
How painful is an RCT?
The root canal procedure in itself is essentially painless. Most of the root canal procedures are done under local anesthesia which is administered via an injection in your mouth. It is common to feel a bit of pinch in the area where the needle goes in. Actually, most people report that the procedure itself is no more painful than having a filling placed. Your doctor will start the treatment only after the tooth gets numb. In some cases, the anesthetic injection may not be needed at all.
What to expect during the procedure?
Root canal procedure can be performed in a single sitting or multiple sittings ranging from two to four visits. The anesthetic injection is administered only in the first visit. Before starting the procedure your doctor will discuss the treatment time, duration, outcome, and complications of the treatment and make you sign the consent form to undertake the procedure on you. A comprehensive summary of the steps during the procedure include:
- Your dentist will use a drill to make a hole in the tooth
- Very small instruments called root canal files either hand held or with the help of drill are used to clean the pulp chamber and the root canals.
- A special type of medicament is used to help in the process of cleaning and shaping the root canals.
- The canals are disinfected with antiseptic and antibacterial solutions
- The canals are shaped in order to receive a bio-compatible thermoplastic filling material
- This thermoplastic material is then heated and sealed with a red-hot hot instrument
- If the tooth lacks sufficient structure to hold the restoration in place a dentist may place a post (kind of a screw) inside the tooth
- Finally, a restoration (filling) is done and a crown is placed
- Your dentist may prescribe antibiotics and analgesics during or after the procedure
What after the procedure?
After effects of treatment are minimal, generally lasting from a couple of days to about a week. One should avoid biting on the treated tooth until a restoration (filling) is done, since the un-restored tooth is susceptible to fracture. .
Root canal treatments are highly successful, many teeth treated with root canal treatment can last a life time. Maintaining a good oral hygiene with brushing, flossing, using a mouthwash and regular checkups and cleaning is imperative.
Occasionally a treated tooth may become painful or diseased sometime after a successful treatment, in such cases redoing of endodontic procedure is considered in adjunct with endodontic surgeries such as apicocetomy or root-end resection
What is the cost of RCT?
The cost varies depending on how complex the problem is and which tooth is affected. The posterior teeth cost more than the anterior teeth because of the complex anatomy of root canal system. Many dental insurance policies cover endodontic treatment.
Generally, endodontic treatment and restoration of the natural tooth are less expensive than the alternative of having the tooth extracted. An extracted tooth must be replaced with an implant or bridge to restore chewing function and prevent adjacent teeth from shifting. These procedures tend to cost more than endodontic treatment and appropriate restoration.
Alternatives to root canal treatment?
The only alternative to a root canal procedure is having the tooth extracted and replaced with a bridge, implant, or removable partial denture to restore chewing function, aesthetics and prevent adjacent teeth from shifting. These alternatives are not only more expensive than a root canal procedure but require more treatment time and additional procedures to adjacent teeth and supporting tissues.
Root canal treatment prevention?
Since some of the reasons why the nerve of a tooth and its pulp become inflamed and infected are due to deep decay, repeated dental procedures on a tooth and/or large fillings, following good oral hygiene practices (brushing twice a day, flossing at least once a day, and scheduling regular dental visits) may reduce the need for a root canal procedure.
The cavities in the tooth if any, need to be filled on a priority basis. Schedule cleaning of your teeth at least once a year.
Trauma resulting from a sports-related injury can be reduced by wearing a mouth guard.
Specialist GP Dentist
Aster Clinic, Naif Road, Deira